A Standards Approach to Embedding Rights in Mental Health Services Quality Framework Mental Health Services in Ireland Patricia Gilheaney Director Standards & Quality Assurance

MHC statutory mandate Section 33, Mental Health Act, 2001 “ The principal functions of the Commission shall be to promote , encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under this Act”. [Section 33(1)]

“ The principal functions of the Commission shall be to promote , encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under this Act”.

[Section 33(1)]

MHC statutory mandate Section 33, Mental Health Act, 2001 “ The Commission shall undertake or arrange to have undertaken such activities as it deems appropriate to foster and promote the standards and practices referred to in subsection (1). [Section 33(2) ] “ The Commission shall have all such powers as are necessary or expedient for the purposes of its functions." [Section 33(4)]

“ The Commission shall undertake or arrange to have undertaken such activities as it deems appropriate to foster and promote the standards and practices referred to in subsection (1). [Section 33(2) ]

“ The Commission shall have all such powers as are necessary or expedient for the purposes of its functions." [Section 33(4)]

Key stages in developing the quality framework for mental health services in Ireland

Quality in Mental Health – Your Views A Quality Mental Health Service is one that:- Facilitates respectful and empathetic relationships between people using the service, their families, parents and carers, and those providing it Empowers people who use mental health services, and their families, parents and carers

A Quality Mental Health Service is one that:-

Facilitates respectful and empathetic relationships between people using the service, their families, parents and carers, and those providing it

Empowers people who use mental health services, and their families, parents and carers

Quality in Mental Health – Your Views Provides a holistic, seamless service and encompasses the full continuum of care Is equitable and accessible Is provided in a high quality environment , which respects the dignity of the individual, his/her carers and family

Provides a holistic, seamless service and encompasses the full continuum of care

Is equitable and accessible

Is provided in a high quality environment , which respects the dignity of the individual, his/her carers and family

Quality in Mental Health – Your Views contd. Has effective management and leadership Is delivered by highly skilled multidisciplinary teams Is based on best practice and incorporates systems for evaluation and review

Has effective management and leadership

Is delivered by highly skilled multidisciplinary teams

Is based on best practice and incorporates systems for evaluation and review

International MHS common problems/deficiencies A lack of focus on mental health Inadequate system capacity and workforce resources and competencies Insufficient involvement of consumers & caregivers in service planning. Variability in service provision and in the quality and effectiveness of care provided Delays in application of evidence-based practices, quality improvement tools & I.T.

A lack of focus on mental health

Inadequate system capacity and workforce resources and competencies

Insufficient involvement of consumers & caregivers in service planning.

Variability in service provision and in the quality and effectiveness of care provided

Delays in application of evidence-based practices, quality improvement tools & I.T.

Quality Framework (QF)- Scope A framework for continuously improving quality in mental health services in Ireland Q.F. is applicable to all mental health services irrespective of the speciality or whether they are being delivered in: Service user’s home Community settings In-patient facilities Q.F. is flexible: Diverse needs of service users Different nature and scale of organisation Standards are not prescriptive

A framework for continuously improving quality in mental health services in Ireland

Q.F. is applicable to all mental health services irrespective of the speciality or whether they are being delivered in:

Service user’s home

Community settings

In-patient facilities

Q.F. is flexible:

Diverse needs of service users

Different nature and scale of organisation

Standards are not prescriptive

Standard A broad statement of the desired and achievable level of performance against which actual performance can be measured Overall goal Outlines the objective that is expected Standards in the Q.F. adhere to the International Principles for healthcare standards.

A broad statement of the desired and achievable level of performance against which actual performance can be measured

Overall goal

Outlines the objective that is expected

Standards in the Q.F. adhere to the International Principles for healthcare standards.

