Response of the Irish College of Psychiatrists to the
Public Consultation by the Mental Health Commission
on Quality Mental Health Services

 

Question 1: Do you know someone who has had a really good experience of mental health services?  What made that experience good?

Many patients experience a high quality of service and feedback to individual psychiatrists frequently bears this out.  An example is a woman who spoke with the psychiatrist she has attended for over five years.  She feels that the State has provided her with considerable help and support in the form of psychiatric care including admissions to hospital, participation in the Day Hospital programme and employment training which linked her to FÁS and a Community Employment scheme.  Throughout she continued to received individual psychotherapy.  She remarked that it has been a good experience “it was all free as well”.  Having been at one time severely mentally ill and a significant suicidal risk, she now feels well, is living independently and working part-time.

Patients’ positive responses highlight their recognition of high quality services which are appropriate, available, courteous and effective.  Access to a mental health service is frequently cumbersome and even after assessment the availability of resources to meet needs identified is frequently limited.  Where patients experience high quality service they identify responses to illness which recognise the seriousness of mental health disorder and appropriately direct resources to those disorders.  Where acute illness or crisis has subsided, patients very often appreciate availability of appropriate longer term supports in the community. 

Question 2: In your view, what makes up a high quality service for those who use the services? (For example, having information about where to get a service, relationships with the person or people giving the service, quality of care, and after-care, etc.)

The first point in the College’s view is that mental health services must be developed for those who use the service.  In this regard there is an urgent need to develop services which respond to local needs.  At present service development is historically driven with insufficient data and needs based development.  As a result there are inherent imbalances and limited funds prove insufficient where morbidity is high. Service development must be in response to recognition of locally based and regional based mental health morbidity. 

The development of needs based local services can only proceed once accurate information about the level of morbidity is available.  This information can then drive the development of acute and chronic services.  Moreover there is a need to recognise the broad range of mental health disorder so as to reduce the tendency to focus only on limited acute issues.  Communities need to be aware of the range of services available. 

Question 3: In your view, what do families expect from services? (For example, knowing where to get advice or help, easy access to a service, being treated with respect, etc.)

Meeting the needs of families in which mental health disorder exists is a priority.  There is a need to provide greater information and greater access to families as well as balancing the families’ requests with the needs of patients themselves.  Mental health providers need to recognise the special needs of families in which there is more than one person suffering from mental health disorder.  The Irish College of Psychiatrists encourages the development of the multi-disciplinary team in this regard.  Members of the team with special expertise in social or family therapies are not available to many psychiatrists.  An increasing focus on home-based treatment will require expertise and the development of understanding of the needs of families.  There is an issue here for training and multi-disciplinary team development. 

People with a learning disability and a psychiatric disorder have particular difficulty accessing mental health services.  The availability of a mental health service to people with a learning disability is currently dependent on a “postcode lottery”.

Question 4: In your view, what factors have most influence on the quality of the service given by the people delivering mental health services? (For example, training, opportunities for teamwork, codes of practice etc.)

The Irish College of Psychiatrists has a commitment to Continuing Professional Development and training.  We see the development of expertise and the maintenance of standards of professionalism as being essential elements of a service which will both recruit and retain people able to deliver a high quality mental health service. 

We have highlighted many times the under resourcing of the multidisciplinary team which minimally exists in many sectors.

Question 5: In your view, what aspects of the way in which a service is organised will make the biggest difference to the quality of service?

The Irish College of Psychiatrists believes that the development of community focussed mental health services in which a multi-disciplinary team led by the Consultant Psychiatrist, developed in response to needs based analysis of the locality and resourced sufficiently to meet those needs is the model.    A mental health service needs access to the full complement of specialties within psychiatry e.g. Child & Adolescent Psychiatry, Forensic Psychiatry etc.  The interface must be effectively managed and the resultant liaison must be visible to all.  When required, in-patient beds and day programme places need to be available immediately which frequently is not possible due to under resourcing and political decisions.

Question 6: If an organisation providing mental health services wanted to make sure it was doing a good job, what questions would it ask?

The Irish College of Psychiatrists fully endorses a service which is patient focussed and involves carers.  We also endorse the development of service based research and audit.  There is a need to recognise and address the concerns of patients and staff from the range of professions allied to mental health.  Carers also need to be involved in this process.  Service organisers need to put in place mechanisms for this audit underpinned by commitment to address the issues raised. 

Question 7: Have you any other views on what quality in mental health services means?

Quality in mental health service needs recognition of serious mental health disorder.  Quality services need a commitment to supporting mental health workers in the challenge of meeting the needs of patients.  This includes a commitment to fight stigma by introducing effective, safe and sustained treatments in the community.  There is a need for an appropriate range of facilities whether clinic, hospital or community based.  There is a need for recognition of the rights of patients and a support for the professional practice of psychiatrists and other mental health workers.