Date Published: 15 February 2007

Community residential mental health services – A time for change (Ireland)

Health News from the Republic of Ireland (Eire).

The first comprehensive study of community residential mental health services will be launched today by the Mental Health Commission. The study was carried out by a research team at the Health Research Board (HRB). Findings indicate that the goal of a recovery orientated service, in which service users are empowered to take more control of their lives and participate more fully in society, has not yet been realised. ‘A Vision for Change’ – the Report of the Expert Group on Mental Health Services recommended in 2006 that recovery should inform every aspect of service delivery and that service users should be partners in their own care.

According to Brid Clarke, Chief Executive at the Mental Health Commission:

" The number of people living in community residences has risen from 900 to 3065 in the past twenty years. These residences are now central to the provision of mental health services in Ireland and are shaping the lives of more than 3000 people. It is essential that we review the extent to which they are meeting the needs of service users. It is clear from the results that while most residents are happy with their current accommodation, there is still a high level of dependence and we have not achieved the level of recovery anticipated 20 years ago."

Dr Donna Tedstone Doherty, Senior Researcher at the HRB said:

" When residents were asked about their expectations and aspirations, it was clear that they would prefer to live in their own home, have greater autonomy and participate more fully in the community. Many residents were receiving more support than was necessary and the staff in the community residences were providing continuing care as well as rehabilitation. While some needs were over-provided for in terms of an excess of care, other needs were not met, such as availing of mainstream employment and housing. Both residents and staff believed that they had a limited opportunity of getting housing from the local authority.

_ Mental health services have historically provided community-based accommodation for those with persistent mental health problems who require housing. This places an additional financial burden on mental health services. This study highlights the need for local housing authorities to meet their statutory obligation to cater for persons with mental health problems and the importance for intersectoral groups representing housing and mental health interest to progress this issue," said Dr. John Owens, Chairman, Mental Health Commission.

An objective assessment of a sample of residents revealed that the residents’:

  • social and occupational functioning was at a relatively high level
  • symptoms were mild and stable and that
  • they had few physical health disabilities that would limit social or physical activities

These findings indicate that many residents have the potential to live more independent and interactive lives in a community setting than is currently the case. The survey results show that although the majority of residents went out into the community on their own, few availed of community facilities. Notwithstanding this many of the residents reported that they exercised their right to vote.

" Many residents acknowledged the support provided by the staff in helping them to cope," said Dr Tedstone Doherty.

" Residents reported that staff were the main providers of psychological, social and practical support. There was a lack of external support from those outside of the residences and in many cases families and friends were not used as a support network," she explained.

The report revealed that there was a clear lack of multidisciplinary and recovery teams for the provision of evidence-based rehabilitation programmes. Only two sectors within the Health Service Executive (HSE) local areas had multidisciplinary rehabilitation and recovery teams and these had yet to receive the full complement of staff. There was little involvement of residents in their own care and treatment. Individualised care planning that incorporated the residents’ expectations and aspirations for the future was generally lacking.

The study makes recommendations for the future development of mental health services community residences so that it reflects a recovery-oriented service. Recommendations focus on action in three key areas, the adoption of the philosophy of recovery, the adoption of comprehensive and vigorous rehabilitation services and the future provision of housing.

According to Dr Ruth Barrington, Chief Executive at the HRB, the study is good example of how the Mental Health Commission and the Health Research Board are working together to use research and information to improve the quality of services for people with mental health problems.

 

Source: Health Research Board (Ireland).

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