Treatment may not produce a cure, but it should enable individuals to live a meaningful life, writes Dr Muiris Houston, Medical Correspondent
Mental health problems have a high prevalence, with an estimated one in four adults experiencing psychological difficulties that benefit from expert intervention.
As well as the major impact of mental illness on the individual and his or her carers, work, social life and family life are affected by psychological disease. All of which make yesterday's publication of the report, A Vision for Change, a significant milestone in the development of health policy in the Republic.
The World Health Organisation has calculated that mental disorders are second only to infectious diseases in the global burden of diseases. The economic costs of mental health problems are also significant. Mental health has long been the poor relation of our health system, with many shortcomings.
Among those identified by the expert group are a lack of community orientation in the delivery of mental health services; a dearth of true multidisciplinary team working; little practical help available for patients once they go back to the community; and a high rate of relapse and readmission.
"Current service provision lacks a positive focus on the capacity of individuals to recover and lead lives that are personally and socially meaningful to them," the report notes. This comment reflects the vision that informs every chapter of the document.
One of the key principles set out by the authors is the need to adopt a "recovery perspective" at all levels of treatment.
Treatment may not produce a cure, but it should enable individuals to live a productive and meaningful life and equip them with the necessary self-understanding and resources to minimise relapse.
Other key values include the need for patients to be viewed as active participants in their own recovery, as well as a requirement for greater access to psychological or "talk" therapies.
The fundamental change proposed by the report is the development of community mental health teams as the basic providers of services. Covering catchment areas with populations between 250,000 and 400,000, the teams will consist of psychiatrists, psychologists, social workers, nurses, occupational therapists, counsellors and support workers. Based in community mental health centres, each will have a clinical leader, a team co-ordinator and a practice manager.
What will it be like for patients if this plan is implemented in full? They will no longer be admitted to old Victorian institutions but to a ward in a general hospital. They and their families will be involved in drawing up a care plan, giving access to a full range of treatment options, including improved psychological services.
In the community, they will be looked after by the new mental health teams based in health centres. Should an acute problem develop, a 24-hour crisis response team will be available to help.
Crisis houses, based in the community, will offer 24- to 72-hour respite rather than immediate readmission to hospital.
Meanwhile, GPs with the back-up of expanded teams will look after 90 per cent of mental health problems in the community.