Quality Framework · Theme 4 A quality physical environment, that promotes good health and upholds...

Quality FrameworkMental Health Services in Ireland

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Mental Health Commission

St. Martin’s House

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ISBN: 978-0-9553994-1-1

Quality FrameworkMental Health Services in Ireland

Table of Contents PAGE

Foreword Chairman 06

1. Introduction 07

Mandate 1.1 MentalHealthCommission 07

InternationalContext 1.2 InternationalContextinrelationtoQualityandHealthcare 08

NationalContext 1.3 NationalContextinrelationtoQualityandHealthcare 09

- Quality&Fairness:AHealthSystemforYou - AVisionforChange - TheIrishHealthServicesAccreditationBoard - TheInterimHealthInformationandQualityAuthority

ConsultationProcess 1.4 QualityinMentalHealth–YourViews 11

2. QualityFramework 12

2.1 ScopeoftheFramework 12

2.2 WhattheFrameworkshouldachieve 13

2.3 FormatoftheFramework 14

2.4 StandardsFormat 15

SummaryTable 16

Theme 1 Provision of a holistic seamless service and the full continuum of care provided by a multidisciplinary team 19

1.1 Individualcareandtreatmentplan 20

1.2 Plannedentranceandexit 21

1.3 Communitybasedservice 22

1.4 Prevention,earlydetection,earlyinterventionandmentalhealthpromotion 22

1.5 Therapeuticservicesandprogrammes 23

Theme 2 Respectful, empathetic relationships are required between people using the MHS and those providing them. 25

2.1 Respectforserviceusersvalues,beliefsandexperiences 26

2.2 Serviceuserrights 27

2.3 Promotingintegration 27

Theme 3 An empowering approach to service delivery is beneficial to both people using the service and those providing it 29

3.1 Activeinvolvementthroughinformation 30

3.2 Choice,rightsandinformedconsent 31

3.3 Accesstopeersupport/advocacy 32

3.4 Accessiblemechanismforparticipation 32

3.5 Recoveryfocusedapproachtotreatmentandcare 33

Theme 4 A quality physical environment, that promotes good health and upholds the security and safety of service users 35

4.1 Safesettings,respectfordignityandprivacy 36

4.2 Well-balancednutritiousdiet 36

Theme 5 Access to services 37

Theme 6 Family/chosen advocate involvement and support 39

Theme 7 Staff skills, expertise and morale are key influencers in the delivery of a quality mental health service 41

7.1 Qualitystaffwithappropriateskills 42

7.2 Trainingandcontinuousprofessionaldevelopment 43

7.3 Learningandusingqualityandsafetymethods 44

7.4 Outcomes-focusedcareandtreatment 45

Theme 8 Systematic evaluation and review of mental health services underpinned by best practice, will enable providers to deliver quality services 47

8.1 Evidence-basedcodesofpractice,policiesandprotocols 48

8.2 Integratedmentalhealthinformationsystem 49

8.3 Managementanddeliveryunderpinnedbycorporategovernance 50

3. Implementation 51

Introduction 3.1 Introduction 52

ContinuousQuality Improvement 3.2 ContextforContinuousQualityImprovement(CQI) 53

Plan 3.3 ImplementationPlan2007forQualityFrameworkforMentalHealthServices 58

CriticalSuccessFactors 3.4 ImplementationPlanCriticalSuccessFactors 61

Glossary 64

References 65

Bibliography 67

Appendices

AppendixA–ConsultationProcess 68

AppendixB–StrategicPriorities2006-2008inMentalHealthCommission:StrategicPlan2006-2008 69

AppendixC–ComparativeAnalysisofQualityFrameworkforMentalHealthServicesand “AVisionforChange”(DepartmentofHealthandChildren,2006) 74

AppendixD–RelevantActsandRelatedDocuments 91

AppendixE–Reasonsforlackofattentiontotheeconomicsofquality 92

AppendixF–PhasesofContinuousQualityImprovement(CQI) 93

Foreword

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Chairman’sIntroduction

The statutory mandate of the Mental HealthCommission isto‘promote,encourageandfosterthe establishment and maintenance of highstandards and good practices in the delivery ofmentalhealthservicesandto takeall reasonablestepstoprotecttheinterestsofpersonsdetainedin approved centres.’ [Mental Health Act 2001,Section33(1)]

An earlier publication Quality in Mental Health – Your Views, highlighted the commitment ofthe Mental Health Commission to working inpartnership with the people who use mentalhealth services, families, carers, advocacyand representative organisations, voluntaryorganisations involved in the area of mentalhealth, statutory, voluntary and independentproviders,thefullrangeofprofessionalsinvolvedin mental health services, government agenciesand the general public. The aforementionedreport gathered the views and perspectives ofall stakeholders as to what constitutes quality inmental health services. The Quality Framework for Mental Health Services in Ireland hasbuiltonthewealthofideasexpressedinthatreport.

Unprecedented reform of mental health servicesinIrelandisnowunderpinnedbymodernmentalhealthlegislation-the Mental Health Act 2001 andmodern national mental health policy - A Vision for Change. This publication Quality Framework for Mental Health Services in Ireland provides, forthe first time in this country, a mechanism forservices to continuously improve the quality ofmental health services. It marks a real changein the way mental health services will work withpeoplewhoexperiencementalhealthdifficulties.It promotes an empowering approach to servicedelivery, where services facilitate an individual’spersonal journey towards recovery. The qualityframework is non-prescriptive to ensure thatit applies equally to all mental health services,irrespective of funding mechanisms or whethertheyarebeingdeliveredinthehome,communitysettingsorinapprovedcentres.

I wish to record the Commission’s appreciationtothemembersofourinternationalexpertpanelwhose advice and enthusiasm were invaluableto the successful development of the qualityframework – Dr John Øvretveit, Director ofResearch,MedicalManagementCentre,KarolinskaInstitute, Stockholm, Sweden and Professorof Health Management, Faculty of Medicine,Bergen University, Norway and Dr Michelle Funk,Coordinator of Mental Health Policy and ServiceDevelopment, Department of Mental Health andSubstanceAbuse,WorldHealthOrganisation.

Developing, implementingandmaintainingcost-effective mental health services of the highestquality presents a number of challenges thatcan only be addressed incrementally. ‘Achievingtogether’ through collaborations on qualityinitiativeswillbeparamountforservicestoreachfull implementation of the Quality Framework for Mental Health Services in Ireland. This publicationaims toserveasauseful resource for supportingcontinuousqualityimprovement.

Dr. John OwensChairman

1. Introduction1.1 Mental Health Commission: Mandate

TheMentalHealthCommissionisanindependentstatutorybodyestablishedpursuanttoSection32oftheMentalHealthAct2001.

The principal functions of the Mental HealthCommission under the Mental Health Act 2001,Section 33(1) are 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”. Furthermore,the Mental Health 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) [Section33(2)].

The Mental Health Commission’s StrategicPlan 2006-2008 (Strategic Priorities 2006-2008,AppendixB)givesexplicitexpressiontothesekeyresponsibilities.

In order to discharge its statutory duties topromote, encourage and foster high standardsin the delivery of mental health services, theCommissionhasdeveloped,followingconsultationwith stakeholders, a quality framework forimplementation within mental health servicesin Ireland. The quality framework for mentalhealthservicesprovidesamechanismforservicesto continuously improve the quality of mentalhealth services. It promotes an empoweringapproach to service delivery, where servicesfacilitateanindividual’spersonaljourneytowardsrecovery.

Thequality framework isapplicabletoallmentalhealth services in the public, voluntary andindependent sectors. It includes mental healthservices for children and adolescents, adults,older persons, persons with an intellectualdisabilityandamentalillness,andforensicmental

health services. It applies equally to all mentalhealth services irrespective of whether they arebeing delivered within the service user’s home,community settings, both residential and non-residential,orwithinin-patientfacilities.

The quality framework incorporates the MentalHealthAct2001(ApprovedCentres)Regulations2006, prescribed by the Minister for Healthand Children, which came into effect on1st November 2006. The regulations set outminimum standards for approved centres1,necessary in order to provide quality andsafety in the provision of inpatient mentalhealth services. The Minister has provided forthe enforcement of these regulations by theCommission[MentalHealthAct2001(ApprovedCentre) Regulations 2006, Reg. 35]. The qualityframework is, however, much broader andmoreambitious thanthe regulations,as itaimsto deliver high standards and good practicesacrossallmentalhealthservices.

1 Approvedcentre:A“centre”meansahospitalorotherin-patientfacilityforthecareandtreatmentofpersonssufferingfrommentalillnessormentaldisorder.An“approvedcentre”isacentrethatisregisteredpursuanttotheAct. Q

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1.2 International Context in relation to Quality and Healthcare

Professionals and their associations have longworked to improve thequalityof their individualservices.However,itisonlyinthelast20yearsthatmodernorganisationalapproachestoqualityhavebeenemployed inhealthservices. Internationallyit is recognised that, given the complexities ofhealth care and the many workers involved inserviceusercare,goodorganisationandindividualcompetence are essential. Without combinationandcoordination,specialisationbecomesadangertopatients(InstituteofMedicine,2000).

TheUnitedStateswasthefirstcountrytomakeuseofmodernmethodsonalargescaleinhealthcare,followingground-breakingpilotprojectsinthelate1980s(Berwicket al,1990).Atthesametime, in the UK, Canada and Australia, serviceswereexperimentingwithusingstandards-basedorganisational assessment and developmentsystems, such as accreditation (Shaw, 2001). Inthe early 1990s, there appeared to be conflictbetween standards-based approaches andcontinuous improvement approaches toqualitybothofwhichspreadquickly inwesternhealth care systems. However, the late 1990ssaw a convergence between standards-basedaccreditationandcertificationschemesrequiringprocessimprovement(Leland,2002;ISO,2000).

In1994,thefirstsubstantialnationalstrategyforquality in healthcare was developed in Norway(Statens Helsetilsyn, 1994, with a new 10 yearstrategy in 2006). This was rapidly followed bynational strategies for other countries. In 1998,the British published and started a 10 yearprogramme, which has been referred to by onequalityexpertas“the largest quality programme in health care ever” (Øvretveit,2000a).ThishashadamajorimpactonimprovingallNHSservicesintheUK,includingmentalhealthservices(DepartmentofHealth,1998,2001;Øvretveit,2000a).

Mental health services across the westernworld also experimented with different qualityimprovementapproachesduringthe1990sandmany countries adopted quality assessment

schemes for different sub-services (Balog, 1991;Hansson,1993;WorldHealthOrganisation,1994).Quality standards, measurement, assessmentand improvement in mental health becamewidespread fromthe late1990sonwards.Theseareas were further developed by additionalattention being paid to patient safety, patient/serviceuserandrelativeparticipationincare,andmoreinformationandchoiceforpatients/serviceusers (Corrigan et al, 2000; American HospitalAssociation, 2004). Such changes also began tobeintroducedinsomemiddleandlowerincomecountries in the late 1990s, notably in Zambia,Russia,Peru,SouthAfricaandThailand(Øvretveit,2002;Berwick,2004).

Quality assessment, measurement andimprovement, combined with professionaldevelopment are now an integral part ofmost western health systems and services.These methods have been adopted by privatehealthcaretorespondtoincreasedcompetitionandserviceuserexpectationsandareincreasinglybeingusedtoregulatequality.Forpublicservices,these methods are contributing to meetingthe changing health needs and expectationsof service users, and minimising any gaps thatmight exist between public and private caree.g.accesstoservices.Healthserviceshavealsodiscoveredwhatcommercialserviceshavelongknown – that quality methods, skilfully applied,can reduce costs as well as increase patientsatisfaction and clinical outcomes (Øvretveit,2000b). With this background of experienceand greater knowledge of which methods areeffective,Irelandisnowabletotakeasubstantialinitiative to improve quality for mental healthserviceusers.

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1.3 National Context in relation to Quality and Healthcare

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InIreland,thequalitydimensionhasbeenputontheagendaforhealthandpersonalsocialservicesby the government of the day (Department ofHealth,1989,1992,1994,1996,1997;DepartmentofHealthandChildren,1998a,1998b,2001,2006).The Report of the Commission on Health Fundingsuggestedthat:

“Any organisation involved in the delivery of services must be concerned with the consumer perception of the quality of services provided” (1989)

Quality has become a central tenet of the Irishhealthserviceandwasoneofthemainprinciplesunderlying the 1994 health strategy Shaping a Healthier Future: A Strategy for effective Health Care in the 1990s.ThecurrenthealthstrategypublishedbytheDepartmentofHealthandChildrenin2001entitled Quality and Fairness: A Health System for You isguidedbyfourprinciples–equity,people-centeredness, accountability and quality. TheProjectTeamandSteeringGroupthatdevisedtheStrategystatedthat:

“It is now time to embed quality more deliberately into the health system through comprehensive and co-ordinated national and local programmes” (DepartmentofHealthandChildren,2001,p.19)

Thestrategyalsoarticulatedthatqualityinhealthmeansthat:

• “evidence-based standards are set in partnership with consumers and are externally validated”

• “Continuous improvement is valued” (p.19)

Inordertoachievethevisionmappedout inthestrategy,fournationalgoalswereset:

• Betterhealthforeveryone

• Fairaccess

• Responsiveandappropriatecaredelivery

• Highperformance

The fourth goal of high performance has directapplicabilitytoqualityasitrelatestoqualityofcare,planning and decision-making, commitment tocontinuous improvement and full accountability.Theobjectivesidentifiedunderhighperformanceinthehealthstrategyare:

• “Standardised quality systems support best patient care and safety”

Thisobjectiveisconcernedwithensuringthatthequalityandsafetyofcaremeetagreedstandardsandareregularlyevaluated.

• “Evidence and strategic objectives underpin all planning/decision making”

This objective is concerned with ensuring thatan evidence-based approach informs policy anddecision-making and underpins the planning,managementanddeliveryofhealthservices.

ThereportoftheExpertGrouponMentalHealthPolicy published by the Department of Healthand Children entitled A Vision for Change (2006)hasbeenadoptedbytheIrishgovernmentasthepolicy framework for mental health services inIreland for thenextsevento10years.The reportplaces theserviceuserat thecentreofcarewitha firm emphasis on recovery and facilitatingactive partnerships between service users, carersand mental health professionals. The qualityframework for mental health services in thisreport complements the key recommendationsofA Vision for Change. Therecommendationsandtheir‘fit’withthequalityframeworkareoutlinedinAppendixC.

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TheIrishHealthServicesAccreditationBoard

The Irish Health Services Accreditation Board(IHSAB) was established via Statutory Instrumentin 2002 by the Minister for Health and Children.The main function of IHSAB is to operate acutehospital accreditation programmes and to grantaccreditation to hospitals meeting standardsset or recognised by the Board. The process ofaccreditationisvoluntary.

The Interim Health Information and QualityAuthority(iHIQA)

The Interim Health Information and QualityAuthoritywasestablishedviastatutoryinstrumentby the Minister for Health and Children in 2005(S.I.No.132of2005). TheHealthBill2006,whenenacted, will establish the Health Informationand Quality Authority (HIQA). In the meantime,theiHIQAareresponsibleforputtinginplacethestructures and systems to enable the Authorityto commence work as soon as the legislation ispassed. The functions of HIQA, as stated in theHealthBill2006,shallnotencroachonthestatutoryfunctionsoftheMentalHealthCommission[HealthBill2006,Head9(2)].

The functions of HIQA enunciated in the HealthBill2006are:

• SettingandmonitoringstandardsonsafetyandqualityinhealthandpersonalsocialservicesprovidedbytheHealthServiceExecutive(HSE)oronbehalfoftheHSEandadvisingtheMinisterandtheHSEonthelevelofcompliancewiththosestandards

• CarryingoutreviewstoensurethebestoutcomesforresourcesavailabletotheHSE

• Carryingoutassessmentsofhealthtechnologies

• EvaluatinginformationonhealthandsocialservicesandthehealthandwelfareofthepopulationandadvisingtheMinisterandtheHSEondeficienciesidentified

• Settinginformationstandardsandmonitoringcompliancewiththosestandards

• Undertakinginvestigationsastothesafety,qualityandstandardsofserviceswheretheMinisterbelievesthatthereisseriousrisktothehealthorwelfareofapersonreceivingservices.

ItisintendedthatIHSABandtheChiefInspectorateofSocialServiceswillbeintegratedintotheHIQAwhenitisestablished.

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1.4 Consultation Process

TheQualityFrameworkforMentalHealthServicesin Ireland is the Mental Health Commission’sresponse to the stakeholder consultation onquality inmentalhealthservicesentitled Quality in Mental Health – Your Views, whichwaspublishedbytheMentalHealthCommissionin2005.

Thepublicationofthisreportfollowedanextensiveconsultation process aimed at finding out frompeoplewithaninterestinmentalhealthservices,theirviewsonqualityacrossthebroadspectrumofmentalhealthservicesfromchildhoodthroughadulthood to later years. From the outset, theCommission was clear in its vision that a qualityframework for mental health services is bestdevelopedinpartnershipwithpeoplewhoavailofmental health services, families, carers, advocacyandrepresentativegroups,voluntaryorganisationsinvolved in the area of mental health, statutoryand independent providers, the full range ofprofessionals involved in mental health services,government agencies and the general public.The views identified in the report have beenincorporatedintothestandardsandcriteriawithinthequalityframework.

Quality in Mental Health – Your Views defines aquality mental health service in Ireland as onewhichencompassesthefollowingeightthemes:

• Facilitatesrespectfulandempatheticrelationshipsbetweenpeopleusingtheservice,theirfamilies,parentsandcarers,chosenadvocates,andthoseprovidingit

• Empowerspeoplewhousementalhealthservicesandtheirfamilies,parentsandcarers

• Providesaholistic,seamlessserviceencompassingthefullcontinuumofcare

• Isequitableandaccessible

• Isprovidedinahighqualityenvironment,whichrespectsthedignityoftheindividual,his/hercarersandfamily

• Haseffectivemanagementandleadership

• Isdeliveredbyhighlyskilledmultidisciplinaryteams

• Isbasedonbestpracticeandincorporatessystemsforevaluationandreview

Theframeworkand itsassociatedstandardsandcriteriaaretheresultoftheconsultationprocessand the recommendations emerging from thereport. Additionally, it has been informed by areview of quality frameworks in health systemsin other countries, international principles forhealthcarestandardsandprofessionalliaisonwithinternational experts in the fields of healthcarequality and mental health care services. Detailsof the consultation process are included inAppendixA.

2. Quality Framework 2.1 Scope of the Framework

The themes, standards and criteria contained inthequality frameworkprovideclearguidance forservice users, their families/chosen advocates,service providers and the public as to what toexpectfromamentalhealthservice.

A mental health service is defined as a servicethat provides care and treatment for a personsuffering from a mental illness or a mentaldisorder under the clinical direction of aconsultant psychiatrist [Mental Health Act 2001,Section 2(1)]. As stated in the introduction, thequality framework is applicable to all mentalhealth services including services for childrenand adolescents, adults, older persons, personswithanintellectualdisabilityandamentalillnessand forensic mental health services. It appliesequally toallmentalhealthservices irrespectiveof whether they are being delivered withinthe service user’s home, community settingsboth residential and non-residential, or withinin-patientfacilities.

The quality framework is flexible to allow forthe diverse needs of service users as well asthedifferentnatureandscaleoforganisationsinvolved in service delivery. Accordingly,the standards are broad and enabling.Understandingtheintentofeachstandardandassociatedcriteriawillassist inapplying it inapracticalmannertoparticularservices.

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2.2 What the Framework should achieve

The achievements for the quality frameworkand its associated standards and criteria can besummarisedasfollows:

ServiceUsersandtheirFamilies

Thestandards informserviceusers,their families/chosen advocates and the general public as towhat to expect from a mental health service. Italso affords the opportunity for service users toprovidefeedbackonthestandards,whichshouldbeincorporatedintotheserviceplanningprocess.

MentalHealthServiceQualityImprovement

Amentalhealthserviceshouldusethestandardsas a guide to good service delivery and qualityimprovement.Theframeworkfacilitatesthementalhealth service to monitor its own performanceagainst the standards. The quality frameworkwill also act as a driver for change in mentalhealth policies, practice and structures at local,regionalandnational level. It is thereforea‘timepositive’initiativeforservices,asitwillseeamovetowardsconsistencynationallyacrossservicesandacross service providers. The quality frameworkwill assist in generating a culture of continuousquality improvement by encouraging staff andthe services to be pro-active about continuallyimprovingservicequality.Aquality improvementculture ispresentwherepeoplearecontinuouslyscrutinisingtheiractionsandtheservice inordertoidentifyandsolveproblemsastheyarise.

