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A Policy Approach to embedding rights in Mental Health Services: A Vision for Change and the experience in Ireland Irish M...
Introduction <ul><li>Brief on Vision for Change </li></ul><ul><li>Implementing Vision for Change </li></ul><ul><li>The imp...
Real Life <ul><li>Dave, aged 64 years, spent a number of years in a psychiatric hospital.  </li></ul><ul><li>Discharged to...
Vision for Change 2006 1 <ul><li>Framework for  complete model  of mental health service provision </li></ul><ul><li>Princ...
Vision for Change 2 <ul><li>Service user  involvement the norm in every aspect of service development and delivery- simila...
Vision for Change 3 <ul><li>Managed by a National Directorate-working directly within the HSE </li></ul><ul><li>Locally by...
Implementation-who’s watching?  Independent Monitoring Group   1 <ul><li>Vision cannot be implemented effectively without ...
Implementation-Who’s watching ?  2   Inspector of Mental Health Services <ul><li>Lumping all mhs tog. in  PCCC  +  no Ment...
Implementation-Who’s watching? 3   Irish Mental Health Coalition   <ul><li>“ Late for a Very Important Date” progress pain...
Real Life <ul><li>Community in the Gaeltacht presented a purpose built house to the HSE for sole use of the mental health ...
Issues arising <ul><li>Offer by an Independent sector to manage the service </li></ul><ul><li>What are the expectations? <...
Impact <ul><li>Mental Health Act 2008-Dail Debate-Minister Harney  “unthinkable” that anyone would lose his/her liberty be...
Re-institutionalisation? <ul><li>What are Dave’s options? </li></ul><ul><li>He is re-institutionalised in a generic servic...
Principles and Capacity <ul><li>Least restrictive alternative </li></ul><ul><li>Dignity and respect </li></ul><ul><li>Capa...
Is legal action an option? <ul><li>Olmstead v. Zimring  527 US (1999)  </li></ul><ul><ul><li>Costs of segregated instituti...
Is legal action an option? <ul><li>Courts are reluctant to get involved in directing how the public purse is spent </li></...
Why is this happening? <ul><li>Key issue-  Political Motivation  </li></ul><ul><li>No director for mental health at top le...
 
Bird’s Eye View <ul><li>Are we witnessing the new generation of human rights abuses? </li></ul><ul><ul><li>Moving people w...
Optimism <ul><li>Office for Disability and Mental Health </li></ul><ul><li>Mental Health Inspector’s Report 2009  </li></u...
Conclusion  <ul><li>Policy approach is not enough </li></ul><ul><li>Extreme caution and careful monitoring of  local  acti...
Recommendations <ul><li>Immediate need for administrative/ management  protocol  </li></ul><ul><li>Advocacy/representation...
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Dr Mary Keys A Policy Approach to Embedding Rights in Mental Health Services

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A Policy Approach to Embedding Rights in Mental Health Services

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Transcript of "Dr Mary Keys A Policy Approach to Embedding Rights in Mental Health Services"

  1. 1. A Policy Approach to embedding rights in Mental Health Services: A Vision for Change and the experience in Ireland Irish Mental Health Coalition Conference, Dublin May 18 th 2009 Mary Keys, School of Law, NUI Galway
  2. 2. Introduction <ul><li>Brief on Vision for Change </li></ul><ul><li>Implementing Vision for Change </li></ul><ul><li>The impact of current practices </li></ul><ul><li>Is legal action realistic? </li></ul><ul><li>Some possible explanations </li></ul><ul><li>The future </li></ul><ul><li>Conclusions </li></ul>
  3. 3. Real Life <ul><li>Dave, aged 64 years, spent a number of years in a psychiatric hospital. </li></ul><ul><li>Discharged to a medium support hostel, his home for a number of years </li></ul><ul><li>Attended a day centre each day, paid rent from his DA </li></ul><ul><li>Difficulty with using the stairs -nursing home was proposed </li></ul><ul><li>Now lives in a nursing home and complains that he has no-one to talk to as many of the residents have communication difficulties </li></ul>
