issue 6, november 2011 - health service executive

Issue 6, November 2011

Minister of State for Mental Health opens new Department of Psychiatry Admissions Unit: A Vision for Change Chapter 17 Ms. Kathleen Lynch, T.D., the Minister of State for Disability, Equality, Mental Health and Older People, has officially opened the new Department of Psychiatry Admissions Unit on the grounds of Letterkenny General Hospital. The Department of Psychiatry Admissions Unit, which is part of Donegal Mental Health Services, has 34 beds offering inpatient care to service users over 18 years of age, along with mother and baby accommodation and facilities which are specifically designed to accommodate people over 65 with particular mental health needs. In addition, the local Mental Health service focus on rehabilitation and recovery will be enhanced by the fully equipped recreational and occupational therapy departments at the new unit, along with administration,

treatment, teaching and tribunal facilities.

Congratulating the Donegal Mental Health Services on progress made in the implementation of ‘A Vision for Change’, Minister Lynch remarked that "the Donegal Mental Health Service has reached a significant milestone here today; the old institution

at St Conal’s has closed, community services have been developed and the new acute admissions unit is being opened. Yes, I am very happy to report that ‘A Vision for Change’ is alive and progressing well in Donegal." The Department of Psychiatry Admissions Unit consists of a single storey building with a total floor area of approximately 1,790m2. Construction started in March 2010 and the project cost €5.95m in total. The new unit will support a comprehensive integrated mental health service for a defined catchment area of approximately 145,000 in population. It will provide a wide range of treatments, multidisciplinary interventions, counselling and support geared towards meeting individual needs. Speaking at the official opening on Monday, John Hayes, HSE Area Manager for Donegal, said; “The

opening of the new unit is a great step forward in the delivery of mental health services in Donegal. In addition to the new unit we have a community mental health team located in the primary care centre in Letterkenny; a new base was established in Donegal Town for Child and Adolescent Services in the past eighteen months; and rehabilitation services were established.

These developments are a tribute to the HSE Staff in the mental health services and their drive to modernise and de-stigmatise mental health services. The common goal is simply to provide the best service in an environment which promotes recovery and well

being for patients who use the service”. Effective from Monday, 19th September, the telephone numbers for the new Department of Psychiatry Admissions Unit are: 074 91 04700/ 07491 04704 / 087 6182621

Service users celebrate success of completing new self harm reduction programme: A Vision for Change Chapter 15

12 service users from the HSE South’s North Lee adult mental health services in Cork graduated on September 14th 2011 having successfully completed a new self-harm reduction programme, called the “Endeavour Programme”. The graduates received their certificates from Cork’s Lord Mayor, Cllr. Terry Shannon at Cork City Hall.


The graduates have been diagnosed with borderline personality disorder, which is recognised by its key features of difficulties in managing emotions, continual self-harm and repeated suicidal behaviour. They have been learning how to cope with these difficulties through intensive individual therapy and by learning alternative healthy coping skills and behaviour. The Endeavour programme is an evidence based treatment using dialectical behaviour therapy (DBT), a treatment developed by Dr. Marsha Linehan, a US based clinical psychologist. The treatment is comprised of group skills training, individual therapy and phone coaching (9am to 9pm Monday to Friday and 2 to 6 pm on Saturday and Sunday) to help clients let go of self-destructive behaviour and improve their quality of life. The programme began in early September 2010 and ran for a period of 12 months. Self-harm and repeated suicidal behaviour is a growing problem in Cork and indeed nationally in recent years. To tackle this, six HSE South staff with backgrounds in psychology, psychiatry, nursing and art therapy based at the HSE South’s North Lee Adult Mental Health Services developed and co-ordinated the Endeavour Programme for people diagnosed with borderline personality disorder. A Vision for Change (2006), the national mental health policy document highlights that given the complexity of their presentations, individuals with borderline personality disorder present a significant challenge for mental health services. Due to their severe self-damaging behaviours, these individuals can find it difficult to engage in standard care and don’t respond well to typical treatments. Family