TheUseofModernQualityandSafetyMethodsforContinuousImprovement

Theframeworkencouragesmentalhealthservicesto train their staffanddevelop theirorganisationtosupportstaffinusingmodernqualitymethodsto improve their services. These methods areespeciallyneededtosolvequalityproblemsarisingbetween professions, services and sectors, andwhen service users are transferred. Improvementrequiresregularcollectionanduseofqualityandsafetymeasures.

DevelopmentofMentalHealthServices

The standards provide a framework for thedevelopment of a mental health service, whichcould be used to change existing services or inestablishing new services. Implementation ofthe quality framework will place emphasis onresults, as well as on structure and process, andit will generate real improvements in mentalhealth services.The quality framework is alignedto the national mental health policy – A Vision for Change (Department of Health and Children,2006)thatprovidesthestrategic‘roadmap’forthedevelopment of mental health services over thecomingyears(AppendixC).

MonitoringbytheMentalHealthCommission

TheMentalHealthCommissionwillbeusing thestandards and associated criteria to monitor thedelivery of mental health services in the public,independentandvoluntarysector.TheframeworkprovidesserviceusersandserviceproviderswithatransparentmechanismforevaluatingthequalityofmentalhealthserviceprovisioninIrelandforthefirsttime.

ImplementationbyHealthServiceProviders

Health service providers should incorporate thestandards into service level agreements for theprovision of mental health services and regularlymonitorprogressinrelationtocompliance.

ProfileofMentalHealthServices

TheMentalHealthCommissionwillusethequalityframeworkasaplatformforincreasingtheprofileof mental health services in terms of nationalpoliciesandpriorities.

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2.3 Format of the Framework

Thequalityframeworkcomprisesofeightthemes,24 standards and 163 criteria. The frameworkplaces the service user at the centre (see page18).Sixthemeswereidentifiedintheconsultationin response to the questions, “what constitutes a quality service for people using mental health services?” and “what constitutes a quality mental health service for families/parents and carers?” Thesesixthemesprovidethebasisforthestandardsthatsurroundandimpactupontheserviceuseratthepointofmentalhealthservicedelivery.

Themes1to6areasfollows:

1. Provisionofaholisticseamlessserviceandthefullcontinuumofcareprovidedbyamultidisciplinaryteam

2. Respectful,empatheticrelationshipsarerequiredbetweenpeopleusingthementalhealthserviceandthoseprovidingthem

3. Anempoweringapproachtoservicedeliveryisbeneficialtobothpeopleusingtheserviceandthoseprovidingit

4. Aqualityphysicalenvironmentthatpromotesgoodhealthandupholdsthesecurityandsafetyofserviceusers

5. Accesstoservices

6. Family/chosenadvocateinvolvementandsupport

Onethemewaselicitedinresponsetothequestion“what is needed to deliver a quality mental health service?”.This theme, theme 7, provides the basisforthesecondlayerofstandards.

Theme7is:

7. Staffskills,expertiseandmoralearekeyinfluencersinthedeliveryofaqualitymentalhealthservice

Thestandardsfallingundertheme7relatetothesystemsandprocessesthatarerequiredtodeliverthe first layer of standards, which includes, forexample, learning and using recognised qualityandsafetymethods.Fromamentalhealthserviceprovider perspective, the standards in relation tothis theme are theenablers that are required inorder for theserviceuser toexperienceaqualitymentalhealthservice.Forexample,ifthestaffofamentalhealthservicedonothavetheeducationand skills (second layer) required to develop anindividualcareandtreatmentplan,thentheserviceuserswillnotbeinreceiptofcareandtreatmentbased on an individual care and treatment plan(firstlayer).

The third layer, which comprises of one theme,theme 8, provides for monitoring and evaluationofallofthestandards.

Theme8isasfollows:

8. Systematicevaluationandreviewofmentalhealthservicesunderpinnedbybestpractice,willenableproviderstodeliverqualityservices

The outer layer, or final layer in this framework,acknowledgesthatmentalhealthservicescannotbe looked at in isolation but are an intrinsiccomponent of society and are consequentlyimpacteduponbyabroadrangeofsocietalfactors,includinggeneralhealthservices,politicalagenda,education,housingandemployment.

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2.4 Standards Format

Thethemesarestatedintheframeworkwiththerelevantstandardsandrelatedcriteria.

Thestandardisabroadstatementofthedesiredand achievable level of performance againstwhichactualperformancecanbemeasured.Thestandardistheoverallgoal.Itrelatesdirectlytotheperson receiving the mental health service andoutlinestheobjectivethatisexpected.

The criteria are measurable elements of serviceprovision. Criteria relate to the desired outcomeor performance of staff or services.The standardis achieved when all criteria associated with itaremet.

Toassistinmeasuringattainmentofstandardsandassociated criteria, a toolkit has been developedtoaccompanytheframework(QualityFrameworkforMentalHealthServicesinIreland–DraftAuditToolkit).Thetoolkitcontainsinformationonqualityand safety tools, methods for self-assessment,andaproposedaudittoolfortheframework.Thetoolkitcanbeusedbyanymentalhealthservicewishing to evaluate its service in accordancewith the standards and criteria contained in theframework.

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Summary Table

Theme Standard

1. Provisionofaholistic,seamlessserviceandthefullcontinuumofcare,providedbyamultidisciplinaryteam

1.1 Eachserviceuserhasanindividualcareandtreatmentplanthatdescribesthelevelsofsupportandtreatmentrequiredinlinewithhis/herneedsandiscoordinatedbyadesignatedmemberofthemultidisciplinaryteam.(7Criteria)

1.2 Eachserviceuserexperiencesaplannedentrancetoandexitfromeverypartofamentalhealthservice.(9Criteria)

1.3 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunitybasedservicethataddressestheperson’schangingneedsatvariousstagesinthecourseofhis/herillnessandrecoveryprocess.(6Criteria)

1.4 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunitybasedservicethataddressesprevention,earlydetection,earlyinterventionandmentalhealthpromotion.(5Criteria)

1.5 Therapeuticservicesandprogrammestoaddresstheneedsofserviceusersareprovided.(8Criteria)

2. Respectfulempatheticrelationshipsarerequiredbetweenpeopleusingthementalhealthservicesandthoseprovidingthem

2.1 Serviceusersreceiveservicesinamannerthatrespectsandacknowledgestheirspecificvalues,beliefs,andexperiences.(8Criteria)

2.2 Serviceuserrightsarerespectedandupheld.(5Criteria)

2.3 Thementalhealthservicepromotesmentalhealthandcommunityintegrationofmentalhealthserviceusers.(5Criteria)

3. Anempoweringapproachtoservicedeliveryisbeneficialtobothpeopleusingtheserviceandthoseprovidingit

3.1 Serviceusersarefacilitatedtobeactivelyinvolvedintheirowncareandtreatmentthroughtheprovisionofinformation.(8Criteria)

3.2 Serviceusersareempoweredregardingtheirowncareandtreatmentbyexercisingchoice,rightsandinformedconsent.(8Criteria)

3.3 Peersupport/advocacyisavailabletoserviceusers.(4Criteria)

3.4 Aclearaccessiblemechanismforparticipationinthedeliveryofmentalhealthservicesisavailabletoserviceusers.(5Criteria)

3.5 Serviceusersexperiencearecovery-focusedapproachtotreatmentandcare.(7Criteria)

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Theme Standard

4. Aqualityphysicalenvironmentthatpromotesgoodhealthandupholdsthesecurityandsafetyofserviceusers

4.1 Serviceusersreceivecareandtreatmentinsettingsthataresafe,andthatrespecttheperson’srighttodignityandprivacy.(11Criteria)

4.2 Serviceusersinresidentialordaysettingsreceiveawell-balancednutritiousdiet.(5Criteria)

5. AccesstoServices 5.1. Thementalhealthserviceisaccessibletothecommunity.(7Criteria)

6. Family/chosenadvocateinvolvementandsupport

6.1 Families,parentsandcarersareempoweredasteammembersreceivinginformation,adviceandsupportasappropriate.(6Criteria)

7.Staffskills,expertiseandmoralearekeyinfluencersinthedeliveryofaqualitymentalhealthservice

7.1 Serviceusersreceivecareandtreatmentfromqualitystaffwiththeappropriateskills.(10Criteria)

7.2 Thementalhealthserviceismanagedanddeliveredbystaffinreceiptofplannedtrainingandcontinuousprofessionaldevelopment.(8Criteria)

7.3 Learningandusingprovenqualityandsafetymethodsunderpinsthedeliveryofamentalhealthservice.(8Criteria)

7.4 Thecareandtreatmentprovidedbythementalhealthserviceisoutcome-focused.(6Criteria)

8. Systematicevaluationandreviewofmentalhealthservicesunderpinnedbybestpracticewillenableproviderstodeliverqualityservices

8.1 Thementalhealthserviceisdeliveredinaccordancewithevidence-basedcodesofpractice,policiesandprotocols.(5Criteria)

8.2 Mentalhealthservicesaresupportedandinformedbyanintegratedmentalhealthinformationsystem.(5Criteria)

8.3 Corporategovernanceunderpinsthemanagementanddeliveryofthementalhealthservice.(7Criteria)

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Quality Framework for Mental Health Services in Ireland

Theme 1

Standard 1.1

Individual care & treatment plan

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Standard 1.2

Planned entrance and exit

Standard 1.3

Community based service

Standard 1.4

Prevention, early detection, early

intervention and mental health

promotion

Standard 1.5

Therapeutic services and programmes

Provision of a holistic seamless service and the full continuum of care provided by a multidisciplinary team

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Provisionofaholistic,seamlessserviceandthefullcontinuumofcareprovidedbyamultidisciplinaryteam

CRITERIA:

1.1.1 ApprovedcentresadheretoRegulation15-IndividualCarePlan,Regulation17-Children’sEducation,andRegulation19-GeneralHealth,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

1.1.2 Thedevelopmentoftheindividualcareandtreatmentplanhasinputfromtheserviceuser,themultidisciplinaryteam(MDT),andthefamily/chosenadvocate,whereappropriate.

1.1.3 TheCareandTreatmentPlan (i) Reflectstheassessedneedsoftheservice

useraspertheMDTratherthanbyanyoneprofessionalgroup

(ii) Isdeveloped,implementedandreviewedinatimelymanner

(iii) IssignedbytheserviceuserandmemberoftheMDT

(iv) Acopyisheldbytheserviceuser(unlesstherearerecordedreasonsnottoprovidesame)

1.1.4 Theindividualcareandtreatmentplanisevaluatedwiththeserviceuserinacomprehensiveandtimelymanner.Evaluationsare:

(i) Serviceuserfocused (ii) Documented (iii) Indicatetheresponsetosupport/

intervention(s) (iv) Indicateprogresstowardsmeetingdesired

outcome(s)/goal(s).

1.1.5 (a) ApprovedcentresadheretoRegulation27-MaintenanceofRecords,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006,inrespectofthecareandtreatmentplan.

(b) ThecareandtreatmentplanismaintainedinaccordancewithExcellence in Mental Healthcare Records guidance(MentalHealthCommission,2005b)andismaintainedwithintheserviceuser’sclinicalfile.

(c) Thecareandtreatmentplanismaintainedinonecompositesetofdocumentation.

(d) Serviceuserrecordsarecomprehensive,factualandobjective,provideasequentialaccountoftheserviceuser’sinvolvementwiththementalhealthserviceandreflecthis/herjourneythroughtheservice.

1.1.6 Thementalhealthservicehasapolicyinplaceregardingtheimplementationofthisstandard.

Thisshallincludebutisnotlimitedto:

(i) Rolesandresponsibilitiesofteammembers (ii) Timeframeforassessment,planning,

implementationandevaluationoftheindividualcareandtreatmentplan

(iii) Monitoringofthisstandard

1.1.7 Thementalhealthservicemonitorsitsperformanceinrelationtothisstandardaspartofaqualityimprovementprocess.

STAnDARD1.1 Eachserviceuserhasanindividualcareandtreatmentplanthatdescribesthelevelsofsupportandtreatmentrequiredinlinewithhis/herneedsandisco-ordinatedbyadesignatedmemberofthemultidisciplinaryteam,i.e.akey-worker.

RATIONALE: Individualisedcareplanningwasseenbyallstakeholdersasoneofthekeyaspectsofholisticservicedelivery(MentalHealthCommission,2005a,p46)

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CRITERIA:

1.2.1 Admission,transferanddischargeofpatients,whereapplicable,arecompliantwiththeMentalHealthAct,2001.

1.2.2 ApprovedcentresadheretoRegulation18-TransferofResidents,andRegulation36-ClosureofanApprovedCentre,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

1.2.3 TheMentalHealthCommission’scodeofpracticeregardingadmission,transferanddischargetoanapprovedcentre,pursuanttoSection33(3)(e)oftheMentalHealthAct2001,isadheredto.

1.2.4 Thementalhealthserviceproviderfacilitatesplannedreferral,admission,transferanddischargeoftheserviceuser.Thisprocessisdocumentedandclearlycommunicatedtotheserviceuserandhis/herfamily/chosenadvocate,whereappropriate.

1.2.5 Thementalhealthserviceproviderassesses,documentsandminimisesrisksassociatedwitheachserviceusersdischargeortransferormovementbetweenservicecomponents,includingexpressedconcernsoftheserviceuserandhis/herfamily/chosenadvocate,whereappropriate.

1.2.6 Serviceusertransitionbetweencomponentsofthementalhealthserviceisfacilitatedbyadesignatedmemberofstaffwhomaintainscontactwiththeserviceuser.

1.2.7 Thementalhealthserviceproviderfacilitatescontinuityofcareandarrangementsforreviewandfollow-up.



STAnDARD1.2 Eachserviceuserexperiencesaplannedentrancetoandexitfromeverypartofamentalhealthservice

RATIONALE: Stakeholdersidentifyaseamlessserviceasanessentialcomponentofaqualityservice.(MentalHealthCommission,2005a)

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CRITERIA:

1.3.1 Thereisanintegratedmentalhealthservicetoserveeachdefinedcatchment/communityarea.

1.3.2 Multidisciplinaryteamshavecoremembersdrawnfrompsychiatry,clinicalpsychology,nursing,socialworkandoccupationaltherapy.Additionalmembersthatreflecttheserviceuser’sneedsarealsoavailable.

1.3.3 Theserviceuserexperiencesreceiptofcare/treatmentbasedonhis/heridentifiedneedsasdocumentedintheindividualcareandtreatmentplan.Suchcareisprovidedbyidentifiedmembersofthemultidisciplinaryteamandisdocumentedintheserviceuser’sclinicalfile.

1.3.4 Careandtreatmentinanapprovedcentreisprovidedonlywhencommunitybasedoptions,ifappropriatetoserviceuser’sneeds,havebeenconsideredandimplemented.



STAnDARD1.3 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunitybasedservicethataddressestheperson’schangingneedsatvariousstagesinthecourseofhis/herillnessandrecoveryprocess

RATIONALE: Stakeholdershaveidentifiedtheprovisionofcommunitybasedmentalhealthcarebyamultidisciplinaryteamasacoreelementofaqualitymentalhealthservice.


CRITERIA:

1.4.1 Communitymentalhealthteamsadoptaprevention,earlydetectionandearlyinterventionapproachtounderpintheirsystemsofworking.

1.4.2 Adesignatedhealthpromotionofficerwithformallinkstothementalhealthserviceworkswithlocalvoluntaryandcommunitygroups.

1.4.3 Eachserviceuserexperiencesapreventionandhealthpromotioncomponenttohis/hertreatmentandcare.

1.4.4 Thementalhealthservicehasapolicyinrelationtoprevention,earlydetection,earlyinterventionandmentalhealthpromotion.


STAnDARD1.4 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunity-basedservicethataddressesprevention,earlydetection,earlyinterventionandmentalhealthpromotion

RATIONALE: “Mentalhealthpromotionshouldbeavailableforallagegroupstoenhanceprotectivefactorsanddecreaseriskfactorsfordevelopingmentalhealthproblems”(DepartmentofHealthandChildren,2006).

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CRITERIA:

1.5.1 ApprovedcentresadheretoRegulation16-TherapeuticServicesandProgrammes,andRegulation17-Children’sEducation,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

1.5.2 Serviceusershaveaccesstoamulti-disciplinarycommunitymentalhealthteamandanappropriatemixoftherapeuticprogrammestoaddressidentifiedneeds.

1.5.3 Meaningfulindividualprogrammes(usinggrouporindividualtherapies)areusedtoevaluate,facilitate,restoreandmaintainanindividual’sabilitiestomeetdemandsinhis/herlifeandareagreedwiththeserviceuseranddeterminedwithintheindividualcareandtreatmentplan.

1.5.4 Alltherapeuticprogrammeswillbereviewedandmonitoredatregularintervalsbothformallyandinformallytoensurethattheyareplanned,consistentandneeds-led.

1.5.5 Thecommunitymentalhealthteamwilldeveloppositivepartnershipsandactivecommunicationwithkeyagenciesinthecommunity.Allcommunityresourcesshouldbeusedeffectivelytomaximiserealintegration.

1.5.6 Thementalhealthservicehasestablishedformallinkswith:

(i) Mainstreamhealthservices (ii) Socialwelfareservices (iii) Educationservices (iv) Housingauthorities

1.5.7 Thementalhealthservicehasapolicyregardingtheimplementationofthisstandard.


STAnDARD1.5 Therapeuticservicesandprogrammestoaddresstheneedsofserviceusersareprovided

RATIONALE: Serviceuserrecoveryisfacilitatedbytheprovisionofappropriateprogrammesbasedonidentifiedneedsanddeliveredinthemostappropriateenvironment.

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Theme 2

Standard 2.1

Respect for service users

values, beliefs and experiences

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Service user rights

Standard 2.3

Promoting integration

Respectful, empathetic relationships are required between people using the

mental health services and those providing them

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Respectful,empatheticrelationshipsarerequiredbetweenpeopleusingthementalhealthservicesandthoseprovidingthem

CRITERIA:

2.1.1 ApprovedcentresadheretoRegulations10-Religion,13-Searches,14-CareoftheDying,16-TherapeuticServicesandProgrammes,20-ProvisionofInformationtoResidents,andRegulation21-Privacy,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

2.1.2 Serviceusersareconsultedregardingindividualvaluesandbeliefs.

2.1.3 Serviceprovidersrespondsensitivelytothebeliefs,valuesystemsandexperiencesoftheserviceuserduringservicedelivery,andprovideappropriateprivacyforserviceuserstopracticetheircultural,religiousandspiritualbeliefs.

2.1.4 Serviceusershaveaccesstoadvocatesacceptabletotheserviceuser.

2.1.5 Serviceusersexperiencereceiptofcarethatrespectsconfidentiality,privacy,autonomyanddignity.

2.1.6 Serviceusersexperiencereceiptofcarethatisincompliancewithequalitylegislationandprohibitsdiscriminationonthegroundsofgender,maritalstatus,familystatus,sexualorientation,religion,age,disability,ethnicity,membershipofthetravellingcommunityorsocialclass.



STAnDARD2.1 Serviceusersreceiveservicesinamannerthatrespectsandacknowledgestheirspecificvalues,beliefsandexperiences

RATIONALE: TheMentalHealthAct,2001specifiesthatinmakingadecisionaboutthecareandtreatmentofapersondueregardshallbegiventotheneedtorespecttherightofthepersontodignity,bodilyintegrity,privacyandautonomy[Section4(3)].

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Respectful,empatheticrelationshipsarerequiredbetweenpeopleusingthementalhealthservicesandthoseprovidingthem

CRITERIA:

2.2.1 Thementalhealthservicecomplieswithrelevantlegislation,regulations,professionalstandardsandcodesofethicsprotectingandrespectingtherightsoftheserviceuser(AppendixD).Thisincludes,butisnotlimitedto:

(a) Regulations7-Clothing,8-Residents’PersonalPropertyandPossessions,11-Visits,20-ProvisionofInformationtoResidents,30-MentalHealthTribunals,andRegulation31-ComplaintsProcedures,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

(b) TheMentalHealthCommission’srulesgoverningtheuseofElectro-convulsivetherapy(ECT),therulesgoverningtheuseofseclusionandmechanicalmeansofbodilyrestraint,thecodeofpracticeontheuseofphysicalrestraintinapprovedcentres,andthecodeofpracticerelatingtotheadmissionofchildrenundertheMentalHealthAct2001.

2.2.2 Informationiscommunicatedinawaythatiseasilyunderstoodbytheserviceuser,andrepeatedasrequired,beingawarethatexplanationsmaybenecessaryonmorethanoneoccasion.Supportivewrittenmaterialismadeavailableinavarietyoflanguages,formatsandmediatomeetcommunicationneedsatalllevelsinthementalhealthservice.

