SECOND OPINION:It's easy to say what's wrong, it's harder to be part of the solution
THERE WAS something bleak about the conclusion to this newspaper’s editorial on October 12th in relation to mental health reform in Ireland. The implication seemed to be that the Government’s commitment to reform was nothing more than a cynical exercise. This view is often encountered in conversations about mental health across the sector. I wonder if it ever leads to constructive action or whether it simply reinforces a sense of helplessness and collective despair.
I believe in the cut and thrust of public debate, especially about an issue as important as mental health. Discourse about the shortcomings of our mental health service system and how it should be remedied wake us up to the reality of mental distress in people around us. This ongoing discussion sharpens our awareness of how frightened we are of anything “mental” and how painfully inadequate and unethical our response to people with mental health difficulties has been in the past. It challenges all of us to think creatively about supporting people with mental health difficulties and enabling them to recover.
In many ways, A Vision for Changewas a document that captured the best of these conversations and proposed a model of what an effective and person-centred service would look like. But the problem with Visionwas that it described a destination but did not provide the road map to get there.
I think our current frustration about the implementation of Visionis born of the fact that we don't understand the type of change it proposes. We think of change in terms of addition – adding more to what's already there. The change Vision proposes is about systems transformation – changing how we think about people with mental health difficulties, changing how our services engage with the people who need them, believing more in the potential of service users to recover, helping professionals design better services, and measuring success in terms of outcome for the people who use our services rather than the output of the people running them.
What we need are ways to track significant meaningful changes in the way we support people, rather than focusing on how many more services we add each year. More is not always better, and we all know that large infusions of new resources are highly unlikely given the current economic situation.
Another source of frustration is that we don’t always appreciate that transformational change takes time. It’s not an event which Government either chooses to do or not do in a given year; it’s a process that happens gradually when thoughtful change strategies mature and become aligned.
Perhaps what is most needed is a changed management strategy that is coherent, focused and measures incremental change in a more nuanced way. If we continue to focus on judging the progress of reform in terms of numbers – annual investment figures, number of additional positions – we will miss the more important indicators of change. What we should care most about are things such as service users’ satisfaction with system responses, community attitudes toward people with mental health difficulties, outcomes related to service provision, collaboration and co-ordination across various service sectors to ensure that services are integrated and appropriate, and the efficiency of resource allocation.
I became involved with Headstrong to change how this country thought about the mental health of young people and because I believed that early intervention and prevention were key to system transformation. Youth has always been identified as a period of intense vulnerability in the lifecycle. In fact, 75 per cent of all adult mental health disorders emerge in the late teen years.
Last week’s editorial left one feeling that no one really cares, but this has not been my experience. Right across the sector, I see deeply committed people who are putting their lives and reputations on the line to change a system that is outdated and, in many ways, more unwell than the people it is trying to serve.
It’s easy to point out what is wrong with the system; it’s a lot harder to be part of the solution. We need to support one another as we strive toward transformation. It’s a vision worth fighting for, and now the task is to create a navigable road map together.
Tony Bates is founding director of Headstrong – The National Centre for Youth Mental Health