members and others who are concerned for a person

with BPD commonly report feeling overwhelmed and traumatised by the behaviours that frequently accompany borderline personality disorder (suicide attempts, intense anger and self-harm). This results in highly stressful and chaotic situations for the person and their families. According to Daniel Flynn, Senior Clinical Psychologist and leader of the Endeavour Programme, “This is a comprehensive treatment programme for patients with severe self-harm. It represents how existing mental health staff can work in a co-ordinated fashion to deliver highly effective evidence-based treatments to chronically self-harming and suicidal clients with minimal additional costs to the HSE. These clients normally have frequent contact with GPs, emergency departments and multiple hospital admissions in the context of emotional distress and self-damaging behaviour. Today 12 programme graduates and their families should see a marked decrease in this behaviour, which will improve their lives and that of their families and should also reduce their crisis attendances at our heath facilities.”

Mr. Flynn and two colleagues Dr. Mary Kells, Clinical Psychologist and Ms. Sarah Herley, Assistant Psychologist are also trained to deliver a 12 week family treatment programme to accompany the Endeavour programme. The Family Connections Programme developed by Dr. Alan Fruzetti and Dr. Perry Hoffman in the United States educates families about borderline personality disorder and helps them to cope more effectively with the challenges posed by their loved ones' emotional and behavioural problems. According to Mr. Flynn, “This has been invaluable to families who have in many cases struggled for years in not understanding their loved ones' difficulties and feeling isolated and marginalised. The Endeavour Family Connections Programme has allowed families to meet, gain understanding, learn coping skills and gain support from the service and each other. This has helped reduce both levels of family stress and anxiety in coping with the behaviours associated with their loved ones' condition.” Mr. Flynn acknowledged “the hard work and dedication of both staff and programme participants in making the inaugural year of the Endeavour programme such a success” and announced that he was “delighted that funding has been secured from the HSEs National Office for Suicide Prevention (NOSP), to expand the programme beyond North Lee to all of Cork county in early 2012. This should enable us to offer the Endeavour programme to an additional 36 service users and their families, with the potential to expand this further in time.” Maura (not her real name), one of Endeavour’s graduates said, “After 25 years of chronic low self-esteem, a combined total of 12 year’s hospitalisation on foot of repeated self-harming behaviours and


multiple suicide attempts, my life is now transformed. I am now working and studying part-time, I am using the skills from the programme and at last I am living life. I am so grateful for DBT and to the Endeavour team. Without them I would not be here today. I could not have lived another year as I was.” Families also appear to have benefited greatly from their improved understanding of their loved one's difficulties and have begun to make changes too. One of the graduates’ family members was able to go on holidays this summer for the first time in years. Gretta Crowley, Operations Manager with the HSE South said “The staff involved in Endeavour has worked very hard to develop a programme that is in-line with best international practice, and now 12 months on we have seen the positive changes that such work can bring for these individuals and their families. The Endeavour programme represents the first comprehensive DBT programme in Ireland outside of Dublin. This graduation ceremony marks the end of a year of intensive intervention for the programme participants and celebrates the ongoing commitment of the HSE South in providing effective treatment for those impacted by self-harm and chronic suicidal thoughts. New funding from NOSP is providing for the programme’s expansion throughout Cork county along with research projects, which will further our knowledge and understanding of the challenges faced by this client group and their families.”

For more information please contact North Lee Adult Mental Health Services 021-4921632

WORLD MENTAL HEALTH WEEK EVENT: A Vision for Change Chapter 5

The North Strand Community Mental Health Team, organised a multi-agency open day event to mark World Mental Health Week. The theme of the day was ‘Resilience’. Over 25 local and national groups participated and the event was supported by Eileen Dunne. The event reflected the team’s philosophy that positive mental health is supported and promoted by many local and non-statutory agencies within the community, in addition to HSE services. The participants included local counselling services for young people and adults, training/education centres, family support services, suicide prevention and public advice services. The North Strand Community Mental Health Team had presentations on recovery process, mood and food, health body-health mind (exercise) and on how a multidisciplinary team approach works well in mental health. Feedback from the event was very positive from both participants and public –

‘good to learn there is help out there for people my age’ ‘great health promotion’ ‘great to see services from different aspects of mental health’

-North Strand Community Mental Health Team.