2.2.3 Theserviceuserhasaccesstoresponsiveandfairformalcomplaintsprocedures.



STAnDARD2.2 Serviceuserrightsarerespectedandupheld

RATIONALE: ThefundamentalprincipleunderpinningmentalhealthcareasenshrinedintheMentalHealthAct2001isthattheinterestsofserviceusersareparamount[Section4].

CRITERIA:

2.3.1 Thementalhealthserviceworkswithserviceusergroupsandcommunityagenciestopromotemeaningfulintegrationwithinlocalcommunities.

2.3.2 Thementalhealthserviceworkswithstafftopromotepositiveworkingrelationshipsinaccordancewithagreednationalpolicies/guidelines.

2.3.3 Thementalhealthserviceimplementsmentalhealthpromotionactivities.



STAnDARD2.3 Thementalhealthservicepromotesmentalhealthandcommunityintegrationofmentalhealthserviceusers

RATIONALE: AsurveyofpublicattitudestodisabilityconductedfortheNationalDisabilityAuthorityin2001showedmostpeople(81-84%)hadahighlevelofcomfortwithpeoplewithphysical,sensoryorlearningdisabilitieslivingintheirneighbourhoods,butonlyhalfwouldbeverycomfortableandathirdwouldbeuncomfortablewithpeoplewithmentalhealthdifficultieslivingintheirneighbourhood(NationalDisabilityAuthority,2001).

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Theme 3

Standard 3.1

Active involvement through

information

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Choice, rights and informed consent

Standard 3.3

Access to peer support/advocacy

Standard 3.4

Accessible mechanism for participation

Standard 3.5

Recovery focused approach to treatment and care

An empowering approach to service delivery is

beneficial to both people using the service and

those providing it

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Anempoweringapproachtomentalhealthservicedeliveryisbeneficialtobothpeopleusingtheserviceandthoseprovidingit

CRITERIA:

3.1.1 ApprovedcentresadheretoRegulation20-ProvisionofInformationtoResidents,andRegulation34-CertificateofRegistration,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

3.1.2 Mentalhealthservicesmakeaccessibleinformationavailabletoserviceusersontheirservices.

3.1.3 Mentalhealthservicesprovideserviceuserswithaccessibleinformationonthecareandtreatmenttheyreceive.

3.1.4 Wherenecessary,serviceusershaveaccesstointerpretationservices(includingsignlanguagetranslators).

3.1.5 Inrelationtoaproposaltomakearecommendationoranadmissionorderinrespectofaperson,ortoadministertreatmenttoapersonundertheMentalHealthAct2001,theprovisionsofSection4(2)arecompliedwith.

3.1.6 Mentalhealthserviceshavesystemsinplacetoensurethatserviceusersandfamily/chosenadvocates,whereappropriate,haveinformationaboutformalcomplaintsproceduresthatisclear,unambiguousandeasytonavigate.



STAnDARD3.1 Serviceusersarefacilitatedtobeactivelyinvolvedintheirowncareandtreatmentthroughtheprovisionofinformation

RATIONALE: Knowledgeandinformationaboutallaspectsofaserviceusersmentalhealthoptionsareessentialifserviceusersaretoactivelyparticipateandleadtheirownrecoveryprogramme.

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CRITERIA:

3.2.1 Serviceusersareprovidedwithwrittenandverbalinformationontheirrightsonenteringthementalhealthservice.

3.2.2 Serviceusersareactivelyconsulted,involvedandofferedchoicesinrelationtotheirowncareandtreatment.

3.2.3 Whereaserviceuser’schoiceisnotprovided,clearexplanationsaregiventotheserviceuserastothereasonsandthesereasonsarerecordedintheperson’sclinicalfile.

3.2.4 (a) Validconsentisobtainedfromserviceusersinrelationtocareandtreatmentandtheprovisionofconfidentialinformation.

(b) Intheabsenceofpatientconsenttotreatment,theprovisionsofSections59(Electro-convulsivetherapy),60(Administrationofmedicine),and61(Administrationofmedicinetoachild)oftheMentalHealthAct2001,mustbecompliedwith.

(c) Inthecaseofachild,informedconsentisobtainedfromtheparents(eitherofthem),orthelegalguardian,ortheCourts.Theviewofthechildistakenintoconsideration.

3.2.5 TheMentalHealthCommission’sCodeofPracticerelatingtoAdmissionofChildrenundertheMentalHealthAct2001,pursuanttoSection33(3)(e)oftheAct,isadheredto.

3.2.6 Thementalhealthservicerespectstherightsofserviceusersbyprovidingservicesthatarecompatiblewithrelevantrights-basedlegislation.



STAnDARD3.2 Serviceusersareempoweredregardingtheirowncareandtreatmentbyexercisingchoice,rightsandinformedconsent

RATIONALE: Aqualityservicewasseenbyallstakeholdersasonewhichempowersserviceusers. “Itwillaccordthemequalityofstatuswithintherelationship,enablethemtotakeas

muchresponsibilityfortheirownhealthandwell-beingastheycantake,andprovidethemwiththesupportstheyneedtomaximiseautonomy,choiceandself-determination.”(MentalHealthCommission,2005a,p65)


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CRITERIA:

3.3.1 (a) ApprovedcentresadheretotherelevantsectionsofRegulation20-ProvisionofInformationtoResidents,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

(b) Serviceusersareprovidedwithclear,writteninformationonadvocacyservicesandonhowtoaccesssuchservices.

3.3.2 Mentalhealthservicesprovideserviceuserswithaccesstoadvocacytraining.



STAnDARD3.3 Peersupport/advocacyisavailabletoserviceusers

RATIONALE: Havingaccesstopeersupportandpeergroupsisanimportantpartoftherecoveryprocess.(MentalHealthCommission,2005a,p66)


CRITERIA:

3.4.1 Serviceusersareactiveparticipantsintheplanning,implementation,evaluationandreviewoftheirowncareandtreatment.

3.4.2 Mentalhealthservicesprovideamechanismforobtainingcollectivefeedbackfromserviceusersatservice/multidisiplinarylevel.

3.4.3 Mentalhealthservicesprovideamechanismforserviceuserinvolvementinthedevelopmentandevaluationofmentalhealthserviceplanning.



STAnDARD3.4 Aclear,accessiblemechanismforparticipationinthedeliveryofmentalhealthservicesisavailabletoserviceusers

RATIONALE: Bothindividualserviceusersandserviceusergroupsidentifiedtheneedforformalmechanismsthroughwhichpeopleusingmentalhealthservicescanbepartnerswithprovidersbothatanindividuallevelandcollectively.(MentalHealthCommission,2005a,p66)

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CRITERIA:

3.5.1 Mentalhealthservicesarerecovery-orientedintheirapproachtocareandtreatment.

3.5.2 Serviceusersexperiencearecoveryapproachtocareandtreatmentthatfocusesonself-determination,empoweringrelationshipsbasedontrust,understanding,respectandmeaningfulrolesinsociety.

3.5.3 Staffareskilledintherecoveryapproachofthementalhealthservice.

3.5.4 Serviceusersreceiveamentalhealthserviceinsettingsthatfosterandmaintainlinkswithhis/hercommunityandretainasmuchcontroloverhis/herlifeaspossible.

3.5.5 Serviceusersandfamilies/chosenadvocates,whereappropriate,areinvolvedinplanningandevaluationofrecovery-focusedapproachestocare,treatmentandsupportservices.



STAnDARD3.5 Serviceusersexperiencearecovery-focusedapproachtotreatmentandcare

RATIONALE: Arecovery-focusedapproachtotreatmentandsupport/careisimportantforpeopleusingmentalhealthservices.(MentalHealthCommission2005a,p76)


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Theme 4

Standard 4.1

Safe settings, respect for dignity

and privacy

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Well-balanced nutritious diet

A quality physical environment that promotes

good health and upholds the security and safety of

service users

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CRITERIA:

4.1.1 ApprovedcentresadheretoRegulations6-FoodSafety,7-Clothing,8-Residents’PersonalPropertyandPossessions,9-RecreationalActivities,11-Visits,12-Communication,13-Searches,14-CareoftheDying,18-TransferofResidents,20-ProvisionofInformationtoResidents,21-Privacy,22-Premises,24-Health&Safety,andRegulation25-UseofClosedCircuitTelevision,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

4.1.2 Serviceusersreceivecareandtreatmentinanenvironmentthatisclean,tidy,peaceful,safeandwell-maintained.

4.1.3 Wasteisproperlymanagedtominimiseriskstoserviceusers,families,staffandanyindividualwhocomesincontactwiththementalhealthservice.

4.1.4 Bedrooms,whereshared,providefortheprivacyanddignityofserviceusers.

4.1.5 Serviceusershaveaccesstofacilitiestokeeptheirpropertysafe.

4.1.6 Serviceusersaresupportedinexercisingcontrolovertheirbelongingsandpersonalspaceinin-patientorcommunityresidentialsettings.

4.1.7 Thementalhealthcareandtreatmentsettingcomplieswithstatutorybuilding,firesafetyandotherrelevantlegislation.

4.1.8 Thementalhealthservicedemonstratesevidenceofamanagedenvironment,whichensuresasfarasisreasonablypracticable,thesafety,healthandwelfareofserviceusers,visitors,staffandallwhocomeintocontactwiththeservice.

4.1.9 Theenvironmentinwhichtheserviceuserisaccessingamentalhealthserviceisappropriatetothoseusingtheservice.

4.1.10Thementalhealthservicehasapolicyregardingtheimplementationofthisstandard.

4.1.11Thementalhealthservicemonitorsitsperformanceinrelationtothisstandardaspartofaqualityimprovementprocess.

STAnDARD4.1 Serviceusersreceivecareandtreatmentinsettingsthataresafe,andthatrespecttheperson’srighttodignityandprivacy

RATIONALE: Stakeholdersseethequalityofthephysicalsurroundingsashavingastrongimpactonthoseusingmentalhealthservicesandontheirrecoveryprocesses.(MentalHealthCommission,2005a,p70)

Aqualityphysicalenvironmentthatpromotesgoodhealthandupholdsthesecurityandsafetyoftheserviceusers

CRITERIA:

4.2.1 ApprovedcentresadheretoRegulation5-FoodandNutrition,andRegulation6-FoodSafety,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

4.2.2 Serviceusers’dietaryneedsareassessedandaddressedinresidentialordaysettings.

4.2.3 Serviceusersinresidentialordaysettingsreceiveawell-balanceddietthatincorporateschoiceofmenuandisavailableattimeintervalsappropriatetotheserviceusersidentifiedneeds.

4.2.4 Thementalhealthservicehasapolicyregardingtheimplementationofthisstandard.Thispolicyshouldmakereferencetothereception,storage,preparationanddistributionoffoodtopreventfoodborneillnesses.


STAnDARD4.2 Serviceusersinresidentialordaysettingsreceiveawell-balancednutritiousdiet

RATIONALE: Awell-balancednutritiousdietisafactorinmaintainingmentalhealth.

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Theme 5

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Standard 5.1

Mental health service accessible

to community

Access to Services

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CRITERIA:

5.1.1 Thementalhealthserviceensuresequalityinaccessingaserviceregardlessoftheserviceuser’sgender,maritalstatus,familystatus,sexualorientation,religion,age,disability,ethnicity,membershipofthetravellercommunityorsocialclass.

5.1.2 Membersofthegeneralpublic,primarycareservices,serviceusersandfamilies/chosenadvocates,receiveinformationabout:

(i) Whatservicesareavailable

(ii) Howtheywork

(iii) Howtoaccessthem,especiallyinacrisis

5.1.3 Informationisavailableinwaysthatareaccessibletopeoplefromminoritygroupsincludingrefugees,asylumseekers,homelesspersons,travellers,andpersonswhoaredeaf.

5.1.4 Thementalhealthserviceisavailableona24-hourbasis,sevendaysaweek.

5.1.5 Thementalhealthservicelocationisaccessiblebothgeographicallyandphysically.



STAnDARD5.1 Thementalhealthserviceisaccessibletothecommunity

RATIONALE: Stakeholderssharetheviewthatqualityandaccesscannotbeseparated.(MentalHealthCommission,2005a,p72)

Accesstoservices

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Theme 6

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Families, parents and carers

empowered as team members

Family/chosen advocate involvement

and support

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CRITERIA:

6.1.1 Clearboundariesareinplaceregardingfamilyinvolvement,andcommunicationbetweenfamiliesandthementalhealthserviceisinaccordancewiththewishesoftheserviceuser.

6.1.2 Families/chosenadvocatereceiveinformationabout:

(i) Whatservicesareavailable

(ii) Howtheywork

(iii) Howtoaccessthem,especiallyinacrisis

6.1.3 (a) Families/chosenadvocatesexperiencesupportfromthementalhealthteamthroughanassignedmemberofstaff.Thelevelofsupportrequiredisprovidedbasedonidentifiedneed.

(b) Families/chosenadvocateshaveaccesstotheserviceuser’skeyworkersubjecttoserviceusers’consent.

6.1.4 Specificoutcomecriteriaforchildservicesareasfollows:

(i) Parents/guardiansarepartnersinthetreatmentprocess

(ii) Parents/guardiansreceiveclearinformationabouttreatmentprocesses

(iii) Follow-upandoutreachservicesareavailableforparents



STAnDARD6.1 Families,parentsandcarersareempoweredasteammembersreceivinginformation,adviceandsupportasappropriate

RATIONALE: Familiesindicatedthattheyrequiresupportateverystageoftheperson’sillnessandrecoveryprocess.(MentalHealthCommission,2005a,p88)

Family/chosenadvocateinvolvementandsupport

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Theme 7

Standard 7.1

Quality staff with appropriate skills

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Training and continuous professional development

Standard 7.3

Learning and using proven

quality and safety methods

Standard 7.4

Outcomes-focused care and

treatment

Staff skills, expertise and morale are key influencers in the

delivery of a quality mental health service

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CRITERIA:

7.1.1 ApprovedcentresadheretoRegulation26-Staffing,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

7.1.2 Arigorousrecruitmentprocessisinplacetoattractqualitystafftothementalhealthservice.

7.1.3 Thementalhealthservicehasaretentionpolicyinplaceandconductsexitinterviews.

7.1.4 Thementalhealthserviceprovidesflexible,family-friendlyworkingarrangementstakingaccount,asfaraspossible,staffchoiceregardingwheretheywishtowork.

7.1.5 Thementalhealthserviceensuresequalityinrecruitmentandretentionofstaffregardlessoftheirgender,maritalstatus,familystatus,sexualorientation,religion,age,disability,ethnicity,membershipofthetravellercommunityorsocialclass.

7.1.6 Workloadmanagementisinplacetoensurethatstaffcarrymanageablecaseloadsandstaffburnoutisprevented.

7.1.7 Multidisciplinaryteamsincludestaffwiththeappropriateskillsmixandexpertisetoaddresstheassessedneedsofthepopulationbeingserved.

7.1.8 Aninterdisciplinaryworkingapproach(teamworking)isadoptedandsupportedwithinmultidisciplinaryteams.


7.1.10Thementalhealthservicemonitorsitsperformanceinrelationtothisstandardaspartofaqualityimprovementprocess.

STAnDARD7.1 Serviceusersreceivecareandtreatmentfromqualitystaffwiththeappropriateskills

RATIONALE: AkeymessagefromQuality in Mental Health – Your Viewswasthat,aboveeverythingelse,thestaffdeliveringthementalhealthserviceinfluencedthequalityoftheexperience(MentalHealthCommission,2005a,p94)

Staffskills,expertiseandmoralearekeyinfluencersinthedeliveryofaqualitymentalhealthservice

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7.2.1 Staffreceiveformalinductiontothementalhealthservice.

7.2.2 Thementalhealthserviceensuresregularformalandinformalprofessionalsupervisionisavailabletostaff.

7.2.3 Mentalhealthservicestaffparticipateineducationandprofessionaldevelopmentprogrammes.

7.2.4 Serviceusersandadvocatesareinvolvedindeliveringtrainingprogrammesforstaff.

7.2.5 (a) ApprovedcentresadheretoRegulation27-MaintenanceofRecords,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006,inrespectofstaffrecords.

(b) Thementalhealthservicekeepsanaccuraterecordofstafftraining,qualificationsandsupervisionreceived.

7.2.6 Non-clinicalstaffreceivetrainingtodevelopanunderstandingofmentalill-healthanditsimpactonthepersonconcernedandhis/herfamily.



STAnDARD7.2 Thementalhealthserviceismanagedanddeliveredbystaffinreceiptofplannedtrainingandcontinuousprofessionaldevelopment

RATIONALE: Trainingisakeyelementinthedeliveryofaqualitymentalhealthservice.(MentalHealthCommission,2005a,p98)


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CRITERIA:

7.3.1 Thementalhealthservicecomplieswithrelevantlegislationandregulationsgoverningtheprovisionofsafementalhealthinterventionsandfacilities.

7.3.2 ApprovedcentresadheretoRegulation4-IdentificationofResidents,6-FoodSafety,11-Visits,12-Communication,13-Searches,18-TransferofResidents,19-GeneralHealth,23-Ordering,Prescribing,Storing&AdministrationofMedicines,24-Health&Safety,25-UseofClosedCircuitTelevision,26-Staffing,28-RegisterofResidents,32-RiskManagementand33-Insurance,oftheMentalHealthAct2001(ApprovedCentre)Regulations2006.

7.3.3 Thementalhealthservicehasawholesystemsapproachtosafetythatensuresclinicalrisksareaddressed,atalllevels,fromthepointofcaredeliveryuptoandincludingboardlevelconsiderationofriskmanagement.

7.3.4 Thementalhealthservicehasaneffectiveriskmanagementsystemthatincludesbutisnotlimitedtothefollowing:

(i) Capturesinformationonserviceusersafety,includingnearmissesandadverseevents

(ii) Usestheinformationfrom(i)tolearnfromandtodevelopsafermentalhealthservices

(iii) IsinaccordancewithanycodeofpracticeorguidanceissuedbytheMentalHealthCommissioninthisregard

7.3.5 Mentalhealthservicestaffreceivetraininginqualityimprovementandsafetymethods.

7.3.6 Mentalhealthservicestaffhaveaccesstoaresourcetoassistinthedevelopmentofcapacitytousemodernqualityandsafetymethodsandindicators.



STAnDARD7.3 Learningandusingprovenqualityandsafetymethodsunderpinsthedeliveryofamentalhealthservice

RATIONALE: Asafe,qualitymentalhealthservicewillflourishwhereacultureofqualityimprovementisencouragedbyusingqualityandsafetymethodswhichadoptsawhole-systemapproach.


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CRITERIA:7.4.1 Thementalhealthserviceintegratesformal

outcomemeasuresinmulti-disciplinaryteampractice.

7.4.2 ApprovedCentresadheretoRegulation31–ComplaintsProcedures,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.

7.4.3 Thementalhealthserviceroutinelymonitorsthehealthoutcomesofserviceusers.Thismayincludeandisnotlimitedto:

(i) Serviceusersatisfactionsurvey

(ii) Qualityoflifemeasures

(iii) Consultationwithserviceusersontherelevanceofvariousoutcomemeasures

(iv) Measuresofchangeinthehealthstatusandindividualfunctioningoftheserviceuser

(v) Accountsofanindividual’smentalhealthserviceexperience

7.4.4 Thementalhealthserviceusesevidence-basedmentalhealthresearchtoinformpracticeaspartofacontinuousqualityimprovementinitiative.



STAnDARD7.4 Thecareandtreatmentprovidedbythementalhealthserviceisoutcomes-focused

RATIONALE: “Inordertoimprovethequalityofmentalhealthservicesitwaswidelyagreedthatservicesneedtobemonitoredandevaluatedtoestablishwhatisworkingandwhatneedstobedonedifferently”(MentalHealthCommission,2005a,p104)


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Theme 8

Standard 8.1

Evidence-based codes of practice,

policies and protocols

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Integrated mental health information

system

Standard 8.3

Management and delivery underpinned by corporate governance

Systematic evaluation and review of mental health

services underpinned by best practice, will enable

providers to deliver quality services

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CRITERIA:

8.1.1 ThementalhealthservicecomplieswithallrelevantCodesofPracticeissuedbytheMentalHealthCommissionunderSection33(3)(e)oftheMentalHealthAct2001.

8.1.2 Thementalhealthservicehasevidence-basedpoliciesandprotocolstounderpinpractice.

8.1.3 Thementalhealthservicehasuniformpoliciesacrossserviceareas.

8.1.4 ApprovedCentresadheretoRegulation29-OperatingPolicies&Procedures,oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.


