Law – the missing ingredient for mental health reform

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6 August, 2010

Law should be considered to improve accountability for mental health expenditure and drive mental health reform, Amnesty International Ireland (AI) has said. The human rights organisation has published a discussion paper that outlines why law is needed, and what it might look like, and has opened the topic for discussion.

Click here to read our discussion paper on:
Legislating for Change: Accountability and Reform of our Mental Health Services

Colm O’Gorman, Executive Director of AI, said: “For more than 25 years Ireland has been striving to reform its mental health services to be primarily provided in the community rather than in outdated psychiatric hospitals. The latest Government mental health policy, A Vision for Change, published in 2006 reiterated these recommendations. However, progress has been slow and uneven, and there has been little accountability.

“Just last year a report we commissioned by Indecon International Economic Consultants found that four out of five HSE mental health staff still work in inpatient units. Government policy calls for a person-centred, recovery-oriented and holistic approach to mental health services. However, there continues to be an over-reliance on medication rather than an appropriate choice of treatments and supports.

“It is clear that policy alone is failing. We are calling for the Government to use law to help drive the establishment of effective system of community based mental health services and improve accountability - an approach which has been recommended by the World Health Organisation and mandated by international human rights law.”

Law to date has focused on involuntary treatment and detention and has not been used as a means of driving policy and improving accountability for how mental health services are delivered.

Mr O’Gorman added: “International human rights law demands that mental health services be continuously improved in line with best practice in order to fulfil the right to the highest attainable standard of mental health and avoid social exclusion.For so long as Ireland fails to implement the policy of reform, it will continue to fail to meet international human rights standards. The human cost of this is huge for people who experience mental health problems and their families.”

Legislation could establish a framework for sustained improvement of mental health services and increased transparency and accountability in mental health expenditure by clarifying the obligations of the HSE and the principles that should guide its fulfilment of those obligations.

Background Information

In a report commissioned by AI, Accountability in the delivery of A Vision for Change, Indecon International Economic Consultants recommended the Government consider using the law to drive the delivery of fully staffed community mental health teams.

AI’S RECOMMENDATIONS FOR USING LEGISLATION TO DRIVE REFORM

AND ACCOUNTABILITY ARE THAT GOVERNMENT SHOULD:

place a statutory obligation on the HSE:

to prepare and publish a detailed, time-bound plan for the closure of unsuitable facilities and the development and ongoing provision of comprehensive and community-based mental health services in line with A Vision for Change. This statutory obligation (or accompanying regulations) should stipulate the level of detail to be included in such a plan including measurable targets, milestones, outcomes and indicators as well as clear timeframes and details of funding, human resources and infrastructure needed for implementation. The plan should also include details of management structures and responsibilities and it should be subject to the approval of the Minister for Health and Children and possibly also any independent monitoring group established by the Minister from time to time (i.e. the Independent Monitoring Group in the current context);
to provide comprehensive and community-based mental health services including the specialist services identified in A Vision for Change in line with the detailed plan and to the maximum of available resources; and
to report annually by catchment area and service area to the Oireachtas and any independent monitoring group established by the Minister from time to time (i.e. the Independent Monitoring Group in the current context) on progress towards the implementation of its plan and expenditure of allocated funding and to publish this report. This reporting requirement could point to key performance indicators (both transformation indicatorsand ongoing performance indicators) relating to financial accountability, mental health services infrastructure, staffing/human resources (by speciality/skill mix), scope and quality of services and outcomes such as those recommended in the 2010 Indecon Report.

enshrine principles in law to guide the planning and delivery of mental health services. These could include:

the principle that services and supports should be designed in such a way as to enable people to enjoy their right to live in the community and participate in community life and to prevent social exclusion and isolation;
that persons be able to access the appropriate range of treatments and supports suited to their needs in the least restrictive environment appropriate;
that the mental health services be designed in a way that promotes and underpins the recovery ethos; and
that service user participation be a core element of service planning and delivery.

extend the scope of Part 5 of the Mental Health Act 2001 so that the system of registration and approval of mental health services by the Mental Health Commission also applies to community-based services; and

place equal emphasis on the periodic inspection of inpatient and community-based mental health services by amending section 51 of the 2001 Act (functions of the Inspector).

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