For more information please contact: North Strand Community Mental Health Team members Antoinette Hughes, Michael McCormick or Laura King on 01-8554590

Addressing Mental Health needs in the context of Primary Care: A Vision for Change Chapter 7 In 2010 primary care teams were first offered the opportunity to participate in the “Mental Health in Primary Care” module in DCU. This course raised our awareness of the mental health needs of the general population and the potential role of primary health care professionals in addressing these needs. Through our own practice and discussions with other primary care team members and community workers it was apparent that stress and anxiety were affecting people significantly in the community. In response to this we ran a 6-week “stress and well-being”


programme earlier this year in a local community centre. On Average, 13 people attended the group. This resulted in positive outcomes based on the pre- and post-assessments used. Given the success of this programme and level of demand we are currently running a second programme with 18 people enrolled.

It is hoped that this type of programme will promote the mental health of participants and equip them in

dealing with stress and anxiety. For more information contact: Marie Kinsella (Social Worker: Dublin South Central) and & Jennifer Clarke (Occupational Therapist: Dublin South Central) on 01-4150131.

Recovery & Mental Health personal story on overcoming depression with Recovery International: A Vision for Change Chapter 12 Wednesday evenings are Recovery nights. It has been 6 years since I started attending Recovery International. I now value my mental health. I have it because I practiced Dr. Abraham Lows’ method to get it. This includes both self-spotting and peer comments on others’ examples. My life has changed because Recovery International has given me more hope and motivation than I could ever imagine.

I first had depression about three years after the breakdown of my marriage. During my working days and looking after my daughters, I had days of staying at home and thinking inner dark thoughts. At work I was bullied and really felt put down and suffered from low self-worth and self-esteem.

For years I was filled with fear and feelings of inadequacy. I was overcome with fatigue, depression, anxiety, no spontaneity, fear of being in crowds and fear of isolation. I just didn’t want to exist. I stayed in bed, moving only when I absolutely had to. Some days the effort of trying to decide what to eat, make school lunches and getting up was so overwhelming. After a few years with a variety of different support groups and anti-depressants, I felt I was living in a fog. I remember telling my counsellor, I was having a breakdown. This understandable person, told me about a self-help organization called Recovery International in my local area.

I went along to my first Recovery group meeting in Clontarf. I was so taken in by the support and understanding of what Recovery is about. Meetings are a place where peace and calm are fostered. Reading the work of Abraham Low’s book ‘Mental health through will training’ is the fundamental source of Recovery International. Gradually, my fears changed from hopeless to hopeful. Today, I have completed a third level degree and postgraduate course and I am the assistant leader for the Clontarf Recovery Group. I am more confident and less fearful than previously in terms of raising my emotional self-esteem. Most importantly, my daughters are my life greatest achievements.

It takes time to learn the method, but Recovery International has thought me to break everyday life into situations in part acts. I am incredibly grateful to be part of Recovery International. It has helped me to speak about mental health problems. Depression took over a big part of my life, but thank goodness, so does Recovery International. It is hard work but the quality of life is improving day by day!

For further information on Recovery International and a Group near you, contact: www.recovery-inc-ireland.ie Tel: 01-6260775


HSE National Office for Suicide Prevention Look after your Mental Health on World Mental Health Day Help those around you and seek support when you need it: A Vision for Change Chapter 15.7

According to the World Health Organization, up to one in four people will experience a mental health problem at some point in their lives. With that in mind, the HSE today (Monday 10th October, 2011) on World Mental Health Day, is advising of the importance of seeking help when times are tough, and listening to people around us who need support through its mental health public awareness campaign.