STAnDARD8.1 Thementalhealthserviceisdeliveredinaccordancewithevidence-basedcodesofpractice,policiesandprotocols

RATIONALE: Allmentalhealthservicesshouldbestrivingtowardsevidence-basedcodesofpractice.(MentalHealthCommission,2005a,p101)

Systematicevaluationandreviewofmentalhealthservicesunderpinnedbybestpracticewillenableproviderstodeliverqualityservices

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CRITERIA:

8.2.1 ANationalMentalHealthInformationFrameworkthatwillensurecoherent,efficientandeffectivemanagementofmentalhealthinformationforpolicy-makers,governmentdepartments,mentalhealthserviceproviders,serviceuserrepresentativegroups,advocacyorganisationsandnon-governmentalorganisationsisdeveloped.

8.2.2 WorldHealthOrganisation(WHO)recommendationsonmentalhealthinformationsystems(WorldHealthOrganisation,2005)areadoptedandincludethefollowing:

(i) Startsmall,butkeepthebigpictureinview–progressivedevelopmentofaninformationsystemhasthegreatestchanceofsuccess

(ii) Useindicators–amentalhealthinformationsystem(MHIS)shouldprovidetherawdataforawelldefinedsetofindicators

(iii) Establishaminimumdataset–MHISshouldgathertheminimumrequiredinformation

(iv) MaketheMHISuser-friendly–thepurposeforwhichinformationisbeinggatheredshouldbeclear,consistentandaccessible

(v) Clarifytherelationshipwithinformationsystemsinthegeneralhealthsector

(vi) Consultwithallstakeholderstomaximiseparticipationinitsimplementation

(vii) LinkMHISdevelopmenttowiderservicedevelopment

(viii) Considerroutineandnon-routinedata

(ix) Ensurehighstandardsofinformationgovernance–allmeasuresnecessaryshouldbetakentoensureprivacyandconfidentialityofinformation.Clearpoliciesshouldalsobeinplacegoverningaccesstoinformationandconsent

8.2.3 Anationalmentalhealthminimumdatasubsetisestablished.

8.2.4 Agovernancemodelshouldbecompletedpriortoinitiationofworkonthenationalmentalhealthminimumdatasubset.

8.2.5 Anagreedsetofnationalmentalhealthperformanceindicatorsaddressingneeds,inputs,processesandoutcomesisdeveloped.Theindicatorsmust:

(i) Meettheneedsofallstakeholdersforplanning,evaluatingandmonitoringmentalhealthservices

(ii) Beclearlydefined,unambiguousandmeasurable

(iii) Haveclearandagreedupondatastandardsandformat

STAnDARD8.2 Mentalhealthservicesaresupportedandinformedbyanintegratedmentalhealthinformationsystem

RATIONALE: TheNationalHealthInformationStrategy(DepartmentofHealthandChildren,2004)notedthathealthinformationsystemsareessentialtoplan,manage,deliverandevaluateservicesonaperson-centredbasis.In2005,theReportoftheInspectorofMentalHealthServices(MentalHealthCommission,2005c)highlightedtheissuethatdataisnotcapturedinaconsistentmannerandthelackofinformationsystemswashighlightedasakeyissuewhichinhibitsthecollectionofnecessarydata.Arecentreportonmentalhealthinformationsystemsrecommendedthatthefirststeptoimplementinganationalmentalhealthinformationsystemistoestablishanationalminimumdataset,withgovernancestructurestoensuredataiscapturedinaconsistentmanner(MentalHealthCommission,2006e).


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CRITERIA:

8.3.1 (a) Thementalhealthservicehasadocumentedorganisationalstructurethatidentifieslinesofaccountabilityandauthorityforallocatinganddevolvingresourcesandplanning.

(b) Thementalhealthservicemanagementstructurereflectsthemembershipofthemultidisciplinaryteam.

8.3.2 Thementalhealthservicefacilitatesserviceuserinvolvementatallstagesofpolicyandservicedevelopment,deliveryandevaluation.

8.3.3 Thementalhealthservices’serviceplanisdevelopedthroughaprocessofconsultationwithserviceusers,staffandthefundingauthority.TheplanshallbeconsistentwithDepartmentofHealthandChildren,fundingagencypoliciesandstrategicdirections.

8.3.4 Thementalhealthservicehasoperationalplansbasedontheserviceplanwhichestablishestimeframes,responsibilitiesandtargetsforimplementation.

8.3.5 (a) Thementalhealthservicemanagesitsbudgetinaccordancewithnationallyacceptedaccountingpractices.

(b) Thementalhealthserviceallocatesaportionofitsbudgetfortheprovisionofstaffdevelopmentandfortheparticipationofserviceusersintheservice.

8.3.6 (a) Thementalhealthservicehasadocumentedqualityimprovementplanandassociatedcontinuousqualityimprovementprogramme.

(b) Thementalhealthserviceimplementsthequalityimprovementplanonanongoingbasisandregularlymonitorsitsperformanceagainstit.

8.3.7 Thementalhealthserviceimplementsaclinicalgovernancesystemforimprovingclinicalpractice.Thismayincludebutisnotlimitedto:

(i) Riskmanagement

(ii) Clinicalaudit

(iii) Educationandtraining

(iv) Evidence-basedcareandtreatment

(v) Legalcompliance

STAnDARD8.3 Corporategovernanceunderpinsthemanagementanddeliveryofthementalhealthservice

RATIONALE: Inordertoimprovethequalityofmentalhealthservices,itwaswidelyagreedthatservicesneedtobemonitoredandevaluatedtoestablishwhatisworkingandwhatneedstobedonedifferently.(MentalHealthCommission,2005a,p104)


Implementation

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3. Implementation3.1 Introduction

3.1.1 TheWHO(2003)hasoutlinedaprocessforqualityimprovementinmentalhealthcare.The Quality Framework for Mental HealthServicesinIrelanddescribesaframeworkforcontinuously improving quality in mentalhealthservicesprovisionthat incorporatesthe WHO process (figure 1 on page 54).The themes, standards and criteria in thequality framework provide clear guidancefor service users, their families/chosenadvocates, service providers and thegeneralpublicastowhattoexpectfromaqualitymentalhealthservice.

3.1.2 The implementation of the qualityframework is a critical success factor thatmustbeadheredtoifmentalhealthservicesare going to transform and provide amodernmentalhealthserviceasdescribedinthecurrentnationalmentalhealthpolicyentitled A Vision for Change (DepartmentofHealthandChildren,2006). TheQualityFramework for Mental Health Services inIreland provides mental health serviceswith the quality tools to turn the ‘vision’into a ‘reality’. The Quality Framework forMentalHealthServicesinIreland(AppendixC) provides a comparative analysis of thealignmentbetweentheQualityFrameworkfor Mental Health Services in Ireland andA Vision for Change.

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3.2 Context for Continuous Quality Improvement (CQI)

3.2.1 In addressing implementation issues,it is worthwhile to ask why qualityprogrammes that involve change withinlargeorganisations/systemsaresuccessfulin some organisations/countries andnot in others. There are many modelsand methods of implementing change.The implementation plan for the qualityframework has been informed by thelessons learnt by others internationallyregarding the necessary conditions forlarge-scaleprogrammestosucceed.

“Organisational change is a process that can be facilitated by perceptive and insightful planning and analysis and well crafted, sensitive implementation phases, while acknowledging that it can never be fully isolated from the effects of serendipity, uncertainty and chance”

(Dawson,1996).

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1. Align policy for quality improvement

2. Design Standards

7. Review and modify

3. Establish Accreditation Procedures

5. Integrate QI into management 4. Monitor Services

6. Improve Services

Figure1-QualityImprovementinMentalHealthCare(WorldHealthOrganisation,2003)

Consultation

Partnership

Legislation

Funding

Planning

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3.2.2 ReceptiveContextforChange

A key requirement for change identifiedin a major international programme oftransformational change in healthcareservice provision, initially developed bythe Institute for Healthcare Improvementin theUnitedStates is thedevelopmentofa ‘receptive context’ for change. Receptivecontext describes the degree to whichorganisations/groupsadoptchangeandnewideas. Organisations with a high receptivecontextare seenas ripe forchange in thatthey quickly adopt innovative conceptsto meet the challenges they experience(Pettigrewet al,1992).Mentalhealthservicesin Ireland are undergoing unprecedentedlevels of change with the introduction ofnew mental health policy and reforminglegislation. Ongoing monitoring of thereceptive context for change is essentialinensuring thatmentalhealth servicesaresupported to incrementally address thechallengesthatsuchchangespresent.

The co-operation received by the MentalHealth Commission since its establishmentin 2002 from service users, mental healthcareprofessionalsandmentalhealthserviceprovidersistestimonialtoIreland’s‘receptivecontext’ for change. Mental health serviceusers and mental health care professionalsdelivering mental health services in Irelandare ready to embrace change as they havebeen awaiting change for a considerablenumber of years. The commencement infull of the Mental Health Act 2001 on 1stNovember 2006 provides modern mentalhealth legislation for all stakeholders withan interest in mental health services. Thisreforming legislation has been supportedat all stages of its development. It isevident to the Commission that all keystakeholders are ready and keen to pressforward with the continuing developmentof a quality mental health service and thatsuch a development requires appropriate

supporting mechanisms, resources,includingfunding,andarealistictimeframeforsuchachievement.

TheCommissionacknowledgesthatqualityimprovement, although a requirementof professionals and managers alike inrelation to the delivery of mental healthservices,canbeadauntingtaskthatrequireschallengingwaysofworkingthathavebeenconsideredeffectiveinthepast.Allinvolvedinthenecessarychangeprocessneedtobeenabledandsupportedinchangeinitiativestobeabletoprovidethebestpossiblecareand treatment. It is important to note thatall change initiatives, including those withless positive outcomes, are beneficial inthat they provide valuable learning that isuseful when shared. A useful medium forthe sharing of information is via the IrishMental Health Research Network (www.mhcresearchnetwork.ie) and Database(www.mhcresearchdatabase.ie). Qualityimprovement initiatives may be includedin the Annual Report of the Mental HealthCommissionwhichalsoincludestheAnnualReport of the Inspector of Mental HealthServices. Section 51(1)(b)(iv) of the MentalHealth Act 2001 specifies the contentthat must be included in the report of theInspectorofMentalHealthServices.

3.2.3 ClearPlan

A second requirement for the successfulimplementation of change is a clear planthat identifies the critical success factorsto be attained within achievable specifiedtimeframes along the journey to a qualitymentalhealthservice.Suchaplanmustbemultilayered so that critical success factorsat the levels of service user, professionaland managerial quality are addressed.In order to align policy with practice thequality framework should be implementedin tandem with A Vision for Change. Thetimeframe for full implementation of the

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recommendations inA Vision for Change isstatedasseventotenyears.Adetailedtimeboundandcosted implementationplan isrequired.ManyoftherecommendationsofthepreviousnationalmentalhealthpolicyPlanning for the Future (Department ofHealth,1984)remainedoutstandingtwentyyearspostpublicationandtheabsenceofan implementationplanmayhavebeenakeyfactorinthisregard.

The Commission views that theimplementation plan for the QualityFramework in Mental Health Services inIreland is best developed collaborativelywith the key stakeholders – service users,advocates,mentalhealthcareprofessionals,HealthServiceExecutive,the Independentand Voluntary providers of mental healthservices and the Department of Healthand Children. Mechanisms for monitoringand evaluation are essential componentsoftheplan.

3.2.4 Provision of Infrastructure to FacilitateSustainability

A third important requirement for theattainmentofqualitymentalhealthservicesis the provision of an infrastructure tofacilitatethesustainabilityofmentalhealthservicesqualityimprovement.Sustainabilityreferstomaintainingimprovementsintermsofsettargetsandalsosustainingthechangesthatenable teams to learn fromandworkonquality issues.Financial systemsshouldbe aligned so that they maximise qualityanddonotbecomeanobstacletoqualityimprovement. Ineffective quality activitiesareawasteofresourcesandshouldnotbesustained.Continuousqualityimprovementrequiresthesupportingofeffectivequalityactivities and ceasing the activities thathave been shown to be ineffective. Thepublication of A Vision for Change wasaccompanied by an announcement ofadditional resources for mental health

services.Aclearrelationshipexistsbetweenqualityandresourcesandfailuretodiscusstheissuesdamagesthecredibilityofmanyquality initiatives(Øvretveit,2000).Costingfor quality has been little used in publiclyfunded healthcare organisations. Onereasonsuggested for this lackofattentionmay be because some costing methodsare overly complex. Additional reasonsare identifiedinAppendixE.Whateverthehistoricalreasonsforthelackofcostingforquality,itisrecommendedthattheQualityFramework for Mental Health Servicesin Ireland is costed by the Mental HealthCommission in association with mentalhealth service providers as a matter ofpriority;sothatrealistictimeboundactionplansaredevelopedandimplemented.

The proper management of resourcesand a sound financial standing enablesorganisations to achieve their aims andobjectives. It is recommended that as amatter of quality corporate governance,mental health service budgets aredevolved so that the necessary decisionsregarding expenditure are made at themost appropriate levels within the healthsystem.

Context for Continuous Quality Improvement – Summary

3.2.5 TheCommissionrealisesthatfullintegrationof a continuous quality improvementapproachinmentalhealthservicedeliveryishardwork,takesalongtimeandshouldtherefore be considered an incrementalprocess. Thesynergycreatedfrompeopleachieving together within teams on animportant project is usually enough tosustain enthusiasm and support, eventhrough difficult times. The development,implementation and maintenance of highquality mental health services presents anumberofopportunitiesandchallengesandtheneedtoshareideasacrossthecountryisessential.

1. Receptivecontextforchange

2. Clearplan

(a) Criticalsuccessfactors

(b) Achievablespecifiedtimeframes

(c) Multilayered

(i) Serviceuser

(ii) Professional

(iii) Managerial

3. Provisionofinfrastructuretofacilitatesustainability

(a) Maintainingimprovementsintermsoftargets

(b) Sustainingthechanges

(c) Aligningfinancialsystems

(d) Discontinuingineffectivequalityinitiatives

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ThephasesofcontinuousqualityimprovementareoutlinedinAppendixF.

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3.3.1 Asstatedin2.2.5theNationalMentalHealthPolicy document A Vision for Change has aseventotenyearlifespan.AsillustratedintheQualityFrameworkforMentalHealthServices(Appendix C), the Quality Framework forMental Health Services in Ireland providesan ideal medium for the attainment of asubstantialnumberoftherecommendationsinA Vision for Change.Thenextrequirementisadetailedplanforimplementationwithinthecontext of continuous quality improvementas per sub-section 2.2 and the phases forachievingCQIasperAppendixF.

3.3.2 The Mental Health Commission hasconsulted with all key stakeholders in theprocesstodateandthedevelopmentofthedetailed implementation plan also involvesa collaborative process. It is acknowledgedthat therearekey standards that shouldbeimplemented as a matter of priority withinyear1,andthatsimultaneouslyduringyear1,thepriorities for implementationof therestof the framework and associated standardsover the following years are identifiedcollaborativelybythekeystakeholders.

3.3.3 The Quality Framework for Mental HealthServicesinIrelandcomprisesof24standardsthat have been identified by service users,carers,mentalhealthprofessionalsandotherkey stakeholders with an interest in mentalhealth service provision. It is proposed that14ofthemarecommencedin2007(table1 on page 59). It is acknowledged that thistargetisambitiousandhenceitisconsideredunreasonable to expect that all of the 14standardswillbefullycompliedwithin2007.Mental health services will be expected tobegintoaddresseachoftheaforementionedstandards in 2007 and it is suggested thatthroughconsultationin2007theCommissionwill,inpartnershipwiththekeystakeholders,set challenging albeit realistic timeframesfor full compliance.The achievement of thefirst standard, number 1.1 incorporates inpart, eight of the remaining 13 standardsscheduled for commencement in 2007, i.e.standardsnumber2.1,2.2,3.1,3.2,3.3,4.1,4.2,and6.1.

The Mental Health Act 2001 (ApprovedCentres) Regulations 2006 are in place since1st November 2006. The regulations are astatutory requirement for approved centresand must be complied with.The regulationshave been incorporated into the qualityframeworkandtheyfeatureinthe14standardsthatareprioritisedforimplementationin2007(table1,page59).

The Implementation process includesmonitoring and evaluation. The QualityFramework for Mental Health Services willinclude self-assessment by mental healthservices and external assessment of thestandards and criteria by the Inspectorof Mental Health Services as part of theinspection process for approved centres andmental health services. An audit toolkit hasbeendesignedtoassistmentalhealthservicesin auditing their own service to determinelevelsofattainmentofthestandardsandalsoto aid services in understanding what needsto be done to achieve the standards. Whenassessing a mental health service’s level ofattainment of the standards it is emphasisedthat meeting the standards is not an end initself,ratheritshouldbeviewedasapartofaprocessofcontinuousqualityimprovement.

It is essential that there is a realisation thatthe implementation of safety and qualitymechanismstaketimeandthatitispreferableto commence with a small number ofstandards and, at the same time, build themechanisms for sustainability of continuousquality improvement, and then move on toimplement the remaining standards withinchallenging yet realistic timeframes. Theimplementation of the quality frameworkis however a‘time positive’ activity for bothservice providers and staff, since it involvescontinuous quality improvement, whichsupportseffectivequalityactivitiesandceasesineffectivequalityactivitiesthatareaburdenonresources.

3.3 Implementation Plan 2007 for Quality Framework for Mental Health Services in Ireland

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Implementation of Standards in 2007

Number Standards Commence Completion by[to be decided in consultation with stakeholders]

1.1 Eachserviceuserhasanindividualcareandtreatmentplanthatdescribesthelevelofsupportandtreatmentrequiredinlinewithhis/herneedsandisco-ordinatedbyadesignatedmemberofthemultidisciplinaryteam

3

1.3 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunitybasedservicethataddressesthepersonschangingneedsatvariousstagesinthecourseofthehis/herillnessandrecoveryprocess

3

1.5 Therapeuticservicesandprogrammestoaddresstheneedsofserviceusersareprovided.

3

2.1 Serviceusersreceiveservicesinamannerthatrespectsandacknowledgestheirspecificvalues,beliefsandexperiences

3

2.2 Serviceusersrightsarerespectedandupheld 33.1 Serviceusersarefacilitatedtobeactivelyinvolvedin

theirowncareandtreatmentthroughtheprovisionofinformation

3

3.2 Serviceusersareempoweredregardingtheirowncareandtreatmentbyexercisingchoice,rightsandinformedconsent

3

3.3 Peersupport/advocacyisavailabletoserviceusers 34.1 Serviceusersreceivecareandtreatmentinsettings

thataresafe,andthatrespecttheperson’srighttodignityandprivacy

3

4.2 Serviceusersinresidentialordaysettingsreceiveawell-balancednutritiousdiet

3

6.1 Families,parentsandcarersareempoweredasteammembersreceivinginformation,adviceandsupportasappropriate

3

7.3 Learningandusingprovenqualityandsafetymethodsunderpinsthedeliveryofamentalhealthservice

3

8.1 Thementalhealthservicesisdeliveredinaccordancewithevidence-basedcodesofpractice,policiesandprotocols

3

8.3 Corporategovernanceunderpinsthemanagementanddeliveryofthementalhealthservice

3

Table1- ImplementationofStandardsin2007

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3.3.4 Implementation of the Structures andProcesses to support implementation oftheQualityFrameworkforMentalHealthServicein2007.

The Mental Health Commission’s prioritiesfor2007areasfollows.

1st Quarter • Commencediscussionswith: (a) TheDepartmentofHealthand

Children (b) Senior managers within the Health

ServiceExecutive(HSE) (c) Senior managers from other sectors

(Independent/Voluntaryproviders)

• PublishtheQualityFrameworkforMentalHealthServicesinIreland

• The Inspection template incorporatesmonitoring of compliance with theMental Health Act 2001 (ApprovedCentres) Regulations 2006, the RulespursuanttoSections59(2)and69(2)oftheMentalHealthAct2001andanyCodesofPractice prepared by the Mental HealthCommission in accordance with Section33(3)(e)oftheAct

• Ensure that costing of the qualityframeworkiscommenced

2nd Quarter • Provide information sessions/workshops

forall

• Commence implementationofstandards(Table1).

• MentalHealthCommissionconsultswithstakeholders to identify and prioritisetimeframesforimplementation

• The Inspection process incorporatesmonitoring of compliance with theMental Health Act 2001 (ApprovedCentres)Regulations2006,RulespursuanttoSections59(2)and69(2)oftheMentalHealth Act 2001 and any Codes ofPractice prepared by the Mental HealthCommission in accordance with Section33(3)(e)oftheAct

• Commence training to support theimplementationofthequalityframework

• Developmentofcostedimplementationplaniscompleted.

