Mental Health & Social Inclusion
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Social Inclusion Social Report 36 · October 2007 Mental Health Mental & National Economic and Social Forum Mental Health & Social Inclusion Report 36 Report on Mental Health and Social Inclusion Forum Report No.36 Published by the National Economic and Social Forum Copies of the Report may be obtained from the Government Sales Office Sun Alliance House, Molesworth Street, Dublin 2. or The National Economic and Social Forum 16 Parnell Square, Dublin 2. Price c10.00 (PN A7/1458) ISBN 1-899276-44-0 Mental Health and Social Inclusion NESF Report 36 · October 2007 “Mental health is about the whole of being, about being socially, emotionally, physically and spiritually well. Mental health has to do with how we feel about ourselves and how we are able to meet the demands of life. It is fundamental to physical health, to happiness and to success at work and school, in our families and the health of our communities. We all have mental health needs even if we don’t have current mental health problems.” Submission to the Project Team Contents Glossary vi Executive Summary ix Section I Context and Issues Chapter 1 Introduction 1 Chapter 2 Current Perspectives on Mental Health 9 Chapter 3 Mental Health Policy Context 25 Chapter 4 Barriers to Social Inclusion 43 Section II Strategies and Initiatives Chapter 5 Improving Mental Health 61 Chapter 6 Mental Health in the Workplace 83 Chapter 7 Work, Training and Meaningful Occupation 109 Chapter 8 Towards an Integrated Model of Services Delivery 125 Chapter 9 Strengthening Communities 147 Section III Conclusions Chapter 10 Recommendations 165 References 177 Annexes Annex 1 Terms of Reference 193 Annex 2 Summary of Submissions 194 Annex 3 Additional Figures 215 Annex 4 COPE Map of Drumchapel 217 Annex 5 Seminar Attendance, Plenary Attendance 218 and Consultation List Annex 6 NESF Terms of Reference and Publications 225 iv NESF Report No. 36 List of Figures Figure 1 Key Perspectives in Mental Health x Figure 2 Improving Mental Health xiii Figure 3 Six Strategic Areas: Recommendations xiv Figure 4 Implementation Structures xvi Figure 2.1 Key Messages on Health Promotion 12 Figure 2.2 The Scope of Health Promotion 13 Figure 2.3 Number of Admissions to Psychiatric Units and Hospitals 1965-2005 18 Figure 3.1 Framework for a Comprehensive Mental Health Policy 27 Figure 3.2 Expenditure across the EU on Mental Health Services 38 Figure 4.1 The Structural Model of Mental Health 44 Figure 4.2 Determinants and Protective Factors of Mental Health 45 Figure 5.1 English National Inclusion Programme for Mental Health 66 Figure 6.1 Workplace and Mental Health Policies 88 Figure 6.2 Key Stages in the Development of a Mental Health Policy 89 Figure 6.3 The Mental Health-Friendly Workplace Circle 94 Figure 6.4 Reasons for not Disclosing Mental Ill-health among Employees 98 Figure 8.1 A Vision for Change: Proposed Structure of HSE Mental Health Services 127 Figure 8.2 Percentage of GPs Referring Patients to Specialist Mental Health Services 128 Figure 8.3 Jigsaw Model 140 Figure 9.1 Factors Influencing the Mental Well-Being of Communities 148 Figure 9.2 Sources of Support for People with Mental Ill-Health 152 Figure 10.2 Implementation Structures 168 Figure A.1 Selected Recommendations from A Vision for Change 215 Figure A.2 Making a Recovery Map 216 v List of Tables Table 4.1 Contributory Factors to Social Exclusion 49 Table 5.1 Examples of Strategies to Increase Social Inclusion and Mental Health 63 Table 6.1 Incidence of Bullying by Gender 91 Table 7.1 Relevant FÁS Schemes and Programmes 111 vi NESF Report No. 36 Glossary Mental health “A state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community” (WHO, 2001:1). Well-being Well-being is used here to mean “more than just happiness. As well as feeling satisfied and happy, well- being means developing as a person, being fulfilled, and making a contribution to the community” (New Economics Foundation, 2004:2). Mental illness Mental illness refers here to specific conditions such as schizophrenia, bi-polar disorder and clinical depression. Social exclusion “People are living in poverty if their income and resources (material, cultural and social) are so inade- quate as to preclude them from having a standard of living which is regarded as acceptable by Irish society generally. As a result of inadequate income and resources people may be excluded and marginalised from participating in activities which are considered the norm for other people in society” (NAPinclusion, Government of Ireland, 2007:20). Social capital “Networks together with shared norms, values and understandings that facilitate co-operation within or among groups” (NESF Report No. 28, 2003:3). Service user A person who has personal experience of mental ill- health and mental health services. Advocacy Advocacy is speaking up for, or acting on behalf of, one- self or another person. It is a