IN 2006, the Government’s mental health policy A Vision for Change set out its recommendations for reform of the mental health services, and described a principle of “recovery” that should facilitate service users to “learn to understand and cope with their mental health difficulties, build on their inherent strengths and resourcefulness, establish supportive networks, and pursue dreams and goals that are important to them and to which they are entitled as citizens.”
The recovery principle as set out in A Vision for Change represents a conceptual challenge to reform of the mental health services. Pointing beyond issues of quality, scope and structure, the recovery principle evokes a new ethos to underpin service delivery.
This is not a type of recovery that depends on eliminating a person’s symptoms. Rather, it is complementary to clinical improvement. It is recovery as a process as opposed to an end result. The recovery ethos is key to the long overdue transformation occurring in mental health services in Ireland.
In the 1950s, Ireland had more than 20,000 people in psychiatric hospitals – reportedly the highest per capita rate of psychiatric hospitalisation in the world at that time. In 2010, this figure was around 2,800.
The move that is underway aims to enable people to be treated for mental distress in their own community, with the continued support of their family and friends, and with access to psychologists, social workers, occupational therapists and other mental health professionals. However, for this change to succeed, we also need to see a change in mind-set and in approach, which is where the recovery ethos could make a real difference, if embedded in services.
Recovery is a very personal process of discovering one’s own strengths, values and aspirations. Many people describe it as a journey, which can take place inside or outside the mental health system, through personal development, through relationships with professionals that are built on partnership, through peer support and through community support.
For Mental Health Reform, there are five pillars to a good quality mental health service: hope, listening, partnership, choice and social inclusion.
Hope: At public consultations held by Mental Health Reform in recent years, people with experience of the mental health services have said that the hopeful attitude of a mental health worker or family member helped them to believe in their own capacity to recover.
Listening: People living with a mental health condition come to understand their condition over time, and know what works best for them. They are experts by experience. It is crucial that they are listened to.
Partnership: The recovery approach demands equality between mental health staff and people using the services. People have begun to demand the right to actively participate in their own care and recovery.
Choice: People want and need choice in terms of treatment, and there must be a range of options available that are more than simply medication, including counselling and psychotherapy, occupational therapy and home-based treatment, among others.
Social inclusion: In the words of one person who shared their story with Mental Health Reform, “people need to be more inclusive; people must take responsibility for each other. We all need to be a part of this.” The whole community can play a part in a person’s recovery.
Fulfilment of the vision of recovery set out in A Vision for Change will not be possible without adequate funding. The Government must prioritise resources for community mental health services with multi-disciplinary staff, as promised in the Programme for Government. The HSE and professional bodies must prioritise implementation of the recovery principle in A Vision for Change. Finally, society as a whole has a role to play in supporting the recovery approach.
It would be tempting to consider this vision of a recovery-oriented service as ambitious. One could argue that current resource constraints imposed on the public mental health services make such a reform unrealistic. Yet, services that listen to their “customers” are likely to produce better outcomes, as will a partnership model that involves people using mental health services as active participants in their own care.
The recovery ethos provides a new role for mental health professionals as facilitators of self-care, rather than sole providers of care. This may be the only way forward –and services that are ready to take on the challenge of the recovery ethos may well be best placed to survive and thrive in the future.
Dr Shari McDaid is Director of Mental Health Reform, a coalition of organisations, promoting improved mental health services in Ireland. Dr McDaid is one of twelve national and international speakers scheduled for the 2013 National Mental Health Conference on Wednesday, 13th November at Newbridge Primary Care Centre. See www.mentalhealthcare.ie for more detail about the conference.
For more information on the work of Mental Health Reform, visit this page or contact info@mentalhealthreform.ie.
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