3rd and 4th Quarters • The Inspection process incorporates

monitoring of compliance with the MentalHealth Act 2001 (Approved Centres)Regulations2006,RulespursuanttoSections59(2)and69(2)oftheMentalHealthAct2001andanyCodesofPracticepreparedby theMental Health Commission in accordancewithSection33(3)(e)oftheAct

• Continue training to support theimplementationofthequalityframework

• Developandpublishplans for the followingbased on an analysis of the informationelicited through the consultation process inthe2ndquarter:

(a) Timeframes for completion of thestandardscommencedin2007

(b) Implementation of the qualityframeworkin2008

(c) Audittoolkit

• Commence implementation of the qualityframework monitoring and reportingstructuresandprocesses

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3.4 Implementation Plan Critical Success Factors

The critical success factors that impact upon the attainment of the implementation plan include the following:

• Attainmentof‘buy in’atseniormanagement levelsandcommitmentfromallstakeholderstothequalityframework

• Provisionofappropriateresourcesinaccordancewiththecostedimplementationplan

• Devolvedbudgetstoenableeffectivedecisionmakingandresourceutilisation

• Effectiveplanningthatpermeatesfromthemacro/strategicleveltothepointofservicedelivery

• Strongleadershipatalllevelstoimplementthechangesrequired

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Glossary, References, Bibliography & Appendices

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Glossary

Access

Abilityofapotentialserviceusertoobtainaservicewhenneededwithinanappropriatetime.

Approvedcentre

A “centre” means a hospital or other in-patientfacility for the care and treatment of personssuffering from mental illness or mental disorder.An“approvedcentre” isacentrethat isregisteredpursuanttotheAct.TheMentalHealthCommissionestablishesandmaintainstheregisterofapprovedcentrespursuanttotheAct.

Choice

Thepowertoexpresspreferences,makedecisionsand retain control over one’s own life. It alsodepends on the service user having access torelevant information, discussion with chosenadvocate(s) and mental health professionals, andasenseofworkinginpartnership.

Clinicalgovernance

Itisasystemforimprovingthestandardofclinicalpractice and includes clinical audit, educationand training, research and development, riskmanagement,clinicaleffectivenessandopenness.

Corporategovernance

Thewayinwhichamentalhealthserviceisdirectedandcontrolledsoas toachieve itsorganisationalgoals and to deliver accountability, transparencyandprobity.

Criteria

Measurableelementsofserviceprovision.Criteriarelate to thedesiredoutcomeorperformanceofstafforservices.Thestandardisachievedwhenallcriteriaassociatedwithitaremet.

Mentalhealthservice

Aservicewhichprovidescareandtreatmenttoapersonsufferingfromamentalillnessoramentaldisorderundertheclinicaldirectionofaconsultantpsychiatrist[MentalHealthAct2001,Section2(1)].

Patient

Apersontowhomanadmissionorderorrenewalorder relates pursuant to the Mental HealthAct2001.

Qualityframework

It isa framework forevaluatingandcontinuouslyimproving the quality of services. It shows keyconceptsandtherelationsbetweenthemtoguideanalysisorotheractions.

Resident

Isdefined inSection62oftheMentalHealthAct2001asapersonreceivingcareandtreatment inanapprovedcentre.

Risk

Thechanceofsomethinghappeningthatwillhaveanimpactonobjectives.

Riskmanagement

The culture, processes and structures that aredirectedtowardsrealisingpotentialopportunitieswhilealsomanagingadverseeffects.

Serviceusersafety

Ensuringserviceusersdonotsufferasaresultofreceivinghealthcareorasaresultofnotreceivinghealthcarewhichtheyshouldhavereceived.

Serviceuser

Apersonwhousesmentalhealthservices.

Standard

Abroadstatementofthedesiredandachievablelevel of performance against which actualperformance can be measured. The standard isthe overall goal. It relates directly to the personreceivingthementalhealthservice.Thestandardoutlinestheobjectivethatisexpected.

Teamworking

Themembersofamultidisciplinaryteamworkingtogetherandsharingexpertiseinordertodeliveraholisticmentalhealthservice.

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Corrigan,P.W.,Lickey,S.E.,Campion,J.andRashid,F.(2000)Mentalhealthteamleadershipandconsumerssatisfactionandqualityoflife,Psychiatric Services, 51(6),781-5.

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GovernmentofIreland(2001)Mental Health Act 2001. Dublin.StationeryOffice.

Hansson,L.,Bjorkman,T.,Berglund,I.(1993)Whatisimportantinpsychiatricinpatientcare?Qualityofcarefromthepatient’sperspective, Quality Assurance in Healthcare, 5,41-47.

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Pettigrew,A.,Ferlie,E.,McKeelandMoore,C.(1992)Shaping Strategic Change: making change in large scale organisations. London.Sage.

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MentalHealthCommission(2006)AVisionforarecoverymodelinIrishmentalhealthservices.Discussionpaper.

MentalHealthCommission(2006)Multi-disciplinaryteamworking:fromtheorytopractice.Discussionpaper.

MentalHealthCommission(2006)ForensicmentalhealthservicesforadultsinIreland.Discussionpaper.

MentalHealthCommission(2005)MentalHealthCommissionResearchStrategy.

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Appendix A Consultation Process

Background

In line with the Mental Health Commission’smandateasoutlinedonpage7, theCommissiondecided to develop a quality framework formental health services to support continuousimprovement in the quality of mental healthservices.TheMentalHealthCommissionisstronglycommittedtoconsultationwithallstakeholdersinmentalhealthservices.Thus,inordertodeveloptheframework,itwasdecidedtoconsultwidelywithall key stakeholders. The Commission engagedProspectus in 2004 to design and manage theconsultationprocess.

The overall objective of the consultation processwas to gather the views and perspectives of allstakeholderstoestablishwhatconstitutesqualityinmentalhealthservices.

Methodology

The consultation process involved an initialplanning and design phase undertaken byProspectusinpartnershipwiththeMentalHealthCommission.

Theactualconsultationinvolved:

• Eight consultation workshops, attended by66 people from groups representative of keystakeholders

• Acallforwrittensubmissions,whichledtothereceiptof239writtensubmissionsfromawiderangeofstakeholders

• Two focus groups designed to elicit the viewsof people who have no specific contact withmentalhealthservices

A review of recent consultative processes andstrategieswasalsoundertaken.

ConsultingwithStakeholders

The consultation was designed to gather a widerangeofperspectivesonwhatconstitutesaqualityservice for people using mental health servicesandwhatconstitutesaqualityserviceforfamilies,parentsandcarers.Itaimedtoensureaninclusiveapproach by inviting groups who would be in apositiontobringperspectivesonqualityforadultserviceusers,childrenandyoungpeople,peoplewithdisabilityandmentalillness,andgroupswhomayhaveparticularneedsonaccountofculturalor ethnic minority status, or difficult personalcircumstances, the families, parents and carersof people using mental health services, serviceproviders,organisationswithaninterestinmentalhealthservices(suchasgovernmentdepartmentsandagencies)andmembersofthegeneralpublic.

Fordetailedinformationontheconsultation,pleaserefertotheconsultationreportentitled“QualityinMentalHealth–YourViews:ReportonStakeholderConsultationonQualityinMentalHealthServices”(MentalHealthCommission,2005a).

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Appendix B Mental Health Commission:

Strategic Plan 2006-2008

Strategic Priorities 2006 – 2008

Strategic Priority Number One

Topromote,developandevaluatetheimplementationofhighstandardsofcareandtreatmentwithinthementalhealthservices.

Strategic Priority Number Two

TopromoteandprotecttherightsandbestinterestsofpersonsavailingofmentalhealthservicesasdefinedintheMentalHealthAct2001.

Strategic Priority Number Three

Topromoteandenhanceinformation,knowledgeandresearchonmentalhealthservicesandtreatmentinterventions.

Strategic Priority Number Four

Toadvocatefortheintegrationandparticipationinsocietyofpeoplewhoexperienceorhaveexperiencedmentalillness.

Strategic Priority Number Five

Tomaintainandenhancetheorganisation’ssystemsandcapacitytoensuretheprovisionofaqualityservicebytheMentalHealthCommission.

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Strategic Priority Number One To promote, develop and evaluate the implementation of high standards of care and treatment within the mental health services.

CONTExT:TheMentalHealthAct2001mandatestheMentalHealthCommissiontopromote,encourageandfostertheestablishmentandmaintenanceofhighstandardsandgoodpracticesinthedeliveryofmentalhealthservices[Section33(1)].ThisstatutoryresponsibilitywillbefulfilledbythedevelopmentofaqualityframeworkformentalhealthservicesinIreland.Thequalityframeworkwillbethefoundationtosupportcontinuousimprovementinthequalityofmentalhealthservices.Thisqualityframeworkwillcoverthebroadspectrumofmentalhealthservicesfromchildhoodtoadulthoodtolaterlifeandvariousotherspecialismswithinmentalhealthincludingmentalhealthservicesforpeoplewithanintellectualdisability,andtheforensicmentalhealthservices.

1.1 TocontinuetoleadtheprocessinthedevelopmentofhighstandardsofcarewithinthementalhealthservicesinIreland.

1.2 TocomplywithourstatutoryobligationsundertheMentalHealthAct2001

1.3 Tocontinuetoconsultandworkcollaborativelywiththestakeholdersinthedevelopmentofaqualitymentalhealthservice.

1.1.1 DevelopandenacttheQualityFrameworkforMentalHealthServices.

1.2.1 PrepareandpublishrulespursuanttoSections59and69,MentalHealthAct2001.

1.2.2 PrepareandpublishcodesofpracticeinconsultationwiththestakeholdersasperSection33(3)(e)MentalHealthAct2001.

1.2.3 Establishandmaintaintheregisterofapprovedcentres,incompliancewithregulationsissuedasperSection66MentalHealthAct2001.

1.2.4 ContinueanddeveloptheprogrammeofinspectionandreviewofmentalhealthservicesbytheInspectorateofMentalHealthServicesandpublishthereportofinspectionsandreviewannually.

1.2.5 TomonitortheimplementationbystakeholdersoftherecommendationsoftheInspectorofMentalHealthServicesandanyInquiryestablishedasperSection55MentalHealthAct2001.

1.3.1 Workcollaborativelywithallstakeholderstofacilitatetheimplementation,monitoringandevaluationofthequalityframework.

1.3.2 Provideappropriatetrainingtoassistinestablishingandmaintaininghighstandardsofcarewithinmentalhealthservices.

1.3.3 ContinuetobuildonthecurrentprogrammeofinformationontheprovisionsoftheMentalHealthAct2001.

1.3.4 Publishpositionpapersonmultidisciplinaryteamworking,recoveryapproachinmentalhealthservicesandforensicmentalhealthservices.

Objectives Targets

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Strategic Priority Number One To promote, develop and evaluate the implementation of high standards of care and treatment within the mental health services.

1.4 Tocontinuetosupportthedevelopmentandongoingsustainabilityandauditofqualityinitiativesinmentalhealthservices.

1.5 Tofosteranenvironmentthatrespectsandrecognisestheroleofcurrentandformerserviceusersandtheirfamiliesintheirowncare,inserviceplanningandservicedelivery.

1.3.5 Publishdiscussionandpositionpapersonchildandadolescentsmentalhealthservicesandmentalhealthservicesforpeoplewithanintellectualdisability.

1.4.1 Developauniformlearningsystemonthereportingofadverseeventsinthementalhealthservices.

1.5.1 EstablishsystemswithintheMentalHealthCommissionthatensureserviceuserInvolvement.

Objectives Targets

Strategic Priority Number Two To promote and protect the rights and best interests of persons availing of mental health services as defined in the Mental Health Act 2001.

CONTExT: The Mental Health Commission is mandated to take all reasonable steps to protect theinterestsofpersonsdetainedinapprovedcentresundertheAct[Section33(3)(1)].TheMentalHealthAct2001introducesanautomaticindependentreviewsystemforallpeopleadmittedinvoluntarilytoapprovedcentres,therebybringingIrishmentalhealth legislationintoconformitywiththeEuropeanConventiononHumanRightsandFundamentalFreedoms.

TheMentalHealthAct2001statesthatinmakingdecisionsundertheAct,thebestinterestsofpersonsshallbetheprincipalconsideration(Section4).Thisincludeshavingdueregardtotheneedtorespecttherightofthepersontodignity,bodilyintegrity,privacyandautonomy.

1.1 Toensurethatonlythosewhorequiretreatmentonacompulsorybasisareadmittedinvoluntarilyandsuchadmissionsarefortheminimumperiodnecessary.

1.2 ToensurethatinvoluntaryadmissionsareincompliancewiththeprovisionsoftheMentalHealthAct2001.

1.3 Toreviewandmonitorinvoluntaryadmissions.

1.1.1 Supportthedevelopmentofmentalhealthservicesthatpromotecareandtreatmentonavoluntarybasis.

1.2.1 EstablishtheindependentreviewsystemforinvoluntaryadmissionaspertheMentalHealthAct2001.

1.2.2 PrepareacodeofpracticeontheadmissionofchildrenpursuanttotheMentalHealthAct2001.

1.2.3 PrepareareportforsubmissiontotheMinisterforHealthandChildrenwithin18monthsofthecommencementofPart2MentalHealthAct2001[Section42(4)].

1.3.1 Conductandpublishanannualauditofinvoluntaryadmissionstoapprovedcentres.

Objectives Targets

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Strategic Priority Number Two To promote and protect the rights and best interests of persons availing of mental health services as defined in the Mental Health Act 2001.

1.4 Toprovideinformationtothepublic,serviceusersandtheircarersontheMentalHealthAct2001inanaccessibleformat.

1.5 Tofosterthepromotionandprotectionoftherightsofpersonswhoareunabletogiveinformedconsent.

1.4.1 Developandprovideaprogrammeoftrainingandinformationforallthoseinvolvedintheindependentreviewsystem.

1.5.1 Supporttheintroductionofappropriatelegislativeprovisionsandadvocacyforpeoplewhorequiresupportinmakingdecisions.

Objectives Targets

Strategic Priority Number Three To promote and enhance information, knowledge and research on mental health services and treatment interventions.

CONTExT:Information,knowledgeandresearchonmentalhealthservicesareessentialforeffectivestrategicplanningandservicedelivery.ThelackofreliablerobustmanagementinformationsystemswithinthementalhealthservicesandhowthisimpactsonservicedeliveryhasbeenhighlightedbytheInspectorofMentalHealthServicesandinthereport“AVisionforChange”.InformationsystemswithintheIrishhealthservicesingeneralarepoorlydeveloped,butthisabsenceisevenmoreacutewithinmentalhealthservices.TheMentalHealthCommission,inrecognisingtheimportanceofhighqualitymentalhealthresearch,publisheditsresearchstrategyin2005.ThisreportprovidesthestrategicdirectionfortheMentalHealthCommissioninrelationtomentalhealthresearch.

1.1 TocontinuetopromotehighqualityepidemiologicalandserviceresearchinrelationtomentalhealthservicesinIreland.

1.2 Tosupportnationalandinternationalcrossagencyresearchlinksandnetworks.

1.3 Topromoteandsupportthedevelopmentofanationalmentalhealthinformationsystem.

1.1.1 ContinuetoimplementtheResearchStrategy.

1.1.2 ReviewtheeffectivenessoftheResearchStrategy.

1.2.1 PubliciseandexpandtheIrishMentalHealthResearchNetworkandDatabase

1.3.1 Engagewithstakeholdersonthedevelopmentofanationalmentalhealthinformationsystem.

1.3.2 EnsuretheaccessibilityandrelevanceofmentalhealthinformationdatacollectedbytheMentalHealthCommissionandcontinuetheactiveengagementwithpeopleinvolvedindatacollectionwithinthementalhealthservices.

Objectives Targets

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Strategic Priority Number Four To advocate for the integration and participation in society of people who experience or have experienced mental illness.

CONTExT:Respectingandpromotingthehumanrightsofpeoplewithamentalillnessandensuringtheremovalofbarrierstofullparticipationinsocietyarekeychallenges.ConsultationswithstakeholdersconductedbytheMentalHealthCommissionhavehighlightedtheongoingprevalenceofstigmaanddiscriminationofpeoplewithamentalillnessandfortheirfamilies/carers.

1.1 Topromoteandsupporttheempowermentofserviceuserswithinthementalhealthsystemandwidersociety.

1.2 Topromotearecoveryorientatedapproachinmentalhealthservices.

1.3 Toworkcollaborativelywithstakeholdersinpromotingcitizenshipandsocialinclusionforallpeoplewithmentalhealthproblems,andhighlightingmentalhealthinthepublichealthagenda.

1.4 Tofacilitatethedevelopmentofamentalhealthservicethatisresponsivetoourmulti-culturalsociety.

1.1.1 ContinuetodevelopandintegratetheinputofserviceusersintheworkoftheMentalHealthCommission.

1.2.1 Publishpositionpaperonrecoveryapproachinmentalhealthservicesandfosterinitiativesinthisarea.

1.3.1 Formstrategicallianceswithrelevantagenciescommittedtoresearching,andpromotingcitizenshipandsocialinclusion.

1.3.2 Engagewiththemediaonissuesofintegrationandinclusionandontheappropriatepresentationofmentalhealthissues.

1.3.3 PromoteWorldMentalHealthDayheldannuallyon10thOctober.

1.4.1 ContinuetoprovideinformationfromtheMentalHealthCommissioninanaccessibleandunderstandableformat.

Objectives Targets

Strategic Priority Number Five To maintain and enhance the organisation’s systems and capacity to ensure the provision of a quality service by the Mental Health Commission.

1.1 ToprovideahighqualityserviceresponsetoourcustomersinlinewiththeCustomerCharter.

1.2 Tofurtherdevelopthecommunication,informationandtechnology(ICT)systemswithintheorganisation.

1.3 Tocontinuetoensurecompliancewithcorporategovernancerequirementsandrelevantlegislation.

1.1.1 PublishtheMentalHealthCommission’sCustomerCharter.

1.1.2 DevelopandpublishtheMentalHealthCommission’sCustomerActionPlanfortheperiod2006–2008.

1.1.3 Continuetopromoteanddevelopalearningculturewithintheorganisation

1.2.1 ImplementreportontheinternalinformationsystemsrequiredwithintheMentalHealthCommission.

1.3.1 PublicationofAnnualReportsandotherReportsasrequiredbytheMentalHealthAct2001.

1.3.2 Reviewandmonitorcompliancewiththecorporategovernancerequirements.

Objectives Targets

Appendix C Comparative Analysis of Quality Framework for

Mental Health Services and “A Vision for Change”

Thetableoverleafhighlightstheoverlapbetweenthe current Government mental health policy“AVisionforChange”publishedbytheDepartmentofHealth&ChildreninJanuary2006andtheMentalHealthCommission’sQualityFrameworkforMentalHealthServicesinIreland.

The recommendations made in A Vision for Change were compared with the themes andstandards enunciated in the quality frameworkand any commonality between the twoframeworks was noted. Numerous similaritieswereobservedasisevidentfromthetable,thusit may be said that both documents share acommonvisionformentalhealthservices.

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A Vision for Change Report of the Expert Group on Mental Health Policy

Quality Framework

Number Recommendation Theme Standard

1.1 Theprinciplesandvaluesdescribedhereandunderpinningthispolicyshouldbereflectedinallmentalhealthserviceplanninganddelivery.

Throughout

3.1 ServiceUsersandcarersshouldparticipateatalllevelsofthementalhealthsystem.

1,2,3,5,6,7,8

1.1,1.2,1.3,2.1,2.2,2.3,3.1,3.2,3.3,3.4,3.5,5.1,6.1,7.2,7.4,8.2

3.2 Advocacyshouldbeavailableasarighttoallserviceusersinallmentalhealthservicesinallpartsofthecountry.

3 3.3

3.3 Innovativemethodsofinvolvingserviceusersandcarersshould be developed by local services, including themainstreamfundingandintegrationofservicesorganisedandrunbyserviceusersandcarersofserviceusers.

1,2,3,5,6,7,8

1.1,1.5,2.1,2.2,2.3,3.1,3.2,3.3,3.4,3.5,5.1,6.1,7.2,7.4,8.2

3.4 Theadulteducationsystemshouldofferappropriateandsupportedaccesstoinformation,courses,andqualificationstoserviceusers,carersandtheirrepresentativesthatwouldhelptoenhanceandempowerpeopletorepresentthemselvesandothers.

1,2,3,7 1.5,2.3,3.1,3.3,3.5,7.2

3.5 ANationalServiceUserExecutiveshouldbeestablishedtoinformtheNationalMentalHealthServiceDirectorateandtheMentalHealthCommissiononissuesrelatingtouserinvolvementandparticipationinplanning,delivering,evaluatingandmonitoringservicesincludingmodelsofbestpractice;andtodevelopandimplementbestpracticeguidelinesbetweentheuserandproviderinterfaceincludingcapacitydevelopmentissues.