practice carried out by or on behalf of an individual or a group, whereby others (peers, community groups, family members, profes- sionals) supports them to participate fully in society. Recovery approach A social process of recovering a fulfilling life regardless of the presence or absence of symptoms (Kruger, 2000). PCCC Primary Community and Continuing Care (PCCC), within the Health Service Executive (HSE), provides health and personal social services including primary care, mental health, disability, child, youth and family, community hospital, continuing care services and social inclusion services. vii Community Mental Community-based, multidisciplinary teams Health Teams (CMHTs) providing mental health services. A Vision for Change A Vision for Change (Department of Health and Children, 2006) sets out the policy framework for mental health in Ireland and was produced by an Expert Group on Mental Health. The Expert Group, established in 2003, consisted of 18 people drawn from a range of backgrounds within the mental health services. NAPinclusion The National Action Plan for Social Inclusion 2007–2016 (NAPinclusion) is a strategic plan to combat poverty and social exclusion (Government of Ireland, 2007). Towards 2016 Towards 2016 is a Ten Year Framework Social Partnership Agreement that adopts a lifecycle framework focusing on children, people of working age, older people and people with disabilities (Government of Ireland, 2006). Executive Summary xi The relationship between mental health and social inclusion is examined in the report in terms of: strengthening positive mental health and well-being for the whole population; the impact of poverty and social exclusion on mental health; and access to services and better recovery rates. The focus on community and its contribution beyond the location and the provision of services provides a fresh dimension to policy debate and evaluation in this country. With the institutional model of mental health care still lingering2, it is important to recognise more fully the potential value and contribution of individuals, community-led groups and the wider voluntary and community sector in enhancing positive mental health for all, as well as protecting and supporting those in recovery. Mental Health is Everybody’s Business The consequences of mental ill-health are far-reaching for Irish society, in terms of reduced economic performance, human and social capital and increased health and social welfare costs. The World Health Organisation (WHO, 2005b) argues that these are increasing at global level. According to Jané-Llopis and Anderson (2005), the social and economic costs for societies are wide-ranging, long-lasting and enormous, representing 3-4% of GDP in Europe. Inequality and Social Exclusion While everyone has mental health needs, many people experience mental ill- health at some stage in their lives (Wittchen and Jacobi, 2005; WHO, 2001). The burden falls disproportionately on certain sections of the population (Quin and Redmond, 2005). Within low income and unskilled occupational groups, there are both higher levels of common mental disorders than for other groups, as well as higher rates of admissions to psychiatric hospitals (Daly et al, 2005; European Commission, 2003). Poverty, gender inequalities and ethnicity play a role in mental health, both in the onset of illness but also in terms of access to services and recovery rates (Laffan, 2006; Mind, 2002). Key Findings The report therefore analyses the broad factors which determine mental health for the whole population as well as the key strategies for protecting and supporting people with mental ill-health to recovery and increased social inclusion. The following distinct areas are examined in the report (see Figure 2): Mental Health can be strengthened — Co-ordinated action is needed at all levels to increase social inclusion. These include action at a society level, at an organisational level, at the community and at the individual level. International evidence suggests that strategies have to focus on all these levels. — Vulnerable groups require particular action. 2 Refers to care with psychiatric institutions, rather than within the community. x NESF Report No. 36 There is no Health without Mental Health A Vision for Change (Department of Health and Children, 2006) sets out the policy framework for mental health in Ireland and this report seeks to underpin this with a focus on social inclusion, recovery and population health. As increa- singly understood, mental health1 is shaped by our social, cultural, economic and physical world. In recognition of this, there has been a welcome shift in policy from a purely medical focus, to the promotion of mental health and well-being in many policy arenas. This report adopts a ‘population health’ approach to the development of mental health policy through improvements to the health of the entire population and reducing health inequities among population groups.