  4. 4. Vision for Change 2006 1 <ul><li>Framework for complete model of mental health service provision </li></ul><ul><li>Principle based and respect human rights </li></ul><ul><li>Holistic approach to mental health problems </li></ul><ul><li>Person centred approach based on Recovery ethos to inform every aspect of delivery </li></ul><ul><li>Service user as partner in own care plan- to reflect needs, goals and potential </li></ul>
  5. 5. Vision for Change 2 <ul><li>Service user involvement the norm in every aspect of service development and delivery- similarly with carers </li></ul><ul><li>Integrated multi-disciplinary approach to factors that contribute to mental health problems </li></ul><ul><li>Specialist community mental health teams to address needs across life span </li></ul><ul><li>Effective community service </li></ul>
  6. 6. Vision for Change 3 <ul><li>Managed by a National Directorate-working directly within the HSE </li></ul><ul><li>Locally by Mental Health Catchment Area Management Teams </li></ul><ul><li>Service provision to be prioritised on needs basis </li></ul><ul><li>Services should be meaningfully evaluated </li></ul><ul><li>Closure of all psychiatric hospitals </li></ul>
  7. 7. Implementation-who’s watching? Independent Monitoring Group 1 <ul><li>Vision cannot be implemented effectively without a National Mental Health Services Directorate </li></ul><ul><li>Has impeded progress on poor facilities </li></ul><ul><ul><li>Inconsistent approach to embedding Recovery ethos in services </li></ul></ul><ul><ul><li>Absence of comprehensive implementation plan </li></ul></ul><ul><li>Progress made on some priorities, child and adolescents, engagement with service users, </li></ul><ul><ul><li>2009 Report- www.doh&c.ie </li></ul></ul>
  8. 8. Implementation-Who’s watching ? 2 Inspector of Mental Health Services <ul><li>Lumping all mhs tog. in PCCC + no Mental Health Directorate “caused confusion, misunderstanding, muddied mission, poor decisional capacity ” </li></ul><ul><ul><li>Broad Impact –people admitted to institutions </li></ul></ul><ul><ul><li>No progress in resource equalisation </li></ul></ul><ul><ul><li>Lacking comprehensive community services </li></ul></ul><ul><ul><li>Impact of restrictive work practices </li></ul></ul>
  9. 9. Implementation-Who’s watching? 3 Irish Mental Health Coalition <ul><li>“ Late for a Very Important Date” progress painfully slow </li></ul><ul><ul><li>No Mental Health Directorate </li></ul></ul><ul><ul><li>Children in Adult wards </li></ul></ul><ul><ul><li>HSE Implementation plan with lack of detailed commitments-finance, resources </li></ul></ul><ul><ul><li>HSE should publish quarterly reports of progress for the Implementation Group </li></ul></ul><ul><ul><li>The number of fully staffed Community Mental Health Teams are limited and not clear </li></ul></ul><ul><ul><li>Government commitment to ring fencing existing mental health funding </li></ul></ul>
  10. 10. Real Life <ul><li>Community in the Gaeltacht presented a purpose built house to the HSE for sole use of the mental health service (proposed in 2001) </li></ul><ul><li>Five service users, local Irish speakers selected-no comprehensive rehabilitation process </li></ul><ul><li>House furnished by HSE and ready for occupation in 2005 </li></ul><ul><li>One person lives in a high support hostel, the other people remain in institutional care where between them they have spent many years of their lives </li></ul><ul><li>The house remains unused… </li></ul><ul><li>How is policy assisting their recovery and life potential? </li></ul>
  11. 11. Issues arising <ul><li>Offer by an Independent sector to manage the service </li></ul><ul><li>What are the expectations? </li></ul><ul><li>Greater cost than the HSE original cost? </li></ul><ul><li>At least a good solid knowledge of current mental health policy? </li></ul><ul><li>At least a good solid knowledge of what the Recovery Ethos means? </li></ul>