3,7,8 3.4,3.5,7.2,8.1

3.6 Carersshouldbeprovidedwithpracticalsupport/measuressuchas;inclusioninthecareplanningprocesswiththeagreementoftheserviceuser,inclusioninthedischargeplanningprocess,timelyandappropriateinformationandeducation,plannedrespitecareandshouldhaveamemberofthemultidisciplinaryteamtoactasakeyworker/designatedpointofcontactwiththeteamandtoensuretheseservicesareprovided.

1,2,3,5,6,7,8

1.1,1.2,2.2,3.1,3.5,5.1,6.1,7.2,8.1

3.7 Theexperiencesandneedsofchildrenofserviceusersshouldbeaddressedthroughintegratedactionatnational,regionalandlocallevelinorderthatsuchchildrencanbenefitfromthesamelifechancesasotherchildren.

1,3,4,5,6

1.5,3.5,4.1,5.1,6.1

3.8 Mentalhealthservicesshouldprovideongoing,timelyandappropriateinformationtoserviceusersandcarersasanintegralpartoftheoverallservicetheyprovide.

1,2,3,5,6,8

1.1,1.2,1.4,2.1,2.2,3.1,3.2,3.3,3.4,5.1,6.1,8.3

3.9 Informationontheprocessesinvolvedinmakingcomplaintsorcommentsonmentalhealthservicesshouldbewidelyavailable.

1,2,3,6,8

1.1,2.1,2.2,3.1,3.2,3.3,3.4,3.5,6.1,8.3

3.10 Serviceuserinvolvementshouldbecharacterisedbyapartnershipapproachwhichworksaccordingtotheprinciplesoutlinedinthischapterandwhichengageswithawidevarietyofindividualsandorganisationsinthelocalcommunity.

1,2,3,5,6,7,8

1.1,1.2,1.3,1.5,2.1,2.2,2.3,3.1,3.2,3.3,3.4,3.5,5.1,6.1,7.2,7.4,8.3

4.1 Allcitizensshouldbetreatedequally.Accesstoemployment,housingandeducationforindividualswithmentalhealthproblemsshouldbeonthesamebasisaseveryothercitizen.

1,2,3 1.5,2.3,3.2,3.3,3.5

4.2 Evidence-basedprogrammestotacklestigmashouldbeputinplace,basedaroundcontact,educationandchallenge.

1,2,3,7 1.4,1.5,2.1,2.3,3.5,7.2

4.3 Theflexibleprovisionofeducationalprogrammesshouldbeusedtoencourageyoungpeopletoremainengagedwiththeeducationsystemandtoaddresstheeducationalneedsofadultswithmentalhealthproblems.

1,3 1.5,3.3,3.5


Quality Framework


4.4 Measurestoprotecttheincomeofindividualswithmentalhealthproblemsshouldbeputinplace.Healthcareaccessschemesshouldalsobereviewedforthisgroup.

1,3,5 1.5,3.5,5.1

4.5 Mentalhealthservicesshouldtakeaccountoflocaldeprivationpatternsinplanninganddeliveringmentalhealthcare.

1,5,8 1.2,1.3,1.4,1.5,5.1,8.1,8.2,8.3

4.6 Evidence-basedapproachestotrainingandemploymentforpeoplewithmentalhealthproblemsshouldbeadoptedandsuchprogrammesshouldbeputinplacebytheagencieswithresponsibilityinthisarea.

1,2,3,7,8

1.1,1.4,1.5,2.3,3.3,3.5,7.2,8.1,8.2

4.7 TheprovisionofsocialhousingistheresponsibilityoftheLocalAuthority.MentalhealthservicesshouldworkinliaisonwithLocalAuthoritiestoensurehousingisprovidedforpeoplewithmentalhealthproblemswhorequireit.

1,2,3 1.1,1.2,1.5,2.3,3.5

4.8 Mentalhealthservicesshouldbeprovidedinaculturallysensitivemanner.Trainingshouldbemadeavailableformentalhealthprofessionalsinthisregard,andmentalhealthservicesshouldberesourcedtoprovideservicestootherethnicgroups,includingprovisionforinterpreters.

2,3,4,5,7

2.1,2.2,3.1,3.2,3.3,4.1,5.1,7.2

4.9 Communityandpersonaldevelopmentinitiativeswhichimpactpositivelyonmentalhealthstatusshouldbesupportede.g.housingimprovementschemes,localenvironmentplanningandtheprovisionoflocalfacilities.Thishelpsbuildsocialcapitalinthecommunity.

1,3,5 1.3,1.5,3.3,3.4,3.5,5.1

4.10 TheNationalMentalHealthServiceDirectorateshouldbespecificallyrepresentedintheinstitutionalarrangementswhichimplementtheNationalActionPlanagainstPovertyandSocialExclusion,withspecifictargetstomonitoractioninachievinggreatersocialinclusionforthosewithmentalhealthproblems.

Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework)

5.1 Sufficientbenefithasbeenshownfrommentalhealthpromotionprogrammesforthemtobeincorporatedintoalllevelsofmentalhealthandhealthservicesasappropriate.Programmesshouldparticularlyfocusonthoseinterventionsknowntoenhanceprotectivefactorsanddecreaseriskfactorsfordevelopingmentalhealthproblems.

1 1.4

5.2 Allmentalhealthpromotionprogrammesandinitiativesshouldbeevaluatedagainstlocallyagreedtargetsandstandards.

8 8.1,8.3

5.3 Aframeworkforinter-departmentalcooperationinthedevelopmentofcross-cuttinghealthandsocialpolicyshouldbeputinplace.TheNAPSframeworkisausefulexampleofsuchaninitiative(seeChapterFour).

1,2,8 1.2,1.3,1.5,2.3,8.1,8.3

5.4 Designatedhealthpromotionofficersshouldhavespecialresponsibilityformentalhealthpromotionworkingincooperationwithlocalvoluntaryandcommunitygroupsandwithformallinkstomentalhealthservices.

1 1.4

5.5 Trainingandeducationprogrammesshouldbeputinplacetodevelopcapacityandexpertiseatnationalandlocallevelsforevidence-basedpreventionofmentaldisordersandpromotionofmentalhealth.

1,7,8 1.4,7.2,7.3,7.4,8.3

7.1 Allindividualsshouldhaveaccesstoacomprehensiverangeofinterventionsinprimarycarefordisordersthatdonotrequirespecialistmentalhealthservices.

5 5.1

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7.2 Furtherresearchandinformationontheprevalenceofmentalhealthproblemsinprimarycareandtherangeofinterventionsprovidedinprimarycareisneededtoeffectivelyplanprimarycareservicesandtheinterfacebetweenprimarycareandspecialistmentalhealthservices.

8 8.1

7.4 Appropriatelytrainedstaffshouldbeavailableattheprimarycareleveltoprovideprogrammestopreventmentalhealthproblemsandpromotewellbeing.

1,7 1.2,1.4,7.1,7.2

7.5 Itisrecommendedthattheconsultation/liaisonmodelshouldbeadoptedtoensureformallinksbetweenCMHTsandprimarycare.

1 1.2,1.3,1.4

7.6 Mentalhealthprofessionalsshouldbeavailableintheprimarycaresetting,eitherwithincommunitycare,theprimarycareteamortheprimarycarenetwork.

1,3 1.2,1.3,3.5,5.1

7.7 LocalmultidisciplinaryCMHTsshouldprovideasinglepointofaccessforprimarycareforadvice,routineandcrisisreferraltoallmentalhealthservices(communityandhospitalbased).

1,5 1.2,1.3,5.1

7.8 Protocolsandpoliciesshouldbeagreedlocallybyprimarycareteamsandcommunitymentalhealthteams-particularlyarounddischargeplanning.ThereshouldbecontinuouscommunicationandfeedbackbetweenprimarycareandtheCMHT.

1,8 1.2,1.3,1.5,8.1

7.9 Awiderangeofincentiveschemesshouldbeintroducedtoensurementalhealthtreatmentandcarecanbeprovidedinprimarycare.

5 5.1

7.10 PhysicalinfrastructurethatmeetsmodernqualitystandardsshouldprovidesufficientspacetoenableprimarycareandCMHTstoprovidehighqualitycare.

4 4.1

7.11 TheeducationandtrainingofGPsinmentalhealthshouldbereviewed.GPsshouldreceivementalhealthtrainingthatisappropriatetotheprovisionofmentalhealthservicesdescribedinthispolicy(i.e.community-basedmentalhealthservices).Serviceusersshouldbeinvolvedintheprovisionofeducationonmentalhealth.

7 7.2

9.1 Toprovideaneffectivecommunity-basedservice,CMHTsshouldoffermultidisciplinaryhome-basedtreatmentandassertiveoutreach,andacomprehensiverangeofmedical,psychologicalandsocialtherapiesrelevanttotheneedsofserviceusersandtheirfamilies.Eachmultidisciplinaryteamshouldincludethecoreskillsofpsychiatry,nursing,socialwork,clinicalpsychology,occupationaltherapy.ThecompositionandskillmixofeachCMHTshouldbeappropriatetotheneedsandsocialcircumstancesofitssectorpopulation.

1,3,5,7 1.1,1.3,1.5,3.5,5.1,7.1

9.2 ThecornerstoneofmentalhealthservicedeliveryshouldbeanenhancedmultidisciplinaryCommunityMentalHealthTeam(CMHT),whichincorporatesasharedgovernancemodel,anddeliversbest-practicecommunity-basedcaretoservetheneedsofchildren,adultsandolderpeople.

1,8 1.3,1.5,8.1

9.3 LinksbetweenCMHTsprimarycareservices,voluntarygroupsandlocalcommunityresourcesrelevanttotheserviceuser’srecoveryshouldbeestablishedandformalised.

1,2,3,8 1.3,1.5,2.3,3.5,8.1

9.4 AllCMHTsshouldhavedirectaccesstomedicalandradiologicalservicesaspartofthecomprehensiveassessmentofspecificpresentations.

1 1.3


Quality Framework


9.5 EvaluationoftheactivitiesoftheCMHTintermsofmeaningfulperformanceindicatorsshouldtakeplaceonanannualbasisandincorporateserviceuserfeedback.

3,8 3.4,3.5,8.3

9.6 ResearchshouldbeundertakentoestablishhowmanyservicescurrentlyhaveeffectiveCMHTsandtoidentifythefactorsthatfacilitateandimpedeeffectiveteamfunctioningandtheresourcesrequiredtosupporttheeffectivefunctioningofCMHTs.

7 7.4

10.1 Theneedtoprioritisethefullrangeofmentalhealthcare,fromprimarycaretospecialistmentalhealthservicesforchildrenandadolescentsisendorsedinthispolicy.

1 1.1,1.2,1.3,1.4,1.5

10.2 Childandadolescentmentalhealthservicesshouldprovidementalhealthservicestoallaged0-18years.TransitionalarrangementstofacilitatetheexpansionofcurrentserviceprovisionshouldbeplannedbytheproposedNationalMentalHealthServiceDirectorateandthelocalCMHTs.

1,8 1.2,1.5,8.3

10.3 Itisrecommendedthatserviceusersandtheirfamiliesandcarersbeofferedopportunitiestogivefeedbackontheirexperienceandtoinfluencedevelopmentswithintheseservices.

1,2,3,6,7,8

1.1,1.2,2.2,3.1,3.2,3.4,3.5,6.1,7.2,7.4,8.3

10.4 Programmesaddressingmentalhealthpromotionandprimarypreventionearlyinlifeshouldbetargetedatchildpopulationsatrisk.

8 8.3

10.5 ForthosechildreninschoolsettingsitisrecommendedthattheSPHEbeextendedtoincludetheseniorcycleandthatevidence-basedmentalhealthpromotionprogrammesbeimplementedinprimaryandsecondaryschools.

1 1.4

10.6 ProvisionofprogrammesforadolescentswholeaveschoolprematurelyshouldbetheresponsibilityoftheDepartmentofEducationandScience.

1 1.5Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework)

10.7 TwochildandadolescentCMHTsshouldbeappointedtoeachsector(population:100,000).OnechildandadolescentCMHTshouldalsobeprovidedineachcatchmentarea(300,000population)toprovideliaisoncover.

1,8 1.1,1.3,1.5,8.1

10.8 ThesechildandadolescentCMHTsshoulddevelopclearlinkswithprimaryandcommunitycareservicesandidentifyandprioritisethementalhealthneedsofchildrenineachcatchmentarea.

1,2 1.5,2.3

10.9 Urgentattentionshouldbegiventothecompletionoftheplannedfour20-bedunitsinCork,Limerick,GalwayandDublin,andmultidisciplinaryteamsshouldbeprovidedfortheseunits.

8,1 8.3,1.5,1.3

10.10 Earlyinterventionandassessmentservicesforchildrenwithautismshouldincludecomprehensivemultidisciplinaryandpaediatricassessmentandmentalhealthconsultationwiththelocalcommunitymentalhealthteam,wherenecessary.

1 1.5

11.1 Educationandpromotionofpositivementalhealthshouldbeencouragedwithinthegeneralcommunity.Theseinitiativesshouldhaveclearlyspecifiedgoalsandobjectivesandshouldbeevaluatedregularly.

1 1.4

11.2 AHealthPromotingCollegeNetworkshouldbedevelopedandimplemented.

1 1.4

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11.3 CMHTsshouldprovidesupportandconsultationtoprimarycareprovidersinthemanagementandreferralofindividualswithmentalhealthproblems.

1 1.3,1.5

11.4 TheproposedgeneraladultmentalhealthserviceshouldbedeliveredthroughthecoreentityofoneCommunityMentalHealthTeam(CMHT)forsectorpopulationsofapproximately50,000.Eachteamshouldhavetwoconsultantpsychiatrists.

1 1.3,1.5

11.5 Itisrecommendedthatasharedgovernancemodel,incorporatingclinicalteamleader,teamcoordinatorandpracticemanagebeestablishedtoensuretheprovisionofbest-practiceintegratedcare,andevaluationofservicesprovided.

1,8 1.1,1.2,1.3,8.3

11.6 CMHTsshouldbelocatedinCommunityMentalHealthCentreswithconsiderationforeasyaccessforserviceusers.Highqualitydayhospitalsandacutein-patientcarefacilitiesshouldalsobeprovided.

1,5 1.3,1.5,5.1

11.7 CMHTsshouldevolveaclearcareplanwitheachserviceuserand,whereappropriate,thisshouldbediscussedwithcarers.

1,3,6,8 1.1,1.2,1.3,3.2,3.4,6.1,8.3

11.8 Eachteamshouldincludearangeofpsychologicaltherapyexpertisetoofferindividualandgrouppsychotherapiesinlinewithbestpractice.

1,3 1.3,1.5,3.5

11.9 Serviceusersandprovidersshouldcollaboratetodrawupclearguidelinesonthepsychologicalneedsofusersandtherangeofcommunityresourcesandsupportsavailabletothemlocally.

1,3,8 1.1,1.3,1.5,3.4,3.5,8.3

11.10. Home-basedtreatmentteamsshouldbeidentifiedwithineachCMHTandprovidepromptservicestoknownandnewserviceusersasappropriate.Thissub-teamshouldhaveagate-keepingroleinrespectofallhospitaladmissions.

1,3 1.2,1.3,1.4,1.5,3.5

11.11 ArrangementsshouldbeevolvedandagreedwithineachCMHTfortheprovisionof24/7multidisciplinarycrisisintervention.Eachcatchmentareashouldhavethefacilityofacrisishousetooffertemporarylowsupportaccommodationifappropriate.

1,5 1.3,5.1

11.12 InadditiontotheexistingEarlyInterventionServices(EIS)pilotprojectcurrentlyunderwayintheHSE,asecondEISpilotprojectshouldbeundertakenwithapopulationcharacterisedbyadifferentsocio-demographicprofile,withaviewtoestablishingtheefficacyofEISfortheIrishmentalhealthservice.

1 1.4

11.13 Each50bedacutepsychiatricunitshouldincludeacloseobservationunitofsixbeds.

8 8.1

11.14 EachofthefourHSEregionsshouldprovidea30-bedICRUunit-withtwosub-unitsof15bedseach-toatotalof120placesnationally,staffedwithmultidisciplinaryteamswithappropriatetraining.

8 8.1

11.15 EachofthefourHSEregionsshouldprovidetwohighsupportintensivecareresidencesoftenplaceseach.

8 8.1

12.1 Astrongcommitmenttotheprincipleof“Recovery”shouldunderpintheworkoftherehabilitationCMHT-thebeliefthatitispossibleforallserviceuserstoachievecontrolovertheirlives,torecovertheirself-esteem,andmovetowardsbuildingalifewheretheyexperienceasenseofbelongingandparticipation.

2,3 2.3,3.5

12.2 Some39rehabilitationandrecoveryCMHTsshouldbeestablishednationally,withassignedsectorpopulationsof100,000.Assertiveoutreachteamsprovidingcommunity-basedinterventionsshouldbetheprincipalmodalitythroughwhichtheseteamswork.

1,5 1.3,1.4,1.5,5.1


Quality Framework


12.3 Thephysicalinfrastructurerequiredtodeliveracomprehensiveserviceshouldbeprovidedineachsector.RehabilitationandrecoveryCMHTsshouldhaveresponsibilityforthosephysicalresourcesappropriatetotheneedsoftheirserviceusers,suchascommunityresidences.

1,5 1.3,1.5,5.1

12.4 Opportunitiesforindependenthousingshouldbeprovidedbyappropriateauthoritieswithflexibletenancyagreementsbeingdrawnupinaccordancewitheachserviceuser’sneeds.Arrangementsthatbestenableserviceuserstomovefromhighsupporttolowsupportandindependentaccommodationneedtobeconsidered.

1,3,4 1.2,1.3,1.5,3.5,4.1

12.5 Rehabilitationandrecoverymentalhealthservicesshoulddeveloplocalconnectionsthroughlinkingwithlocalstatutoryandvoluntaryserviceprovidersandsupportnetworksforpeoplewithamentalillnessisrequiredtosupportcommunityintegration.

1,2,3 1.3,1.4,1.5,2.3,3.5

12.6 Allcurrentstaffwithinthementalhealthsystemwhoareappointedtorehabilitationandrecoveryservicesshouldreceivetraininginrecovery-orientedcompetenciesandprinciples.

3,7 3.5,7.2

12.7 Thedevelopmentofformalcoordinationstructuresbetweenhealthservicesandemploymentagenciesshouldbeapriorityifthedeliveryofseamlessservicesistobefacilitated.

1,3 1.2,1.5,3.5

12.8 Tofacilitatetheserviceuserinre-establishingmeaningfulemployment,developmentofaccessiblemainstreamtrainingsupportservicesandcoordinationbetweenrehabilitationservicesandtrainingandvocationalagenciesisrequired.

1,2,3 1.3,1.5,2.3,3.5

12.9 Evaluationofservicestothesevereandenduringserviceusergroupshouldincorporatequality-of-lifemeasuresandassessthebenefitandvalueoftheseservicesdirectlytoserviceusersandtheirfamilies.

7,8 7.4,8.3

13.1 Anyperson,aged65yearsorover,withprimarymentalhealthdisordersorwithsecondarybehaviouralandaffectiveproblemsarisingfromexperienceofdementia,hastherighttobecaredforbymentalhealthservicesforolderpeople(MHSOP).

1 1.3,1.5

13.2 Mentalhealthpromotionamongolderadultsshouldpreservearespectforthepotentialinolderpeopletogrowandflourishinlaterlifeandtocounternegativemythsofageingthatcanbecomeself-fulfillingprophecies.

1,2,3,5 1.4,2.1,2.3,3.5,5.1

13.3 Healthpromotionprogrammesandinitiativesfoundtobebeneficialtoolderadultsshouldbeimplemented.

1 1.4

13.4 Primaryhealthcareteamsshouldplayamajorroleinassessmentandscreeningformentalillnessinolderpeopleandshouldworkinacoordinatedandintegratedmannerwiththespecialistteamstoprovidehighqualitycare,particularlycarethatishome-based.

1,3 1.2,1.3,1.5,3.5

13.5 Atotalof39MHSOPmultidisciplinaryteamsshouldbeestablishednationally,oneper100,000population,providingdomiciliaryandcommunity-basedcare.

1,5 1.1,1.3,1.5,5.1

13.6 PriorityshouldbegiventoestablishingcomprehensivespecialistMHSOPwherenonecurrentlyexist.

1,5 1.1,5.1

13.7 Physicalresourcesessentialtoservicedelivery,acutebedsandcontinuingcare,serviceheadquarters,community-basedanddayfacilitiesshouldbeprovidedforMHSOPwithineachsector.

1,5,8 1.3,5.1,8.3

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13.8 ThereshouldbeeightacuteassessmentandtreatmentbedsineachregionalacutepsychiatricunitforMHSOP.

