Mind Moves: Most of you are probably aware that we have a new mental health policy that will shape our planning and development of services over the next 10 years.
This report, A Vision for Change, outlines a comprehensive framework for building and fostering mental health across the whole population. It also presents a detailed plan for providing accessible, user-friendly, recovery-oriented, community-based services for people who experience severe mental health problems.
Mental health concerns everyone. Most of us have been touched in a very direct way by the reality of mental illness. We may have personally lived through a time of painful emotional distress or witnessed the impact of mental illness in the life of a friend or loved one.
This particular form of human suffering can arouse strong emotions in us, notably fear and pessimism. Fear because we may not know where to turn or the most appropriate help to access; fear that the distress we observe may become a lifelong disability that will prevent us or someone we care about from realising their potential. Pessimism that nothing can be done to stop people from becoming prisoners of their psychological distress.
These feelings can make mental illness an issue that is simply too painful to talk about. They were among the key reasons that led to the establishment of an expert group on mental health, of which I was a member, two years ago.
Comprising 18 individuals with their own unique perspectives on the mental health system, the expert group grappled with the fundamental issues that concern everyone in respect to mental illness and set about creating a new vision of what a real mental health service should look like. The perspectives represented in the group included those of service users, families, psychiatry, nursing, psychology social work, occupational therapy, psychotherapy and health service management.
The expert group was not a group of professionals who considered the mental health service in some detached way; we were the mental health service. Collectively, we embodied key elements of the service and, when we started on our journey, we mirrored the same opposing beliefs and passions that often characterise our services and perplex service users.
The challenge we faced was to create a collective vision of mental health that respected the critical contribution of each person in our group, so that we embodied in own interactions the vision that we ultimately articulated. The vision that evolved is a person-centred, multidisciplinary approach to mental health care, where a range of expertise is partnered with service users and families to achieve true recovery from mental illness.
A key principal in A Vision for Change is that mental health services need to be community-based: they should address the needs of people in trouble in the context of their relationships with families, friends, work and social circumstances. A community approach implies that services are close to the people who need them most, that they are equipped to intervene early in a crisis, and that they offer a range of practical and therapeutic approaches that support someone in finding their legitimate place in community life.
Early intervention will address the issue of mental health in younger people and minimise the disabling aspects of mental illness that can produce unnecessary social isolation and hospital admission. Recovery-oriented teams, dedicated to working with those with severe mental illness as they emerge from a crisis, should significantly reduce the re-admission rate to hospital which runs at 70 per cent of all hospital admissions. It is on this basis that the policy proposes a gradual reduction in bed allocation within catchment areas and the redeployment of the funds vested in traditional psychiatric hospitals to enhancing alternative community-based options.
A Vision for Change poses a challenge to everyone concerned with mental health. Above all, it challenges each one of us to be honest about how normal it is to find oneself in the grip of psychological distress and to work towards making this something we can talk about and deal with without shame or stigma. For those with abiding vulnerabilities, perhaps even eccentricities, the prospects for genuine recovery are considerable and grounds for optimism rather than pessimism.
For this group it is more often our neglect of their practical needs for housing, work opportunities and personal support that result in their abiding difficulties. Our fears, rather than their "symptoms", create walls as sinister as those of any Victorian institution that alienate the mentally ill leaving them socially excluded and vulnerable to relapse.
This policy emphasises that recovery is possible for even the most vulnerable. If we can collectively embrace the reality of psychological distress and respect the rights of people with mental illness as citizens who deserve world-class services focused on recovery, wellbeing and hope, we will all be the richer.
• Dr Tony Bates is principal clinical psychologist in St James's Hospital. A Vision for Change is available from the Government Publications Office, Molesworth Street, Dublin.