Catherine Brogan, Acting Director, National Office for Suicide Prevention said “The key message of the ‘Your Mental Health’ campaign is that sharing a problem with someone you trust will have a positive effect on how you are feeling. We need to encourage people to seek information, support each other and

know that when things are tough they can turn to someone they trust. This is so important for us all given the current economic downturn, and the impact it is having on people’s stress levels and well being.” The HSE encourages people to seek out support by visiting www.yourmentalhealth.ie. The site is part of the HSEs National Office for Suicide Prevention’s ongoing public education campaign, and helps visitors to learn about their own mental health and how to look after it. It also provides a wide range of information on mental health topics, and shows how and when to access help and support services.

For more information please contact National Office for Suicide Prevention on 01-635 2179

Crumlin & District Mental Health Association Cairde Le Chèile Social Club Trip to France: A Vision for Change Chapter 12.

Our group gathered at Armagh Road on Monday 20th June to go on our holidays to France. We set off towards Rosslare Harbour and boarded the Oscar Wilde Car Ferry on time. We had our evening meal and watched the entertainment, afterwards we headed to our personal cabins to sleep through the overnight trip to Cherbourg.

We arrived in France on Tuesday and drove straight to our first destination the IBIS Hotel in Caen. On Wednesday we started with a thoroughly ‘al la François’ breakfast. We had good fun following the


strict instructions and Brendan did a sterling job following the sometimes confusing guiding voice issuing from the satnav along the French roads and motorways. We journeyed to Omaha Beach – the site of the Normandy Landing in 1944, during World War II.

On Thursday we went to Lyon Sur Mer, another site of the Normandy Landing during the Second World War 1940 - 1945. Stephen, Peter, Mary and Brendan had a swim in the Atlantic Sea. The other members of the group had tea on the terrace overlooking the beach. The scenery and weather were beautiful.

Friday brought us to Lisieux, the home of Saint Thérèse of Lisieux and on to Bayeux, where there is the wonderful Bayeux Cathedral. Stephen went to see the beautiful Bayeux tapestry which is a thousand years old. The tapestry is woven in fabric that epics the Conquest of England by William the Conqueror in the battle of Hastings in 1066. It was all most interesting. On Saturday we were free for

shopping at the fabulous French markets. After Sunday mass we had lunch and headed off in the afternoon to Cabourg. This is a beautiful seaside resort not unlike the famous French Riviera. The weather was so good that day and the golden beach was heavenly that Mary described it as not unlike paradise.

On Monday we stopped at Port En Basin and went to a war museum of tanks, guns and old boats that were abandoned at Dunkirk. We headed for the ferry home. The entire trip was a great success and an adventure enjoyed by all. A notable landmark in Cairde Le Chèile activities.

For more information please contact Crumlin Mental Health Association, St Columbas, Armagh Road, Crumlin, Dublin 12 086-287 3526 Crumlin & District

Mental Health Association

Mental Health Awareness at Trinity College A Vision for Change Chapter 5 Trinity College played host to a panel of Dragons on Tuesday 25th October as part of The Dragon’s Den of Mental Health. This event was organized by DCU Psychological Society, in conjunction with the 2 Student Peer Support Services and TCD Students’ Union, for TCD Mental Health Awareness Week.

Five “Dragons”, representing various mental health organizations, were asked to describe their ideal vision of how mental health should be treated and then asked what they think is truly realistic, given logistical constraints. Audience members were free to ask questions throughout, leading to a stimulating and engaging discussion.

The panel consisted of:

Brian Howard - CEO, Mental Health Ireland. John Saunders - Director, See Change and Shine, Cindy O'Connor - Clinical Director and CEO, Pieta House, Tim Smyth - Headstrong Youth Ambassador, Nigel O'Callaghan - ReachOut Ambassador.

After an hour or so, a competition was run. Headstrong provided a fund of up to €2000 for any student to run a project within the college community in order to improve mental health awareness or promote positive mental health. The panel listened to 5 shortlisted finalists propose their ideas before deciding Róisín Garvey, a final year Law student, was the deserved winner.

Róisín's project, entitled "Caoga", the Irish for fifty, involves the dispersion of information cards across Trinity campus. There will be 50 different types of cards; each will fall under one of three headings: 1.Tips on improving your mental health e.g. take part in physical exercise 2. Information on the services available in and out of college e.g. counselling service details, Samaritans, DubDoc 3.Statistics and details on different psychological disorders e.g. symptoms of bipolar disorder. Róisín plans to have these cards distributed around college -


on every lecture seat, bathroom, table and notice board and given out by lecturers to first year students. The first student to collect all 50 cards will win a prize for their class.