  12. 12. Impact <ul><li>Mental Health Act 2008-Dail Debate-Minister Harney “unthinkable” that anyone would lose his/her liberty because of a lack of supported accommodation </li></ul><ul><li>Has Dave lost his liberty, other five people? </li></ul><ul><li>Informed consent-is it a robust approach? </li></ul><ul><li>Does it include information on choices and possible disempowerment? </li></ul><ul><ul><li>That his place in the supported accommodation will be gone? </li></ul></ul>
  13. 13. Re-institutionalisation? <ul><li>What are Dave’s options? </li></ul><ul><li>He is re-institutionalised in a generic service designed for some older people </li></ul><ul><li>Principles and values applying in mental health policy are lost to him </li></ul><ul><li>He is in a service that is not focused on his needs </li></ul><ul><li>What about his human rights, his everyday life activities, his Recovery? </li></ul>
  14. 14. Principles and Capacity <ul><li>Least restrictive alternative </li></ul><ul><li>Dignity and respect </li></ul><ul><li>Capacity means: ( Proposed Scheme of Mental Capacity Bill) </li></ul><ul><ul><li>the ability to understand the nature and consequences of a decision in the context of available choices at the time the decision is to be made </li></ul></ul><ul><li>Best interests- ( Proposed Scheme of Mental Capacity Bill) </li></ul><ul><ul><li>Applies when person is unable to decide </li></ul></ul><ul><ul><li>Person focused </li></ul></ul>
  15. 15. Is legal action an option? <ul><li>Olmstead v. Zimring 527 US (1999) </li></ul><ul><ul><li>Costs of segregated institutional environment vs appropriate community-based care </li></ul></ul><ul><li>R v. Nth & East Devon HA ex p Coughlan (2000) 3 AER 850 </li></ul><ul><ul><li>Person had a been assured of a home for life-she had a legitimate expectation- the decision to close her community residence for financial reasons was unlawful </li></ul></ul>
  16. 16. Is legal action an option? <ul><li>Courts are reluctant to get involved in directing how the public purse is spent </li></ul><ul><li>Rarely make mandatory orders-directing the government (HSE) to do something </li></ul><ul><li>If there are enforceable rights or specific agreements have been made and reneged on may make order then </li></ul>
  17. 17. Why is this happening? <ul><li>Key issue- Political Motivation </li></ul><ul><li>No director for mental health at top level of HSE where key decisions are made </li></ul><ul><li>Unstable, fragmented and inappropriate structures in HSE </li></ul><ul><li>Local level very important but unless principles and values are recognised… </li></ul>
  18. 19. Bird’s Eye View <ul><li>Are we witnessing the new generation of human rights abuses? </li></ul><ul><ul><li>Moving people with mental health problems to nursing homes, or </li></ul></ul><ul><ul><li>Keeping them in institutions while the community service is available </li></ul></ul><ul><li>The context is different from the 1800s and the institutions are smaller now… </li></ul>
  19. 20. Optimism <ul><li>Office for Disability and Mental Health </li></ul><ul><li>Mental Health Inspector’s Report 2009 </li></ul><ul><ul><li>“ Sense of beginnings of a cultural shift in term of increased professionalism, accountability and awareness of importance of good governance </li></ul></ul><ul><ul><ul><li>The central importance of service users/patients is increasingly recognised by clinicians </li></ul></ul></ul><ul><ul><ul><li>Human rights obligations increasingly understood” www.mhcirl.ie </li></ul></ul></ul>
  20. 21. Conclusion <ul><li>Policy approach is not enough </li></ul><ul><li>Extreme caution and careful monitoring of local activities </li></ul><ul><li>Temptation to use established systems as finance in place –it must stop </li></ul><ul><li>State supported nursing home system-extraordinarily costly approach to “community care” </li></ul>
  21. 22. Recommendations <ul><li>Immediate need for administrative/ management protocol </li></ul><ul><li>Advocacy/representation must be made available where any major changes like accommodation are proposed </li></ul><ul><li>Such decisions must be carefully addressed with the person </li></ul><ul><li>Staff managing and working in mental health services must become more aware of impact </li></ul>
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