This month, the Department of Health and Children published the Fourth Annual Report of the Independent Monitoring Group on the implementation of A Vision for Change, Ireland’s blueprint for mental health policy, published in 2006. The report was prepared by the Second Monitoring Group to be established under Vision for Change – which was appointed in early 2009, and similar to previous annual reports, is highly critical of the lack of progress in implementing the goals of A Vision for Change made to date.

Traditionally, mental health was a neglected area of legislation, policy and service provision in Ireland – particularly in terms of developing appropriate mechanisms to respect and protect the rights of mental health service users. The purpose of A Vision for Change was to rectify this by setting out a new framework for mental health service delivery in Ireland– one based on community care (rather than institutionalisation) and person-centred treatment, following the recovery model and a holistic approach to mental illness. One of the main recommendations of the original Vision for Change report was the establishment of multi-disciplinary community mental health teams to serve defined populations and age groups throughout re-configured mental health catchments areas. In order to implement this new structure for service delivery, the report also recommended the establishment of a National Mental Health Services Directorate, to work closely with the HSE on the roll-out of A Vision for Change.

The Annual Report published this month highlights the lack of progress in the last four years on implementing A Vision for Change. Many of the criticisms made in this Annual Report echo those stated in previous annual reports including the failure to fully develop and staff community mental health teams on a nation-wide basis, lack of clarity within the HSE on the respective roles of Executive Directors and Clinical with responsibility for mental health, failure to adequately involve service users in the planning process, and the lack of a comprehensive implementation plan for A Vision for Change as a whole. While it is encouraging to note that the Independent Monitoring Group has indeed been objectively critical and outspoken in its Annual Reports, it is disappointing that these criticisms have still not been taken on board and adequately addressed by the HSE.

A marked increase in lobbying around the implementation of A Vision for Change, particularly by Amnesty International (Irish Section) and the Irish Mental Health Coalition has succeeded in keeping the issue of mental health on the government’s agenda in recent years. This has resulted in a commitment in Budget 2010 to allocate a €43 million multi-annual investment programme (funded from the sale of HSE assets including old institutions) to implement A Vision for Change (which I blogged about here). However, the experience of the multi-annual investment programme for disability services demonstrates that it will be important to carefully track this funding to ensure that it is not diverted to other services within the HSE, as reported on by the Disability Federation of Ireland and Inclusion Ireland.

While resources are undoubtedly needed to implement mental health reform, change cannot be brought about without addressing number of important structural, political and legislative barriers identified in this recent report. These include problems with cross-departmental co-operation on mental health policy, lack of communication within the HSE and a lack of transparent governance structures within the mental health services. Efforts to establish a new framework for mental health service delivery would also be significantly enhanced by the introduction of an independent investigation mechanism for institutions where people with disabilities (who may also have mental health difficulties) live, the publication of mental capacity legislation, and Ireland’s ratification of the United Nations Convention on the Rights of Persons with Disabilities.

The Independent Monitoring Group’s report shines a light on the structural failings in the HSE in the specific context of mental health services; however it should be noted that these are common problems which have also been highlighted recently across other areas of service provision (including children in the care of the state and the state’s response to the elderly). It will be important to address these failings in a holistic manner to ensure comprehensive reform – not only for people who use mental health services, but for all citizens who engage with public services.