Dr Shari McDaid was appointed Director of Mental Health Reform as of 1 October 2013. Shari joined Mental Health Reform as Policy Officer in August 2011. Prior to that, she worked with Amnesty International Ireland from 2008 to 2011 as Policy Officer for the mental health campaign. She was previously policy officer at the National Disability Authority and, before that, Policy and Administration manager at Schizophrenia Ireland. Shari received her doctorate in 2008 from the Equality Studies Centre at UCD, with a thesis entitled Power, Empowerment and User Involvement in the Public Mental Health Services in Ireland.
Opinion piece by Dr Shari McDaid,
Director of Mental Health Reform
Shari previously wrote an article for PAI, regarding the progress made on
A Vision for Change, nine years after its publication.
You can read “A Vision for Change”: Nine Years On
(June 2015) here.
In 2006, A Vision for Change was adopted as Ireland’s National Mental Health Policy. The strategy, which received widespread support, envisaged an Ireland where “positive mental health” would be fostered “across the entire community” and “accessible, community-based, specialist services for people with mental illness” would be provided.
A Vision for Change set out a comprehensive policy for the future direction of Ireland’s mental health services, central to which was the closure of the older Victorian mental health institutions and a shift from in-patient to community-based care.
A decade on, while much work has been done on closing the older mental health institutions and developing a community-based service, unfortunately, for a large proportion of those affected by mental health difficulties — particularly those whose mental health is most at risk – A Vision for Change remains just that: a vision.
In our report, A Vision for Change: Nine Years On, a coalition analysis of progress (published in 2015), we described the implementation of the national mental health policy as “incomplete and uneven”, despite pockets of innovation.
One area in which it is clear that implementation had been almost non-existent is in the provision of mental health services to specialist or high-risk groups. These include groups such as homeless people, those with a eating disorders, people with intellectual disabilities and those with co-morbid severe mental health difficulties and substance abuse problems.
Our report found that
“the evidence on the provision of special categories of mental health service provision shows that these services have received the least development since 2006 compared to other areas of the mental health service”.
The lack of any real progress in the development of mental health services for these marginalised groups is not news. The issue has been consistently raised by successive monitoring groups established to oversee the implementation of A Vision for Change since 2006.
In its sixth and final report published in July 2012, the Independent Monitoring Group (IMG) called for specialist mental health services for older people, rehabilitation and recovery, eating disorders, intellectual disability, co-morbid severe mental illness and substance abuse problems, and others described in A Vision for Change, to be fully-developed and delivered “as a matter of urgency”.
The IMG’s tenure lapsed in 2012 and a replacement group has not been appointed since.
Under the human right to the highest attainable standard of mental health, the Irish Government has a particular responsibility to provide services to marginalised groups.
The recently published Programme for Government makes a broad commitment to fully implement A Vision for Change. According to the document “the new Government is committed to meeting the recommendations of A Vision for Change.”
In our pre-election manifesto Mental Health Reform (MHR) asked the Government to produce a detailed, time-lined, whole-of-Government action plan to continue the reform of mental health supports and improve the mental health of the whole population, in line with A Vision for Change and the Healthy Ireland Framework, ensuring that adequate funding and the structures for good governance and oversight of the plan are in place.
In order to meet this objective the Government must commit to ensuring that mental health funding reaches €973m in real terms within the five-year term of the Government, which would bring staffing levels in the mental health services up to the A Vision for Change recommended level of 12,000.
While the Programme for Government does not set out a budgeted, time-lined whole-of-Government Action Plan for the implementation of A Vision for Change, it does commit to
“conducting an evidence-based expert review of the current status of implementation