Mental Health Commission: Driving and supporting change

In a conversation with eolas Magazine, John Farrelly, CEO of the Mental Health Commission, which includes Ireland’s new Decision Support Service, outlines some of the strategic and systemic issues he encounters and the strides his organisation has made as Ireland transitions to recovery-orientated, human rights-based mental health and decision support services.

In Ireland, inpatient mental health services have improved dramatically over the past five years but, according to John Farrelly, Chief Executive of the Mental Health Commission (MHC), the improvements are mainly due to the expertise and commitment of the people in the system. For change to be embedded, structural and process reform is required, along with adequate financial investment by the State.

The new 2023-2027 MHC strategic plan – entitled Supporting Change – focuses on supporting services to move to a human rights-based agenda which is what service users, their families, the public, and clinicians want, according to Farrelly. The overall goal, strategically, is to ensure that mental health services and decision support services are not just accessible, but that they are best-in-class, integrated with other health and social services, and delivered to all communities in all parts of Ireland.

December 2023 saw the culmination of a joint project with the MHC and the World Health Organisation which will ensure that everybody across Ireland, in the private, public, not-for-profit and NGO sectors, will have access to human rights training based on the United Nations Convention on The Rights of Persons with Disabilities (UNCRPD).

The current remit of the MHC is to regulate inpatient mental health services, which is just 1 per cent of all services provided. At present, 90 per cent of the services are over 90 per cent compliant. Full compliance, says Farrelly, will only be possible on the completion of a national capital investment programme by the State.

“I welcome that the majority of centres have been invested in and it is amazing to see how moving from old, outdated premises to new purpose-built modern facilities empowers both patients and clinicians. Over the next five years, the MHC will continue to work with the HSE and the government to complete a national capital investment programme so that all our inpatient units inspire hope, support healing, and enhance dignity.”

Working in the community

In relation to the human rights-based approach, Farrelly says the MHC and the State, including the HSE as a service provider, need to continue to ensure that there is momentum and investment behind this shift, if it is to be achieved.

“We need to make sure that all this happens, and is supported, at pace. To do this, we need to build high-quality community services so that people can be treated as early as possible in their lives and in their own communities.”

The MHC is aware of the need for significant investment in all community mental health services and the need to build an integrated community infrastructure. Earlier this year, the MHC published the final report of the Inspector of Mental Health Services on the Independent Review of the provision of Child and Adolescent Mental Health Services (CAMHS) in the State.

“The failures in CAMHS have by now been well-documented and the task for the State is to ensure the Inspector’s recommendations for reform and regulation of CAMHS by the MHC are heeded.”

Farrelly is also very conscious of the need for equal-opportunity access to services, saying: “In line with Sláintecare, we share the vision of an integrated community infrastructure where mental health practitioners work together with GPs, so it is essential that we invest in public services including the public mental health system.

“Strategically, Ireland needs to avoid confusing integration with privatisation. At the moment, the playing field is uneven; those with private health insurance or who can afford to pay out of pocket have better care and treatment options than those who do not. People, including children, who may not be able to afford private health insurance, should not have to suffer, or have less access to mental health services. The State must fill this gap. In a republic, we are all equal.

“We witnessed during the recent pandemic that everybody was equal; that everyone was treated equitably and that everyone received the same care. When the medicines and the treatments became available, it was based on risk rather than ability to pay. We should never forget that, even though it is easy to do so. We should learn that lesson and ensure that this equitable approach applies to all our health services in the future,” he says.

The General Scheme to amend the 2001 Mental Health Act, as approved by Cabinet on 13 July 2021, set out the intention of the State to expand the regulation by the MHC of mental health services beyond inpatient services and into the community. Some argue that the process of legislating is too slow.

“It is only when our remit is expanded will we be in a position to set standards so that as services develop over the next 10 years, they are evidence-based, in accordance with the needs of the people, and not sporadic.”

Decision Support Service

When asked about the recent launch of the Decision Support Service (DSS), Farrelly is immensely proud of the progress that he and his team have made up to this point. He explained: “Adults in Ireland can no longer be made wards of court, or subjected to old fashioned or outdated laws which were used on people who were in a vulnerable position. Rather, we now have a service where people’s will, preferences, and their rights are being vindicated. It is unique in Europe; in fact, it might be unique globally. It is something on which we worked hard with other state bodies and the Department of Children, Equality, Disability, Integration and Youth, and it has come to fruition.

“It is so easy for people to get information on the DSS – they can go to www.decisionsupportservice.ie or Citizens’ Information where they can see exactly what is available to them. It is deliberately easy to access and there are no paper barriers, so it is accessible to all.

“At MHC, we have undergone a digital transformation. We have digitalised all processes, internally and externally, so that we can provide a quicker, better service and one that is environmentally friendly and sustainable,” Farrelly states.

He continues: “Embracing the digital age is part of our agenda to improve our services. Our statistics show that family members, people with disabilities and older persons are embracing this digital agenda, and so far, we have received very positive feedback on this aspect of our work.”

Strategy

Looking forward strategically, Farrelly says that the MHC will continue to play their part with all their stakeholders to ensure services in Ireland are rights-based and accessible, which is, he says, what the public, service users and their families, and professionals want.

In conclusion, Farrelly added: “We have come a long way in Ireland, and we need to make sure that we continue to drive and support change. I think closing large asylums and also replacing the wards of courts legislation shows a desire on behalf of the State to move beyond outdated institutions and create high-quality individualised, integrated community-based services which everybody can access, and which are based on needs rather than ability to pay.”

W: www.mhcirl.ie