1 1.3

13.9 Thereshouldbeonecentraldayhospitalpermentalhealthcatchmentarea(300,000population)providing25places,andanumberoftravellingdayhospitalsineachmentalhealthcatchmentarea.

5 5.1

13.10 Thereshouldbeanappropriateprovisionofdaycentresineachmentalhealthcatchmentarea,buttheirprovisionshouldnotbetheresponsibilityoftheMHSOP.

1,5 1.3,5.1

13.11 Thereshouldbeappropriaterecognitionandlinkagewithvoluntaryagenciesinthefield.

1,2,3 1.3,1.5,2.1,2.3,3.3

13.12 Carersandfamiliesshouldreceiveappropriaterecognitionandsupportincludingeducation,respite,andcrisisresponsewhenrequired.

1,6 1.1,1.2,6.1

13.13 Olderpeoplewithmentalhealthproblemsshouldhaveaccesstonursinghomesonthesamebasisastherestofthepopulation.

5 5.1

13.14 Thereshouldbe30continuingcareplacesforolderpeoplewithmentaldisordersineachmentalhealthcatchmentarea.

8 8.3

14.1 Theprocessofservicedeliveryofmentalhealthservicestopeoplewithintellectualdisabilityshouldbesimilartothatforeveryothercitizen.

5 5.1

14.2 DetailedinformationonthementalhealthofpeoplewithintellectualdisabilityshouldbecollectedbytheNIDD.Thisshouldbebasedonastandardisedmeasure.Datashouldalsobegatheredbymentalhealthservicesforthosewithintellectualdisabilityaspartofnationalmentalhealthinformationgathering.

7,8 7.4,8.2

14.3 AnationalprevalencestudyofmentalhealthproblemsincludingchallengingbehaviourintheIrishpopulationwithintellectualdisabilityshouldbecarriedouttoassistinserviceplanning.

7,8 7.4,8.2

14.4 Thepromotionandmaintenanceofmentalwell-beingshouldbeanintegralpartofserviceprovisionwithinintellectualdisabilityservices.

1 1.4

14.5 AllpeoplewithanintellectualdisabilityshouldberegisteredwithaGPandbothintellectualdisabilityservicesandMHIDteamsshouldliaisewithGPsregardingmentalhealthcare.

1 1.1,1.2,1.3

14.6 Mentalhealthservicesforpeoplewithintellectualdisabilityshouldbeprovidedbyaspecialistmentalhealthofintellectualdisability(MHID)teamthatiscatchmentarea-based.Theseservicesshouldbedistinctandseparatefrom,butcloselylinkedto,themultidisciplinaryteamsinintellectualdisabilityserviceswhoprovideahealthandsocialcareserviceforpeoplewithintellectualdisability.

1 1.1,1.3,1.5

14.7 ThemultidisciplinaryMHIDteamsshouldbeprovidedonthebasisoftwoper300,000populationforadultswithintellectualdisability.

8 8.1,8.2

14.8 OneMHIDteamper300,000populationshouldbeprovidedforchildrenandadolescentswithintellectualdisability.

8 8.1,8.2

14.9 Aspectrumoffacilitiesshouldbeinplacetoprovideaflexiblecontinuumofcarebasedonneed.Thisshouldincludedayhospitalplaces,respiteplaces,andacute,assessmentandrehabilitationbeds/places.Arangeofinterventionsandtherapiesshouldbeavailablewithinthesesettings.

1,3 1.1,1.3,1.5,3.5


Quality Framework


14.10 Inordertoensurecloseintegration,referralpoliciesshouldreflecttheneedsofindividualswithintellectualdisabilitylivingathomewiththeirfamily,GPs,thegenericintellectualdisabilityserviceproviders,theMHIDteamandothermentalhealthteamssuchasadultandchildandadolescentmentalhealthteams.

1 1.2

14.11 Anationalforensicunitshouldbeprovidedforspecialistresidentialcareforlowmild,andmoderaterangeofintellectualdisability.ThisunitshouldhavetenbedsandbestaffedbyamultidisciplinaryMHIDteam.

8 8.1,8.2

15.1.1 Everypersonwithseriousmentalhealthproblemscomingintocontactwiththeforensicsystemshouldbeaccordedtherightofmentalhealthcareinthenon-forensicmentalhealthservicesunlesstherearecogentandlegalreasonswhythisshouldnotbedone.Wherementalhealthservicesaredeliveredinthecontextofprison,theyshouldbeperson-centred,recoveryorientedandbasedonevolvedandintegratedcareplans.

1,2,3,5 1.1,2.1,3.5,5.1

15.1.2 FMHSshouldbeexpandedandreconfiguredsoastoprovidecourtdiversionservicesandlegislationshouldbedevisedtoallowthistotakeplace.

8 8.1

15.1.3 Fouradditionalmultidisciplinary,community-basedforensicmentalhealthteamsshouldbeprovidednationallyonthebasisofoneperHSEregion.

8 8.1

15.1.4 TheCMHshouldbereplacedorremodelledtoallowittoprovidecareandtreatmentinamodern,up-to-datehumanesetting,andthecapacityoftheCMHshouldbemaximised.

8 8.1

15.1.5 Prisonhealthservicesshouldbeintegratedandcoordinatedwithsocialwork,psychologyandaddictionservicestoensureprovisionofintegratedandeffectivecare.EffortsshouldbemadetoimproverelationshipsandliaisonbetweenFMHSandotherspecialistcommunitymentalhealthservices.

1,3 1.1,1.2,1.3,1.5,3.5

15.1.6 Adedicatedresidential10-bedfacilitywithafullyresourcedchildandadolescentmentalhealthteamshouldbeprovidedwithanationalremit.Anadditionalcommunity-based,childandadolescentforensicmentalhealthteamshouldalsobeprovided.

8 8.1

15.1.7 A10-bedresidentialunit,withafullyresourcedmultidisciplinarymentalhealthteamshouldbeprovidedforcareofintellectuallydisabledpersonswhobecomeseverelydisturbedinthecontextofthecriminaljusticesystem.

8 8.1

15.1.8 EducationandtrainingintheprinciplesandpracticesofFMHshouldbeestablishedandextendedtoappropriatestaff,includingAnGardaSíochana.

7 7.2

15.1.9 AseniorgardashouldbeidentifiedandtrainedineachGardadivisiontoactasresourceandliaisonmentalhealthofficer.

7,8 7.3,8.3

15.2.1 Adatabaseshouldbeestablishedtorefinethedimensionandcharacteristicsofhomelessnessandanalysehowservicesarecurrentlydealingwithit.

7,8 7.4,8.2

15.2.2 Inthelightofthisinformation,scientificallyacquiredandanalysed,makerecommendationsastorequirementsandimplementthem.

8 8.1

15.2.3 TheActionPlanonHomelessness(162)shouldbefullyimplementedandthestatutoryresponsibilityofhousingauthoritiesinthisareashouldbereinforced.

8 8.1Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework)Q

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15.2.4 Arangeofsuitable,affordablehousingoptionsshouldbeavailabletopreventthementallyillbecominghomeless.

1 1.2,1.5

15.2.5 TheCMHTteamwithresponsibilityandaccountabilityforthehomelesspopulationineachcatchmentareashouldbeclearlyidentified.IdeallythisCMHTshouldbeequippedtoofferassertiveoutreach.Twomultidisciplinary,community-basedteamsshouldbeprovided,oneinNorthDublinandoneinSouthDublin,toprovideamentalhealthservicetothehomelesspopulation.

5 5.0.1

15.2.6 Communitymentalhealthteamsshouldadoptpracticestohelppreventserviceusersbecominghomeless,suchasguidelinesforthedischargeofpeoplefrompsychiatricin-patientcareandanassessmentofhousingneed/livingcircumstancesforallpeoplereferredtomentalhealthservices.

1 1.1,1.2,1.3

15.2.7 Integrationandcoordinationbetweenstatutoryandvoluntaryhousingbodiesandmentalhealthservicesatcatchmentarealevelshouldbeencouraged.

1,2 1.2,1.3,1.5,2.3

15.3.1 Mentalhealthservicesforbothadultsandchildrenareresponsibleforprovidingamentalhealthserviceonlytothoseindividualswhohaveco-morbidsubstanceabuseandmentalhealthproblems.

1 1.2

15.3.2 GeneraladultCMHTsshouldgenerallycaterforadultswhomeetthesecriteria,particularlywhentheprimaryproblemisamentalhealthproblem.

1 1.2

15.3.3 ThepostofNationalPolicyCoordinatorshouldbeestablishedtodelivernationalobjectivesandstandardspertainingtoprimarycareandcommunityinterventionsfordrugandalcoholabuseandtheirlinkagetomentalhealthservices.

8 8.3

15.3.4 Specialistadultteamsshouldbedevelopedineachcatchmentareaof300,000tomanagecomplex,severesubstanceabuseandmentaldisorder.

1,5 1.3,1.5,5.1

15.3.5 ThesespecialistteamsshouldestablishclearlinkageswithlocalcommunitymentalhealthservicesandclarifypathwaysinandoutoftheirservicestoserviceusersandreferringadultCMHTs.

1,3 1.2,1.5,3.5

15.3.6 TwoadditionaladolescentmultidisciplinaryteamsshouldbeestablishedoutsideDublintoprovideexpertisetocareforadolescentsandco-morbidaddictionandmentalhealthproblems.Thisprovisionshouldbereviewedafterfiveyears.

1,5 1.5,5.1

15.4.1 Healthpromotioninitiativesthatsupportgreatercommunityandfamilyawarenessofeatingdisordersshouldbesupportedandencouraged.

1 1.4

15.4.2 Theactivitiesofvoluntaryagenciesinpromotingawarenessandresponsestoeatingdisordersshouldbesupported.

2 2.3

15.4.3 Specialemphasisshouldbeplacedonincludingtrainingmodulesoneatingdisordersintheundergraduateandpostgraduatetrainingofhealthprofessionals.

7 7.2

15.4.4 EatingdisordersinchildrenandadolescentsshouldbemanagedbythechildandadolescentCMHTsonacommunitybasis,usingbedsinoneofthefivein-patientchildandadolescentunitsifrequired.

1,5 1.5,5.1

15.4.5 ThereshouldalsobeafullmultidisciplinaryteaminaNationalCentreforEatingDisorders,tobelocatedinoneofthenationalchildren’shospitals,forcomplexcasesthatcannotbemanagedbylocalchildandadolescentCMHTs.

1,7 1.1,1.5,7.1


Quality Framework


15.4.6 Thereshouldbefourspecialistmultidisciplinaryteamsprovidingspecialistin-patient,outpatientandoutreachservicesforeatingdisorders;oneteamperHSEregion.TheseteamsshouldlinkcloselywithlocaladultCMHTstoensurecontinuityofcare.

1,8 1.2,1.3,1.5,8.3

15.4.7 Eachteamshouldmanageaneatingdisordersub-unitinaregionalgeneralhospitalmentalhealthunit.Thesesub-unitsshouldhavesixbedseach,therebycontributing24publicEDbedsnationally.

8 8.3

15.4.8 Thefourspecialisedmultidisciplinaryadultteams,andthenationalteamforchildrenandadolescents,shouldprovidecommunity-basedconsultation,adviceandsupporttoallagenciesintheirarea.

1,2,3 1.2,1.4,1.5,2.3,3.5

15.5.1 TheexistingprovisionofnineLMHSteamsnationallyshouldbeincreasedtothirteen.

5,8 5.1,8.3

15.5.2 CompletemultidisciplinaryLMHSshouldbeestablishedinthethreenationalchildren’shospitals.

5,8 5.1,8.3

15.5.3 LiaisonchildandadolescentmentalhealthservicesshouldbeprovidedbyadesignatedchildandadolescentCMHT,oneper300,000population(seeChapter10)

8 8.3

15.5.4 Oneadditionaladultpsychiatristandseniornursewithperinatalexpertiseshouldbeappointedtoactasaresourcenationallyintheprovisionofcaretowomenwithsevereperinatalmentalhealthproblems.

5 5.1

15.6.1 TwospecialistneuropsychiatrymultidisciplinaryteamsshouldbeestablishedinthemajorneurosciencecentresinDublinandCork.

8 8.3

15.6.2 Asanationalresource,aspecialneuropsychiatricin-patientunitwithsixtotenbedsshouldbeestablished.

8 8.3

15.6.3 Facilitiesforvideo-conferencingandtelemedicineshouldbeconsideredtoextendtheexpertiselocatedintheseunitsnationally,andtoenablethemtobecomeaconsultationandtrainingresource.

7 7.3

15.7.1 Thereshouldbeagreedprotocolsandguidelinesforengagingwiththoseassessedtobeathighriskofsuicidalbehaviour,andforengagingwiththosewhoareparticularlyvulnerableinthewakeofasuicide,withinmentalhealthcaresettings.

1 1.1,1.2,1.3,1.4

15.7.2 Particularcareshouldbegiventoserviceusersofmentalhealthserviceswhohavebeenidentifiedasbeingathighriskofsuicidalbehavioure.g.thosewithseverepsychosis,affectivedisorders,andindividualsintheimmediateaftermathofdischargefromin-patientsettings.

1 1.1,1.2,1.3,1.4

15.7.3 Integrationandcoordinationofstatutory,research,voluntary,andcommunityactivitiesisessentialtoensureeffectiveimplementationofsuicidepreventioninitiativesinthewidercommunity.InthisregardtheNationalOfficeforSuicidePreventionshouldbesupportedanddeveloped.

1,2,8 1.4,2.3,8.1

15.7.4 ThestrategiesrecommendedinReachOuttopreventsuicideandtoimprovementalhealthprovisionforpeopleengaginginsuicidalbehaviourshouldbeadoptedandimplementednationally.

1,2 1.4,1.5,2.1

15.8.1 Theneedsofpeoplewithmentalhealthproblemsarisingfromorco-morbidwithborderlinepersonalitydisordershouldberecognisedasalegitimateresponsibilityofthementalhealthservice,andevidence-basedinterventionsprovidedonacatchmentareabasis.

1,8 1.2,1.3,1.5,8.1,8.3

15.8.2 SpecialisedtherapeuticexpertiseshouldbedevelopedineachcatchmentareatodealwithsevereandcomplexclinicalproblemsthatexceedtheavailableresourcesofgenericCMHTs.

1 1.2,1.3,1.5

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Quality Framework


16.1 MentalHealthCatchmentAreasshouldbeestablishedwithpopulationsofbetween250,000and400,000withrealignedcatchmentboundariestotakeintoaccountcurrentsocialanddemographicrealities.Thesecatchmentareasshouldbecoterminouswithlocalhealthofficeareasandthenewregionalhealthareas.Theyshouldtakeintoaccountthelocationofacutepsychiatricin-patientunitsingeneralhospitals.

1 1.3

16.2 Substantialupgradingofinformationtechnologysystemsshouldoccurtoenabletheplanning,implementationandevaluationofserviceactivity.

8 8.2

16.3 ANationalMentalHealthServiceDirectorateshouldbeestablished,whichincludesseniorprofessionalmanagers,seniorcliniciansandaserviceuser.ThenewNationalMentalHealthServiceDirectorateshouldactasanadvisorygroupandbecloselylinkedwiththemanagementofthePrimaryandContinuingCareDivisionoftheHealthServiceExecutive.

8 8.1,8.2,8.3

16.4 MultidisciplinaryMentalHealthCatchmentAreaManagementTeamsshouldbeestablished.TheseteamsshouldincludebothprofessionalmanagersandclinicalprofessionalsalongwithatrainedserviceuserandshouldbeaccountabletotheNationalCareGroupManagerandtheNationalMentalHealthServiceDirectorate.

8 8.1,8.2,8.3

16.5 CommunityMentalHealthTeamsshouldself-managethroughtheprovisionofateamcoordinator,teamleaderandteampracticemanager.

8 8.3

16.6 CommunityMentalHealthTeamsshouldberesponsiblefordevelopingcostedserviceplansandshouldbeaccountablefortheirimplementation.

8 8.3

16.7 AmanagementandorganisationstructureofNationalMentalHealthServiceDirectorate,amultidisciplinaryMentalHealthCatchmentAreaManagementTeamandlocal,self-managingCMHTs,shouldbeputinplace.

8 8.3

16.8 MentalHealthCatchmentAreaManagementTeamsshouldfacilitatethefullintegrationofmentalhealthserviceswithothercommunitycareareaprogrammes.Thisshouldincludethemaximuminvolvementwithself-helpandvoluntarygroupstogetherwithrelevantlocalauthorityservices.

1,5,6 1.3,1.4,1.5,5.1,6.1

16.9 CommunityMentalHealthTeamsandPrimaryCareTeamsshouldputinplacestandingcommitteestofacilitatebetterintegrationoftheservicesandguidemodelsofsharedcare.

1,3 1.2,1.3,1.5,3.5

17.1 Substantialextrafundingisrequiredtofinancethispolicy.Aprogrammeofcapitalandnon-capitalinvestmentinmentalhealthservicesasrecommended,adjustedinlinewithinflation,shouldbeimplementedinaphasedwayoverthenextseventotenyears,inparallelwiththereorganisationofmentalhealthservices.

8 8..3

17.2 Capitalandhumanresourcesshouldberemodelledwithinre-organisedcatchment-basedservicestoensureequityandpriorityinservicedevelopments.

8 8.3

17.3 Otheragenciesmusttakeuptheirresponsibilitiesinfullsomentalhealthservicescanusetheirfundingformentalhealthresponsibilities.Mentalhealthservicesshouldnotprovidethebroadrangeofserviceswhicharemoreappropriatelyprovidedelsewhere.

Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework)

17.4 Approximately1,800additionalpostsarerequiredtoimplementthispolicy.Thissignificantnon-capitalinvestmentwillresultinmentalhealthreceivingapproximately8.24%ofcurrent,non-capitalhealthfunding,basedon2005figures.

7 7.1


Quality Framework


17.5 Recognitionmustbegiventotheneedforextrafundingforareasthatexhibitsocialandeconomicdisadvantagewithassociatedhighprevalenceofmentalillhealth.

5 5.1

17.6 Resources,bothcapitalandrevenue,inthecurrentmentalhealthservicemustberetainedwithinmentalhealth.

8 8.1

17.7 Thefulleconomicvalueofpsychiatrichospitalbuildingsandlandsshouldbeprofessionallyassessedandrealised.

8 8.1

17.8 Provisionofcommunitymentalhealthcentresasservicebasesformultidisciplinarycommunitymentalhealthteamsshouldbegivenpriority.

1,2,3,5 1.2,1.3,1.5,2.3,3.5,5.1

17.9 Thecomprehensiveandextensivenatureofthereorganisationandfinancingofmentalhealthservicesrecommendedinthispolicycanonlybeimplementedinacompleteandphasedwayoveraperiodofseventotenyears.

Allstandards

18.1 Education&Training(E&T)shouldbedirectedtowardsimprovingservicesasaprimarygoalandmusthavethewelfareofserviceusersasitsultimateobjective.

2,3,7 2.1,2.2,2.3,3.5,7.2

18.2 Trainingprogrammesshouldemphasisetheacquisitionofskillsthatareclinicallymeaningful,shouldtrainpersonnelforleadershipandinnovativeroles,andshouldfosteranattitudeofcriticalenquiryandself-scrutinyinrelationtoservicedelivery.

7 7.2

18.3 ThereshouldbecentralisationoftheplanningandfundingofeducationandtrainingformentalhealthprofessionalsinnewstructurestobeestablishedbytheHSEincloseassociationwiththeNationalDirectorateofMentalHealthServices.ThiscentralisedE&TauthorityshouldbeconstitutedtorepresentstakeholderandserviceuserinterestandE&Tbodiesrepresentingalldisciplines.

7 7.2,7.3

18.4 TheHSEshouldcommititselftoadequate,rationalandconsistentfundingofE&T.Howevertheaccreditationofcoursesshouldremaintheresponsibilityoftherespectiveprofessionalbodies.

7 7.2

18.5 FundingofHSEsponsoredtrainingcoursesshouldbeestablishedonasecurebasistoallowforexpansionanddevelopmentofthesecoursesandtoensuremanpowerrequirementsinmentalhealthservicescanbemetincomingyears.

7 7.2

18.6 Amulti-professionmanpowerplanshouldbeputinplace,linkedtoprojectedserviceplans.Thisplanshouldlookattheskillmixofteamsandgeographically,takingintoaccounttheservicemodelsrecommendedinthisreportandshouldbepreparedbytheNationalMentalHealthServiceDirectorateworkingcloselywiththeHealthServiceExecutive,theDepartmentofHealthandChildrenandserviceproviders.Thisshouldincludeconsiderationofare-allocationofresourcesworkinggrouptoensureequitabledistributionofmanpowerresourcesacrossthefourregions.

