Second Opinion: Vision for mental health services far from realised

Quite by chance I discovered that a majority of mental health service users do not have the individual care plans (ICP) rec ommended in a Vision for Change , the report of the expert group on mental health policy published in 2006.

Last week a friend receiving outpatient psychiatric treatment for mental health difficulties expressed his frustration with the overall process, which did not include the concept of recovery or any treatment other than medication.

Naively, I asked, "Do you not have a care plan?" No, he did not have a care plan. Puzzled by this, I sought clarification from the HSE and was assured that "all patients in the care of secondary care mental health services [includes outpatients] have a plan of management/care plan based on the person's diagnosis and associated identification of their individual needs".

“The plan encompasses psychological [talk therapy], social [skills] and biological [pills] treatments as clinically indicated.” Not all patients, it seems.

A Vision for Change recommended that "a recovery orientation should inform every aspect of service delivery" and "every mental health service user should be provided with a copy of their care plan".

This should reflect “service users’ individual needs, goals and potential and address community factors that may impede or support recovery”.

In 2014, eight years after the publication of Vision for Change , every mental health service user does not get an individual care plan. The Mental Health Act 2001 (Approved Centres) Regulations 2006, which came into operation in November 2006 and includes individual care plans (Article 15), applies only to residents of these centres.

Community mental health services
Outpatients attending these centres or receiving community mental health services may or may not receive a care plan and most do not. In fact, since a majority of mental health service users are outpatients, most are not provided with a care plan of any kind.

The 2012 report of the Inspector of Mental Health Services concluded that professionals had a “weak grasp of individual care planning” and “Ireland’s mental health services are stagnant and perhaps have slipped backwards in 2012”.

Only 52 per cent of approved centres were in full compliance with article 15, down from 62 per cent in 2011. Inspection reports from 2013 show that whether service users have individual care plans depends on where services are located.

All residents in the acute psychiatric unit at Tallaght Hospital (November 2013) had an individual care plan. An inspection of the departments of psychiatry at Our Lady’s Hospital, Navan (October 2013), and St Luke’s Hospital, Kilkenny (November 2013) found that a number of residents had care plans which were not fully compliant with the regulations.

The department of psychiatry at University Hospital Galway (October 2013) "did not provide an individual care plan for each resident. This breached the condition attached by the Mental Health Commission to the registration of the approved centre."

The 2014 HSE Mental Health Division Operational Plan aims to reduce the variation in services and provide “a standard level of basic service regardless of location”.

Service users, carers and family members will be more involved, and approved centres aim to comply with article 15 of the regulations in relation to individual care plans.

Management-speak
The HSE also intends to "scope" the extension of care plans to community teams. This management-speak means they will look into the possibility of developing individual care plans with non-resident service users, including outpatients.

Given that all approved centres are still not compliant with the regulations in relation to Article 15, eight years after the publication of Vision for Change , it does not seem that outpatients are going to get individual care plans any time soon.

A Vision for Change was widely welcomed in 2006 and most people assumed that within a few years, mental health services would be transformed.

Every citizen would have “access to local, specialised and comprehensive mental health service provision that is of the highest standard”.

Unfortunately, according to the Mental Health Commission, there is a serious deficiency in the development and provision of recovery-oriented mental health services and "most of those receiving treatment will be offered the more traditional medicalised version rather than that propounde d in a Vision for Change ".

While 90 per cent of mental health problems are dealt with by primary care, about 60,000 new patients are referred to, and seen by, secondary care mental health services every year.

These citizens are entitled to an individual care plan. Without one, recovery remains an unattainable goal for many people with mental health difficulties.

Dr Jacky Jones is a former HSE regional manager of health promotion
drjackyjones@gmail.com