Mental Health Reform submission on review of A Vision for Change Published September 2017 Mental Health Reform acknowledges the support of the Department of the Environment, Community and Local Government’s Scheme to Support National Organisations 2016-2019. Contents ............................................................................................. Error! Bookmark not defined. Introduction .......................................................................................................................................... 3 Chapter 1: Service user and family supporter/carer involvement ........................................................ 7 Supports for family supporters/carers .............................................................................................. 7 Service user and family supporter/carer engagement structures .................................................... 12 Advocacy supports & peer-led services ......................................................................................... 14 Recovery ethos ............................................................................................................................... 22 Chapter 2: Social inclusion ................................................................................................................ 24 Employment ................................................................................................................................... 24 Social welfare ................................................................................................................................. 26 Training/vocational education & social inclusion support ............................................................ 27 Housing .......................................................................................................................................... 28 Tackling stigma and discrimination ............................................................................................... 35 Culturally competent mental health services ................................................................................. 37 Gender mainstreaming in mental health services .......................................................................... 40 Chapter 3: Promoting mental health and well-being in the whole population .................................. 43 Early years ..................................................................................................................................... 45 Whole-school approach ................................................................................................................. 51 Chapter 4: Mental health in primary care .......................................................................................... 62 Chapter 5: Adult mental health services ............................................................................................ 78 Chapter 6: Children and young people .............................................................................................. 92 Chapter 7: Older people ................................................................................................................... 102 Chapter 8: Mental health services for people in the criminal justice system ................................... 116 Court diversion ............................................................................................................................. 117 Assisted decision-making ............................................................................................................ 123 Mental health services within the prison system ......................................................................... 123 Chapter 9: Special categories of service provision .......................................................................... 130 Mental health and intellectual disability (MHID) ........................................................................ 130 Mental health services and supports for people from the deaf community ................................. 136 Dual diagnosis (mental health and addiction) .............................................................................. 137 Homelessness and mental health ................................................................................................. 143 Mental health and LGBTI people ................................................................................................ 146 Chapter 10: Accountability/governance/manpower ........................................................................ 149 Conclusion ....................................................................................................................................... 159 2 Introduction Eleven years on from publication of our national mental health policy, A Vision for Change, there is agreement across the mental health community that its implementation has been incomplete and uneven. Despite this implementation deficit, the policy has received widespread support from key stakeholders, including people who use the mental health services, their family members and carers, and mental health professionals, in addition to garnering strong political support. A Vision for Change was hugely innovative in a number of ways in that it: • sought to be a policy for the mental health of the population, not just a policy for mental health services • set out a policy on mental health promotion at all stages of the life cycle • introduced principles of ‘recovery’, ‘citizenship’ and ‘partnership’, which for the first time in national policy clearly recognised the role of the ‘service user’ in their own mental health care and treatment. The involvement of service users and family members/carers at all levels of the mental health system was acknowledged • affirmed the importance of advocacy for people with mental health difficulties at all levels of the care system • incorporated community support and primary care into its framework, and • highlighted the importance of the social inclusion of people with mental health difficulties The recommendations of the Expert Group on A Vision for Change are still of significant value today and must be realised in full. However, there are important policy areas that were not adequately addressed in 2006 that require urgent attention, including: • a problematic policy recommendation on services for people with a dual diagnosis of mental health difficulties and addiction, leading to barriers to people with a dual diagnosis accessing integrated care • inadequate specification of the resources needed for mental health in primary care, leading to undue pressure on specialist services, in particular child and adolescent mental health services and unnecessarily high waiting lists for specialist treatment • the absence of any policy around gender sensitive mental health services • under­developed policy around culturally sensitive mental health services, and • incomplete recommendations to support integrated mental health care that reflects the developmental progression of children through to early adulthood In addition, there are environmental changes such as the homeless crisis, as well as other emerging issues, for example, an increasingly diverse ethnic population, which were not considered in A Vision for Change. Furthermore, the significant shift in ethos required of the mental health services, reflected in the principle of ‘recovery’ in A Vision for Change, and embodied in ideas of partnership, choice and social inclusion, was not spelled out in the policy. As a result, the HSE has experienced significant resistance in trying to drive recovery­orientated mental health services in parts of the country. In 3 addition, detailed policy recommendations are required on the nature and role of peer support as a key component of the mental health system, which holds significant potential. The UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health recognises that “the recovery approach, when implemented in conformity with human rights, has helped to break down [traditional] power asymmetries, empowering individuals and making them agents of change rather than passive recipients of care”.1 In his most recent report, the Special Rapporteur acknowledges that power imbalances have dominated the relationship between mental health services and users of services and ultimately this has created an environment where people are undermined in making decisions about their own health, meaning human rights violations can and do occur. Mental Health Reform has consistently highlighted that people with experience of a mental health difficulty as a group are one of the least protected in terms of their rights. They are also one of the most socially excluded, experiencing prejudice and discrimination in all areas of their life in the community, including employment and housing. It is in this context that it is imperative that human rights strongly underpin any revised mental health policy, taking into account the evolving human rights framework in mental health. The Special Rapporteur and the World Health Organisation have advocated the implementation of rights­based mental health policies which keep pace with most current human rights law. In particular, the UN Convention on the Rights of Persons with Disabilities (UNCRPD), which was adopted in December 2006 almost a year after A Vision for Change was published,