The Psychiatric Nurses Association said today (Thursday 14 th April) that the results of a Joint PNA/RCSI study to mark the 10 th anniversary of the introduction of the Government's ‘ Vision for Change' Strategy for the mental health services has found that key elements have not been implemented and a promised move to community based mental health services has not been achieved.
Addressing the PNA ADC in Cavan, General Secretary Des Kavanagh, said it gave nobody working within the mental health series any satisfaction that so much of the ‘Vision for Change' policy has not achieved its targets, with key elements of the strategy, particularly in the areas of community services, in disarray and not even commenced.
‘VFC promised a great deal of hope when it was launched 10 years ago to those working in the mental health services and service users, that we would see a radical transformation in how services are delivered, with significant investment in facilities and staff driven by a political will to achieve the VFC goals within its 10 year life span. ‘
‘Those hopes have not been realised and our findings today confirm that. A great deal of political lip service has been paid to VFC without the support of resources or a political determination to see the various elements of the strategy put in place.'
‘Most strikingly, the build-up of fully staffed community based multi-disciplinary mental health services as the main method of treatment delivery remains a mere aspiration across most of the country.'
‘PNA is calling on the incoming government to honour commitments made during the General Election by all politicians, and particularly the main political parties, to address the challenges in staffing and investment facing our mental health services. They must acknowledge that VFC has not come close to achieving its goals and cannot without significant investment in staffing and services.'
Main PNA / RCSI Survey Findings .
Method : This mixed methods descriptive study set out to establish a national compositional and contextual baseline insofar as possible and to investigate and examine the evaluation by members (Branch Officers) of the PNA of the impact of VFC on the reality of service provision in terms of adult mental health services within their own area.
High level findings include:
• 67% of respondents indicated that they do not have a fully staffed community based multi-disciplinary rehabilitation and recovery mental health service.
• Over 2 out of 3 respondents indicated that there has been no multi-professional manpower plan linked to projected service planning put in place within the catchment area
• 3 out of every 4 respondents (75%) indicated that within their services they do not have fully staffed community based multi-disciplinary mental health services to ensure home based treatment is the main method of treatment delivery.
• Just 38% of respondents indicated that they have a fully staffed community based mental health teams within their adult mental health service.
• 66% do not work within a well-trained, fully staffed community based multidisciplinary community mental health team.
• While 78% of respondents have access to in-patient admission facilities, 45% did not have access to 50 beds per catchment area.( The challenge reported nationally is access due to occupancy of over 100% within the acute in-patient units, delayed discharges which are primarily attributed to a lack of alternative community based facilities, a lack of rehabilitation beds, a lack of availability of crises or step down beds and a lack of regional ICRU services.)
• 70% said services have not been evaluated with meaningful performance indicators annually to assess the added value the service is contributing to the mental health of the local catchment area population
Crisis Intervention/Outreach Services :
The most significant service deficiencies are the lack of crises services, assertive outreach and ICRU services.
• 74% of respondents do not have access to a crises house service based on the VFC framework.
• 79% said that their service did not have an Assertive Outreach Team based on the VFC framework.
• A further 40% indicated a lack of access to residential units within the recovery and rehabilitation service.
• 73% of respondents report that their services do not have access to regional ICRU beds
Respondents identified the following VFC priorities that have not been achieved
• A lack of High Observation beds/ICRU
• A lack of crises services
• A lack of assertive outreach
• Incomplete (not fully staffed) CMH teams
• A lack of specialist services (addictions, eating disorders
• Lack of home based treatment teams
• Community services offered on a 9-5 Monday to Friday basis.
• No dual diagnosis service (Psyc/ ID)
• Limited EIS
• Inconsistent service development nationally
• Access to day centres and day hospitals limited
Areas where progress had been achieved under VFC
• Psychiatric Hospital Closures
• Acute units with general hospitals
• Strengthened services for older people
• Strengthened Liaison services
• Strengthening of interdisciplinary community teams and home based care
• Strengthening of primary care OPD
• SCAN and suicide prevention programmes