7 7.1

18.7 Familyfriendlystaffpoliciesandflexiblerosteringwithprovisionofsuitablechildcarefacilitiesisanimportantissuefortherecruitmentandretentionofstaff,asishelpwithhousing,particularlyforforeignnationals.

7 7.1

18.8 Aflexibleretirementpackageshouldbeconsideredtomakethebestuseofvaluableexperiencedstaff.Thiswouldenablestaffnearingretirementtomoveintopart-timeworkwithoutreducingpensionbenefitortoretirewhilecarryingonwithfullorpart-timework.Staffearlieronintheircareershouldbeabletotakeacareerbreakandstillcontributetotheirpensionbenefits.

7 7.1

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Quality Framework


18.9 Futuremanpowerrequirementsmustbedrivenbyservicerequirementsratherthanhistoricalfactorsandshouldnotbeweddedtotheperceivedneedsofanysinglediscipline.

1,3,7 1.1,1.2,1.3,1.5,3.5,7.1

18.10 Withinthecontextofoverallservicechanges,manycurrentlyemployedstaffwillneedtoredefinetheirroleinthelightofthedevelopmentofnewcommunity-basedteamsfocusingonearlyintervention,assertiveoutreach,crisisresolutionandhometreatment.Appropriatetrainingshouldbeavailableforaffectedstaff.

3,7 3.5,7.1,7.2,7.3

18.11 Apersonaltraininganddevelopmentplanorequivalentshouldbeintroducedforallgradesofstaffinthementalhealthservices.Thisshouldhelpmanagerssetprioritiesfortheuseofresourcesinordertomeetcommonneedsmoreefficiently,organisestaffreleaseandtargetandschedulein-houseeducationandtraining.Inthisregarditisalsoimportanttomakeavailableclearinformationaboutroutestoemploymenttrainingandcareerprogressionwithinthementalhealthservice.

7 7.1,7.2,7.3

18.12 ThequalityandscopeofundergraduatemedicaleducationprogrammesshouldbereviewedandtherecommendationsoftheFottrellreporttoincreaseintakeshouldbeadopted.

7 7.1

18.13 Currentstepstorevisepostgraduatetraininginpsychiatryshouldbeundertakenwithaviewtoincreasingthenumberofgraduatesinthisspecialityandequippingthemwiththerangeofskillsrequiredwithintheproposedrestructuredmentalhealthservice.

7 7.1,7.2,7.3

18.14 TheGPtrainingbodyandthepsychiatrytrainingbodiesshouldjointlyreviewallissuesinrelationtomentalhealthtrainingforGPs.

7 7.1,7.2,7.3

18.8 Aflexibleretirementpackageshouldbeconsideredtomakethebestuseofvaluableexperiencedstaff.Thiswouldenablestaffnearingretirementtomoveintopart-timeworkwithoutreducingpensionbenefitortoretirewhilecarryingonwithfullorpart-timework.Staffearlieronintheircareershouldbeabletotakeacareerbreakandstillcontributetotheirpensionbenefits.

7 7.1

18.9 Futuremanpowerrequirementsmustbedrivenbyservicerequirementsratherthanhistoricalfactorsandshouldnotbeweddedtotheperceivedneedsofanysinglediscipline.

1,3,7 1.1,1.2,1.3,1.5,3.5,7.1

18.10. Withinthecontextofoverallservicechanges,manycurrentlyemployedstaffwillneedtoredefinetheirroleinthelightofthedevelopmentofnewcommunity-basedteamsfocusingonearlyintervention,assertiveoutreach,crisisresolutionandhometreatment.Appropriatetrainingshouldbeavailableforaffectedstaff.

3,7 3.5,7.1,7.2,7.3

18.11 Apersonaltraininganddevelopmentplanorequivalentshouldbeintroducedforallgradesofstaffinthementalhealthservices.Thisshouldhelpmanagerssetprioritiesfortheuseofresourcesinordertomeetcommonneedsmoreefficiently,organisestaffreleaseandtargetandschedulein-houseeducationandtraining.Inthisregarditisalsoimportanttomakeavailableclearinformationaboutroutestoemploymenttrainingandcareerprogressionwithinthementalhealthservice.

7 7.1,7.2,7.3

18.12 ThequalityandscopeofundergraduatemedicaleducationprogrammesshouldbereviewedandtherecommendationsoftheFottrellreporttoincreaseintakeshouldbeadopted.

7 7.1

18.13 Currentstepstorevisepostgraduatetraininginpsychiatryshouldbeundertakenwithaviewtoincreasingthenumberofgraduatesinthisspecialityandequippingthemwiththerangeofskillsrequiredwithintheproposedrestructuredmentalhealthservice.

7 7.1,7.2,7.3


Quality Framework


18.14 TheGPtrainingbodyandthepsychiatrytrainingbodiesshouldjointlyreviewallissuesinrelationtomentalhealthtrainingforGPs.

7 7.1,7.2,7.3

18.15 Acommonfoundationcoreprogrammeforallstudentnurses,followedbyspecialisttraininguptothepointofregistrationasapsychiatric,intellectualdisabilityorgeneralnurseshouldbegivenseriousconsideration.Intheinterim,shortenedtrainingshouldbeavailableforallqualifiednurseswishingtoregisterinanyoftheothernursingdisciplines. 7 7.1,7.2

18.16 TherecommendationsoftheNursingandMidwiferyResource,July2002FinalReportoftheSteeringGroup“TowardsWorkforcePlanning”shouldbeimplementedinfullandfurtherdevelopedonamultidisciplinarybasis. 7 7.1,7.2

18.17 Thenumberofpsychiatricnursesintrainingshouldbekeptunderconstantreviewtoallowscopeforthefuturedevelopmentofgeneraladult,childandadolescentandotherspecialistmentalhealthservicesandprimarycareteams.

18.18 Thesponsorshipschemeforexperiencedcareassistantstotrainasnursesshouldbemaintainedandextendedtoensureappropriate,matureapplicantsareattractedintothepsychiatricnursingprofession. 7 7.1

18.19 Thereisnoofficialrequirementtoinvolveserviceusersandcarersintheeducationandtrainingofpsychiatricnurses.Itisrecommendedthatserviceusersandcarersshouldbeconsultedandinvolvedinthedevelopmentofeducationalprogrammes.

2,3,6,7,8 2.3,3.2,3.4,3.5,6.1,7.2,8.3

18.20. Specialistandadvancednursepractitionerrolesfornursesinintellectualdisabilityshouldbedevelopedinresponsetoidentifiedneedsofpeopleusingtheservice. 7 7.1

18.21 Amentalhealthtrainingmoduleshouldbemandatoryandstandardisedinsocialworktrainingtoensureallstaffespeciallythosewithoutpracticeexperiencehaveabasicunderstandingofmentalhealthissuesandmentalhealthservices. 7 7.1-3

18.22 Asignificantincreaseinthenumberoffundedpostgraduatetrainingplacesforclinicalpsychologyisneededurgentlytofillthecurrentshortfallandmeetprojectedmanpowerrequirements.Additionalappointmentsatseniorgradeshouldbeestablishedtofacilitatesupervisedclinicalplacementsforthoseintraining.TheuseoftheAssistantPsychologistgradeasacareerstepshouldalsobeconsidered. 7 7.1

18.23 Inordertoincreasetheattractivenessofmentalhealthsocialworkandoccupationaltherapyposts,existingdeficienciesintermsofprofessionalandgeographicalisolation,lackofsupervisionandpoorfacilitiesshouldbeaddressed. 2,7 2.3,7.1

18.24 Itisrecommendedthatthepositionofmentalhealthsupportworkerbeestablishedinthementalhealthsystemtosupportserviceusersinachievingindependentlivingandintegrationintheirlocalcommunity. 7 7.1,7.2

18.25 Advocacytrainingprogrammesshouldbeencouragedandappropriatelyfinanced. 2,3,6,7 2.1,2.2,3.3,3.4,3.5,6.1,7.2

18.26 ANationalManpowerPlanningGroupshouldbeestablishedtomakerecommendationsregardingtheeducation,trainingandworkforceissuesarisingfromthisreport,withreferencetoclinicalpsychology,counsellingpsychologyandpsychotherapy. 7 7.1,7.2,7.3

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Quality Framework


18.27 Avarietyofprogrammesshouldbeinplacefortheworkplacesuchasinductionprogrammes,healthandsafetyprogrammes(forexample,cardio-pulmonaryresuscitation)andtraininginconductingstaffappraisals. 7 7.2,7.3

18.28 Theestablishmentofstructured,accreditedtrainingcoursesandothermeasurestosupportandencouragevolunteeringinthementalhealthserviceshouldbeconsideredwithinthebroadcontextofeducationandtraining. 7 7.2

19.1 Serviceusersandcarersshouldhavereadyaccesstoawidevarietyofinformation.Thisinformationshouldbegeneral(e.g.onmentalhealthservicesintheirarea)andindividualised(e.g.informationontheirmedication).

1,2,3,5,6

1.1,1.3,1.4,2.1,2.2,3.1,3.2,3.3,3.4,3.5,5.1,6.1

19.2 TheHIQAshouldputmechanismsinplacetocarryoutsystematicevaluationsonallformsofinterventionsinmentalhealthandthisinformationshouldbewidelydisseminated. 7,8 7.4,8.2

19.3 Measuresshouldbeputinplacetocollectdataoncommunity-basedmentalhealthservices. 8 8.2

19.4 InaccordancewiththerecommendationintheNationalHealthInformationStrategy,anelectronicpatientrecord(EPR)shouldbeintroducedwithauniqueidentifierforeveryindividualinthestate. 8 8.2

19.5 Anationalmentalhealthminimumdatasetshouldbeprepared,inconsultationwithrelevantstakeholders. 8 8.2

19.6 Mentalhealthservicesshouldimplementmentalhealthinformationsystemslocallythatcanprovidethenationalminimummentalhealthdatasettoacentralmentalhealthinformationsystem. 8 8.2

19.7 Anationalmorbiditysurveyshouldbecarriedouttodeterminetheprevalenceofmentalhealthproblemsinthepopulation. 7 7.4

19.8 Researchshouldfocusonmentalhealthservices-outcomes,policyandservice,andeconomics-creatinganevidencebaseformentalhealthcare. 7,8 7.4,8.1,8.2

19.9 TherecommendationsoftheHealthResearchStrategyshouldbefullyimplementedasthefirststepincreatingahealthresearchinfrastructureinmentalhealthservices.

19.10 Anationalmentalhealthservicesresearchstrategyshouldbeprepared.

8 8.1

19.11 DedicatedfundingshouldbeprovidedbytheGovernmentformentalhealthserviceresearch.

7,8 7.3,8.1,8.2,8.3Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework).

19.12 Peoplewithexperienceofmentalhealthdifficultiesshouldbeinvolvedateverystageoftheresearchprocessincludingthedevelopmentofresearchagendas,commissioning,overseeing,conductingandevaluatingresearchaswellassupportingtheuseoftheemergingevidencebaseinpolicyandpractice.

2,3,8 2.3,3.4,3.5,8.2,8.3

19.13 Mentalhealthresearchshouldbepartofthetrainingofallmentalhealthprofessionalsandmentalhealthservicesshouldbestructuredtosupporttheongoingdevelopmentoftheseskills.

7 7.2,7.3,7.4


Quality Framework


20.1 ItwillbetheresponsibilityoftheHSEtoensuretheimplementationofthismentalhealthpolicy.Thekeyrecommendationsofthepolicymustbeseenasinter-relatedandinterdependentandshouldbeimplementedasacompleteplan.

8 8.3

20.2 TheNationalMentalHealthServiceDirectorate,inconjunctionwiththeHSE,shouldputinplaceadvisory,facilitatoryandsupportcapacitytoassistthechangeprocess.

8 8.3

20.3 ThefirststepsthatshouldbetakentoimplementthispolicyincludethemanagementandorganisationalchangesrecommendedinChapter16andtheprovisionoftrainingandresourcesforchange.

8,7 8.3,7.2,7.3,7.4

20.4 Mentalhospitalsmustbeclosedinordertofreeupresourcestoprovidecommunity-based,multidisciplinaryteam-deliveredmentalhealthcareforall.Aplantoachievethisshouldbeputinplaceforeachmentalhospital.

1 1.3

20.5 AnindependentmonitoringgroupshouldbeappointedbytheMinisterforHealthandChildrentooverseetheimplementationofthismentalhealthpolicy.

Theouterlayeroftheframeworkacknowledgesthatmentalhealthservicescannotbelookedatinisolationbutareanintrinsiccomponentofsociety(SeeS2.3FormatoftheFramework.

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Appendix D Relevant Acts and

related Documents

Thefollowingisanonexhaustivelistoflegislation,regulations,professionalstandards,codesofethicsandrelateddocumentsrelevanttoprotectingandrespectingtherightsoftheserviceuser:

• EuropeanConventiononHumanRightsAct2003

• UNPrinciplesfortheprotectionofpersonswithmentalillness,andtheimprovementofmentalhealthcare(MI,1991)

• MentalHealthAct2001

• MentalHealthAct2001(ApprovedCentres)Regulations2006

• EqualStatusActs2000to2004

• MentalHealthCommissionRulesR-S59(2)/01/2006–RulesgoverningtheuseofECT

• MentalHealthCommissionRulesR-S69(2)/02/2006–RulesgoverningtheuseofSeclusionandMechanicalmeansofbodilyRestraint

• MentalHealthCommission-CodeofPracticeCOP-S33(3)/01/2006-CodeofPracticerelatingtoadmissionofchildrenundertheMentalHealthAct2001

• MentalHealthCommissionCodeofPracticeCOP-S33(3)/02/2006–CodeofPracticeontheuseofphysicalrestraintinapprovedcentres

• AGuidetoEthicalConductandBehaviour(MedicalCouncil,2004)

• CodeofProfessionalEthics(PsychologicalSocietyofIreland,2003)

• CodeofEthicsandProfessionalConductforOccupationalTherapists(AssociationofOccupationalTherapistsIreland,2002)

• IASWCodeofEthics(IrishAssociationofSocialWorkers,2006)

• CodeofProfessionalConductforeachNurseandMidwife(AnBordAltranais,2000)

• VulnerableAdultsandtheLaw(TheLawReformCommission,2006)

• MentalIllness:TheNeglectedQuarter(AmnestyInternational,2003)

Appendix E Reasons for lack of attention

to the economics of quality

Reasons Explanation

Blindness Toseepoorqualityapersonmustbeabletoseethepossibilityofthingsbeingdonetherightwayorofnoerror.Peoplegrowaccustomedtowasteanderrorsandnolongernotice.

Responsibility Healthcareprofessionalsaremoreinterestedinclinicalqualityandoutcomesthaninsavingresources.Theydonotseereducingcostsandsavingmoneyastheirresponsibility,orsomethingthattheirtimeisbestusedfor.

Incentives Healthcareprofessionalsdonotbelievethattheywillbeallowedtokeepanysavingswhichtheymake.Theyseethemselvesasspendingtimeon“non-clinical”mattersfornobenefittothemselvesortheirpatients.

Negativeperceptionsaboutqualitymethods

Manyhealthcareprofessionalsarescepticalornegativetowardsorganisationalqualityinitiativeswhichtheyperceiveasaddingbureaucracy,andtakingresourcesfrompatientcare.Manydonotseequalitymethodsasbeingeffective.

Knowledgeandskill Healthcareprofessionalsandmanagersdonotknowthatcarefullymanagedqualityimprovementcanresultinbetterservicequalityandcostreduction,andhavenoexperiencemanagingprojectstoachievethis.Theyarenoteducatedaboutthesubject,trainedinhowtoreducewaste,orinhowtoselectandmanagequalityprojectsforresults.

Fear Inpublicservicesmanagersareafraidtotalkaboutreducingcostswhentryingtogetaqualityprogrammeacceptedbypersonnel.Theyfearthatpersonnelwillseejoblossesandefficiencysavingsasthemainmotive.

Researchandlocalapplication Whichqualityinitiativesresultinthemostqualityimprovementandwhicharemostcosteffective?Largeamountsoftimeandmoneyarespentondifferentqualityactivities,butlittleisknownabouttheireffectiveness,comparativeeffectivenessorcosteffectiveness.Itisalsodifficulttotranslatetothelocalsituation.Thereisneedformoreevidence,moreskillstoassessandapplytothelocalsituation,andmoreeconomicresearchintoqualityactivities.

(Source:Øvretveit2000)

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Appendix F Phases of Continuous Quality

Improvement (CQI)

Harrigan(2000)identifiedfourphasesintheprocessforCQIwithinahealthservicesystemasfollows:

(a) Awareness

(b) Planning

(c) Deployment

(d) Fullintegration

(a) Thefirststageintheprocess,awareness,includesthreechallenges:

1. movementfromtheacceptanceofthestatusquotoanacknowledgementthatthereisadifferencebetweenhowtheserviceisperformingandhowitcouldbeperforming.

2. theservicerealisesthatthedefinitionofqualityhaschangedandplacesmoreemphasisontheserviceuser.

3. theemphasisontheindependenceofthehealthserviceproviderchangestoanemphasisontheinterdependenceonallpersonsinvolvedinprovidingqualityofcare,includingtheserviceuser.

CQI demands major changes in managementphilosophy and behaviour. It is crucial that beforeimplementation begins the mental health serviceleaders such as senior management teams andseniormentalhealthprofessionals fullyunderstandtherequirementfororganisationalfocus,energyandresources.

(b) Planninginvolvesanumberofsteps:

1. DevelopmentofageneralCQIplan

i. goalsforimplementation

ii. definecriticalsuccessfactors

iii. identifyactionsrequired

2. Establishstructurestosupporttheplan

i. Creation of a high-level action team toguide implementation. This may be anexistingcommitteeoranewgroup.Thesize and nature of the mental healthservice will determine the compositionoftheteam.

ii. The high level action team identifiesimportantissuestoberesolvedbyinitialprojectteams.

iii. Facilitators to support theimplementation of the qualityframework for mental health servicesareselectedandtrained.

iv. Communication systems which includeeffectivefeedbackaredeveloped.

(c) Deployment involves dissemination across themental health services by including the dailymanagement of CQI as an integral part of allstakeholdersworktoprovidethebestpossiblequality of care, building on initial results andcontinuing training in quality methods.Deploymentinvolvesthefollowing:

1. Communication and celebration: Changesshould be communicated and resultscelebrated.

2. Benchmarking: the mental health servicebenchmarks its own performance againstbest practice from other services. This willfacilitate the refinement and developmentof new standards of performance andcontinuousqualityimprovementwillbegin.

3. Serviceuserparticipation:Thementalhealthservicecontinuestoinvolveserviceusersinmentalhealthservicechanges.

(d) Full integration is achieved when internalstructures and processes within the mentalhealth service are in alignment with thecontinuous quality improvement approach.Serviceusersareinvolvedfromtheoutset.

1. Participative management styles arethe norm with quality values part ofmanagementonadaytodaybasis.

2. The quality framework implementationplanismodifiedtoachievegoals.

3. Progress is evaluated with evidence ofimprovement in performance of thewhole system of mental health caredelivery.

AccordingtoHarrigan(2000) it takesaminimumof five years for continuous quality improvementto be integrated. (CQI Implementation Phasestablebelow).

Movement from one phase to another is nota linear approach. For example some of thestepsoutlinedbelow inphase2maybe takeninphase1.

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CQI Implementation Phases

Phase 1 Phase 2 Phase 3 Phase 4

Building Awareness Planning Deployment Full Integration

Time: 6 months 18 months 36 months 60 months

Educateseniormanagersandkeymentalhealthcareprofessionals

Obtaincommitmenttothequalityframeworkformentalhealthservices.

Determineorganisationalreadinessforchange

Clarifystrengthsandidentifyopportunitiesforimprovement

Identifyandunderstandserviceuserexpectations(MentalHealthCommission,2005a)

Formulatecommunicationplan

Developimplementationplan

BuildstructuretosupportCQI

Trainandpreparefacilitators

Selectandlaunchinitialprojects

Buildcommitmenttothequalityframeworkformentalhealthservicesthroughleadershipandcommunication

Refineplan

Communicateandcelebrateinitialresults

Continuetrainingprogramme

Rolloutacrossthementalhealthservices

Establishbenchmarksforthestandards

Seekfeedbackfromserviceusersandproviders

Recordorganisationalprocesses

implementsystemchanges

Maintainmomentum

Evaluateprogress

MakeCQIthemanagementapproach

Involveserviceusersinallprocessesfromthebeginning

Improveprocessescontinuously

Source(adaptedfromHarrigan2000,p119)

Published byMental Health CommissionSt. Martin’s HouseWaterloo RoadDublin 4

Tel: + 353 (0)1 636 2400Fax: + 353 (0)1 636 2440Email: [email protected]

Designed by Penhouse Design www.penhouse.ie

ISBN: 978-0-9553994-1-1

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