Vision, Reality and Direction Trends in Irish Mental Healthcare

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Vision, Reality and DirectionTrends in Irish
Mental Healthcare

• Dr Justin Brophy IMO Conference Apr 09

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Vision
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The Plan

• Reduced hospital admissions.
• Closure of psychiatric hospitals and
  re-investment of resources.
• Phased implementation 7 to 10 years
• 11,000 staff 1803 new posts

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Framework for community services

• 2 Adult mental health teams per 50,000
• 1 Rehabilitation and recovery mental health
  services per 100,000
• 2 Child adolescent mental health teams per
  100,000
• 1 Mental health services for older people per
  100,000
• 1 Adult mental health of ID per 150,000
• 1 Substance misuse mental health services per
  300,000
• 1 Adult Liaison mental health services per
  300,000
• 1 Child and adolescent Liaison mental health
  services per 300,000

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Plan in plenty - implement in scarcity
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Financial crisis and global healthDr Margaret
ChanDirector-General of the World Health
OrganizationGeneva, Switzerland 19 January
2009

• The situation is alarming and highly volatile,
• as it has some unprecedented dimensions.
• People tend to forego private care
• and make more use of publicly financed services.
• already vastly overstretched and under funded
• In the past, we have seen the social sectors
  robbed
• in times of economic downturn,
• with dire long-term consequences.

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Financial crisis and global healthDr Margaret
ChanDirector-General of the World Health
OrganizationGeneva, Switzerland 19 January
2009

• Officials are worried that health in their own
  countries may worsen
• as unemployment rises,
• safety nets for social protection fail,
• savings and pension funds erode,
• and spending on health drops.
• We can expect
• More mental illness and anxiety,
• and a possible jump in the use of tobacco,
• alcohol, and other harmful substances.
• This has happened in the past.

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Benedetto Saraceno, director of WHO's mental
health said.

• "There is a clear evidence that suicide is linked
  to financial disasters.
• I am not just talking about the millionaire
• but mainly about poor people"

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What direction?
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Socioeconomic trends Suicide1968-2000

• We found no evidence that socioeconomic trends
• were the driving force behind Irish suicide
  trends

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New Zealand researchers found

• Men and women aged
• 25 to 44,
• and men who were
• aged 45 to 64
• who were unemployed
• were two to three times more likely to complete
  suicide as their employed peers.

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March 09
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... depression will be the second-most debilitatin
g disease in the world by 2020
JAMA 1992
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Reality
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Two out of three teens feelunable to cope with
problems

• Many teenagers who are anxious
• or depressed feel they have no one to talk to.
• Almost half report having been bullied
• while one in 10 say they have experienced serious
  mental health problems,
• but have not sought professional help.

• CARL O'BRIEN, Social Affairs Correspondent
  March 09

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Irelands Youth Drink problem ? ESPAD

• Ireland is the
• top of the league of European under-age drinkers
• -31 of boys and 33 of girls
• Half experimented with alcohol
• before the age of twelve.  

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Irelands Youth Drink problem ? ESPAD

• One in five of 12-14 years old boys were current
  drinkers.  
• More females in the 18-24 age group engage in
  high risk drinking

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Drugs under 25s

• These are among the highest rates in Europe. 
• double the EU average of availability of cannabis
  and alcohol to under sixteens

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Lack of care at root of the problem WHO

• majority of people worldwide suffering from
  mental illness in developed countries
• there is an "abysmal lack of care,"
• inadequate mental health care budgets
• and where victims suffer from social stigma and
  discrimination.

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The un-necessary burden
Source NHS Executive
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The Gap
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As the authors of The Lie of the Land report
say,

• "The trend apparent to the authors suggests that
  psychiatric services represent an easy target
• by planners and managers to appropriate assets
• to meet shortfalls in current and capital
  expenditures of general health services."

Barry, Brophy Walsh O8
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Proportion of Mental Health Spend

• Reform initiatives

• of Budget

• Commission of Inquiry 1965
• Planning for the Future 1984
• Vision for Change 2006

• 23
• 12
• 6

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The other anti-psychiatry

• Prejudice and discrimination
• Political neglect
• Resource Poaching
• Insurer exclusion
• Legal encroachment

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Why ? A Disconnection?

• Positive mental health measures are high in
  Ireland Slan 07
• Like rich and poor,
• here the gap is wide ?

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Nature of the problem?

• Denial
• Ignorance
• Fear
• Pessimism

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What will happen?
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Direction ?
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Dr Chan recommends..Jan 09

• Protect and pre-empt problems
• persuade other ministries to protect funding for
  health,
• be very smart and cost conscious

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People at risk of suicide failed by funding
cut March 12th 2009

• 12.5 cut in funding for the National Office for
  Suicide Prevention (NOSP)
• means that those at risk of suicide
• are being abjectly failed by authorities,
• an Oireachtas meeting has heard.

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CMH Dundrum

• No proposals to undertake further upgrading
  works on existing site
• New build project is stalled

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Closure plans have been developed for the
following Psychiatric Hospitals

• St. Finans, KillarneySt. Stephens,
  CorkHeatherside, Buttevant Mount Alverna,
  MallowSt. Otterans, WaterfordSt. Cannices,
  KilkennySt. Lukes, Clonmel, St. Senans,
  WexfordSt. Dympnas, Carlow
• Dublin Mid Leinster
• Closure plans are being considered for the
  following psychiatric hospitalsSt. Lomans
  MullingarNewcastle, Co Wicklow
• Dublin North East
• Closure plans have been developed for the
  following Psychiatric HospitalsSt.Brendans,
  GrangegormanSt. Itas, PortraneSt. Brigids
  Ardee St. Davnets, Monaghan

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MHS Overtime to be cut

• Target of 55 reduction of overtime costs
• Also savings from improved drug prescribing
  practices of 2.5 m

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Recruitment embargo to stay

• Up to 20,oo0 vacancies potentially unfilled over
  the next 20 months -INO

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HSE executive warns of health service 'rationing'
27 March 09

• THE CHALLENGES now facing the HSE are akin to
  war-time challenges,
• certain services will have to be rationed
• said Seán McGrath, national director of human
  resources with the HSE,
• things were going to get worse.
• We may have to face really, really stark choices
  as the situation deteriorates over the coming
  weeks and months.
• I do believe we need war-time solutions and
  proposals.