Criteria Measurable elements of service provision Relate to desired outcome or performance of staff or services Include SI 551 of 2006 [Mental Health Act 2001 (Approved Centres) Regulations 2006 Rules & Codes of Practice Standard is achieved when all associated criteria are met RUMBA rule (relevant, understandable, measurable, behaviourally stated & achievable)

Measurable elements of service provision

Relate to desired outcome or performance of staff or services

Include

SI 551 of 2006 [Mental Health Act 2001 (Approved Centres) Regulations 2006

Rules & Codes of Practice

Standard is achieved when all associated criteria are met

RUMBA rule (relevant, understandable, measurable, behaviourally stated & achievable)

Standards Approach: Strengths Service users/families Know what to expect from a MHS Opportunity for service user feedback at all levels in system MHS Quality improvement Standards facilitate self monitoring of performance Driver for change – policies/legislation/practice/structures Provide consistency Development Focus on results Generate real improvements in MHS

Service users/families

Know what to expect from a MHS

Opportunity for service user feedback at all levels in system

MHS

Quality improvement

Standards facilitate self monitoring of performance

Driver for change – policies/legislation/practice/structures

Provide consistency

Development

Focus on results

Generate real improvements in MHS

Standards Approach: Strengths (contd.) Monitoring Transparent mechanism for evaluating quality of MHS provision in Ireland for the first time Service users / MHC / service providers Profile Platform for increasing the profile of mental health

Monitoring

Transparent mechanism for evaluating quality of MHS provision in Ireland for the first time

Service users / MHC / service providers

Profile

Platform for increasing the profile of mental health

Comparative Analysis: Vision for Change Themes and standards in QF compared with the 207 Recommendations - Highlights the overlap between current Government mental health policy – A Vision for Change & Quality Framework for Mental Health Services in Ireland

Themes and standards in QF compared with the

207 Recommendations

- Highlights the overlap between current Government mental health policy – A Vision for Change & Quality Framework for Mental Health Services in Ireland

Framework, standards and associated criteria informed by: “ Mental Health – Your Views” Review of quality frameworks in health systems in other countries International principles for healthcare standards International experts Healthcare quality Mental health care services Recommendations from Commission Inspectorate of Mental Health Services

“ Mental Health – Your Views”

Review of quality frameworks in health systems in other countries

International principles for healthcare standards

International experts

Healthcare quality

Mental health care services

Recommendations from

Commission

Inspectorate of Mental Health Services

Legislative framework to support standards Legislation √ Appropriate enforcement √ Panacea? What else do we need?

Legislation √

Appropriate enforcement √

Panacea?

What else do we need?

Implementation & Sustainability “ For Clinical Improvements to be anything other than a fad, the improvements we make must be lasting….” Langley et al (1996) Langly G, Nolan K, Nolan T, Norman C, Provost L. (1996) The Improvement Guide . San francisco: Jossey Bass.

“ For Clinical Improvements to be anything other than a fad, the improvements we make must be lasting….”

Langley et al (1996)

Langly G, Nolan K, Nolan T, Norman C, Provost L. (1996) The Improvement Guide . San francisco: Jossey Bass.

System Level Change In order for reform to succeed changes must occur at all of the following 4 levels The experiences of individuals, families and communities Microsystems of care – the point of patient / health professional interaction Larger healthcare organisations and systems External environment of care, including policy, financing and legislation / regulation Berwick,2002

In order for reform to succeed changes must occur at

all of the following 4 levels

The experiences of individuals, families and communities

Microsystems of care – the point of patient / health professional interaction

Larger healthcare organisations and systems

External environment of care, including policy, financing and legislation / regulation

Implementation: Receptive context for change Clear plan Critical success factors Achievable specified timeframes Multilayered (service user, professional, managerial) Provision of infrastructure to facilitate sustainability Maintaining improvements in terms of targets Sustaining the changes Aligning financial systems Discontinuing ineffective quality initiatives

Receptive context for change

Clear plan

Critical success factors

Achievable specified timeframes

Multilayered (service user, professional, managerial)

Provision of infrastructure to facilitate sustainability

Maintaining improvements in terms of targets

Sustaining the changes

Aligning financial systems

Discontinuing ineffective quality initiatives

Implementation Critical Success Factors Attainment of “buy in” at senior management levels and commitment from all stakeholders to the quality framework Provision of appropriate resources in accordance with the costed implementation plan Devolved budgets to strengthen accountability and effective resource utilisation Effective planning that permeates from the macro / strategic level to the point of service delivery Strong leadership at all levels to implement the changes required.

Attainment of “buy in” at senior management levels and commitment from all stakeholders to the quality framework

Provision of appropriate resources in accordance with the costed implementation plan

Devolved budgets to strengthen accountability and effective resource utilisation

Effective planning that permeates from the macro / strategic level to the point of service delivery

Strong leadership at all levels to implement the changes required.

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