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Developments

• Minister Moloney also noted that significant
  progress is being made in providing additional 8
  beds in the mental health services for children
  and adolescents.
• a further 14 beds in Cork and Dublin will become
  operational this year
• and construction is underway on new 20-bed units
  in Cork and Galway.
• In addition, funding is being provided in 2009
• for 35 additional therapy posts for child and
  adolescent mental health services.

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Expansion in some areas

• 8 Bed CAAMHS unit open
• St Stephens Cork April 3 09
• 20 bed in patient unit under construction
• TBC late 2009
• 9m Capital
• Unit in Vincents Fairview still not operational

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The Minister of State with responsibility for
Equality, Disability and Mental Health, Mr. John
Moloney, T.D., today (26th January 2009)

• revealed plans that will see
• community mental health teams
• operating alongside primary care personnel
• in 20 new Primary Care Centres
• to be put in place by the HSE this year.
• both pragmatic and strategic and will benefit
  service users, their families and all
  professionals involved.

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Money

• The proceeds of the sales in recent years of St.
  Lomans Hospital, Verville Retreat in Clontarf
  and two other Dublin properties amount to over
  42m.
• This funding needs to be made available now to
  fund new mental health infrastructure
• if we are to progress A Vision for Change in
  the next few years.

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Old Struggles
New Vistas
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Old Struggles
New Vistas
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What Direction Now ?
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A Political Objective

• Mental Health
• A Service Priority

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Smart Politics

• Lowry announces suicide prevention package for
  North Tipp 15 Nov 07
• THE 750,000 FUND
• INCREASE PUBLIC AWARENESS
• PROVIDE INFORMATION
• IMPROVING MENTAL HEALTH
• SHOW BENEFIT OF POSITIVE COPING STRATEGIES.
• ASIST TRAINING

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Investing in Social CapitalInvesting in
Political Systems
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Solidarity
Mental health problems do not affect one or two
out of every five persons - but five
out of five
Menninger
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What are the Characteristics of Resilient People?

• Ability to "bounce back" and "recover from almost
  anything"
• Have a "where there's a will, there's a way"
  attitude
• Tendency to see problems as opportunities
• Ability to "hang tough" which things are
  difficult
• Have deep-rooted faith in a system of meaning
• Have a healthy social support network
• Able to recover from experiences in the panic
  zone or of a traumatic nature

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Lifestyle

• Find out about about safe ways to
• reduce anxiety, depression,
• muscle tension,
• and sleep difficulties.
• Eat well, exercise,
• get enough sleep,
• and use your family and others for support.

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Community Responses

• having goals and dreams
• appreciating family members,
• Building communityvalues,
• building family communications
• handling peer pressure,
• Doing whats right

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Patient-Provider convergences

• Partnership
• Peer-to-peer networks
• WRAP NSUE GROW
• Spunout TEENTEXT
• Jigsaw
• e-therapy
• Beating the blues
• Fear fighter
• OC fighter
• UCanPoopToo

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The Final Frontier Stigma
Mental Health Awareness and Attitudes in Ireland
Study commissioned by the National Office for
Suicide Prevention found significant levels of
stigma still persist around mental health,
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Managing alcohol, medication, and drug use

• Pay attention to any change in
• your use of alcohol
• and/or drugs
• including prescription and over-the-counter
  medications.

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PreventionTargeting High risk groups
prevention

• Mentally ill
• Alcohol and drug abusers
• Elderly
• Migrants and Refugees
• Occupational targeting
• Prisoners

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College of Psychiatry of Ireland
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Good practitionersKnowledge wisdomEffective
treatments

• Better outcomes
• Less stigma
• Less fear

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Clinical Direction
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Clinical Directorates

• Span
• Acute / Primary / Community / Continuing care
• Across boundaries
• Leadership
• Executive Clinical Director
• Finance / Business
• Director of Nursing
• Budget and strategic planning

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• 'We have for the first time the prospect of
  significantly empowering clinicians as the key
  designers and leaders of modern health services
  at all levels right across the organisation.
• 'We know from experience they deliver far better
  results in terms of clinical effectiveness,
  patient safety, patient outcomes and financial
  returns.
• The new contract,
• the creation of a National Clinical Care and
  Quality Directorate
• and the merging locally of our hospital and
  community based services
• creates a unique opportunity and momentum to
  achieve this,

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Partnerships

• The Minister added One of the most significant
  developments since 2006
• is that there is increasing service user
  involvement in planning and delivering mental
  health services.
• that this expertise is invaluable in the
  development of person-centred mental health
  services which are the cornerstone of a A Vision
  for Change

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Lead, follow, or get out of the way Thomas
Paine

• Choice
• Resist?
• Passive?
• Engage?
• Lead?

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An New and Powerful Alloy?
Sciences, Technology, Industry
Independent Service Providers
Law Rights
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In Conclusion

• Dont Panic
• Do be aware
• How we choose matters
• Recapture our values
• Mind Ourselves
• Relentless but astute campaigns
• Mind the most vulnerable
• Develop a National Response
• Protect Mental Health Services
• Implement Agreed Policy

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Thank You for your attention