HSE West Cork Mental Health Services receives a commendation in 10th Annual Irish Healthcare Awards: A Vision for Change Chapter 9 West Cork Mental Health Services (WCMHS) received a commendation under the category ‘Best Public Health Initiative’ at the 10th Annual Irish Healthcare Awards ceremony which took place in Dublin recently.

West Cork Mental Health Services received this commendation for their project entitled ‘Making the “Vision” a Reality’. Changing the underlying culture is always the most difficult task for any organisation. Yet in the field of mental health, this is exactly what is demanded by our national policy on mental health, ‘A Vision for Change’. In West Cork they have sought to make this a reality by:

• Service user and carer involvement at every level

• Strong community involvement • Working in partnership with the wider

community and voluntary agencies • A genuine multidisciplinary commitment to

care and assessment • The centrality of ‘Recovery’ philosophy

Dr Pat Bracken, Clinical Director of the West Cork Mental Health Service said: ‘We are very honoured to be recipients of this commendation from the Irish Medical Times. Everyone knows that it is hard to get everything right in the field of mental health. We have genuinely tried to make the vision of Vision for Change’ a reality in West Cork. We have worked to provide a service in which the values of respect and dignity are the bedrock underpinning all other interventions. This has resulted in a very positive atmosphere in both our inpatient and outpatient facilities. We initiated a ‘residential review’ of our service users in residential facilities, which resulted in a number of them moving to more independent living conditions in the community” Ms. Gretta Crowley, Operations Manager for the Mental Health Services in Cork said “This is a fantastic achievement in one of the toughest

categories. It is really important to us as it is a reflection of the commitment our staff and the local partner agencies have undertaken to provide and sustain a high-quality mental health services for the people of West Cork. Involving service users in service design and delivery in a meaningful way is a key element of our transformation programme and I am very proud of the achievements of everyone involved. We came together with other organisations to create the West Cork Mental Health Forum, in which individuals and organisations work together to combat stigma and to create supports for service users and their families” Mr. Michael Bambrick, Director of Nursing for West Cork Mental Health Service said “To receive this commendation is a great honour for all staff in the service. Collaborate working with positive attitude and values are key components in the provision of good mental health care. This commendation affirms this direction of care and I am very proud of our staff’s achievement. We appointed a team coordinator who receives all referrals and liaises actively with GPs and other services. We developed an active counselling and psychotherapy programme, which is strongly integrated with the multidisciplinary team and we developed a range of therapeutic groups (creative writing, art, music, and gardening) in our resource centre. For more information contact Michael Bambrick,

Director of Nursing, West Cork


WHO Award for High Support Unit in Mountjoy Prison: A Vision for Change Chapter 15.1

The High Support Unit in Mountjoy Prison has won an international World Health Organisation (WHO) award. The Best Practice Award for Prison Mental Health was presented at the international health body’s 2011 network meeting on October 5th in Abano, Italy.

The unit, which was initiated by the HSE’s National Forensic Mental Health Service in collaboration with the Irish Prison Service, received the “WHO Health in Prison – Best Practice Award” under the category “Health Care services provided to Prisoners”. Mountjoy Prison’s 10-bed High Support Unit, which opened in December 2010, provides a dedicated area within the prison where mentally ill and vulnerable prisoners, who present with a risk of harm to self or to others, can be separated from the general prison population and closely monitored in a safer environment.

Historically, in the Irish Prison Service, at-risk prisoners were accommodated in Special Observation Cells (SOCs) for considerable periods of time. The use of SOCs has been criticised by the Council of Europe Committee for the Prevention of Torture. The primary aim of the psychiatric in-reach team at the HSE National Forensic Mental Health Service in seeking to set up the HSU in Mountjoy was to reduce the frequency and duration of time spent by prisoners in SOC cells, within Mountjoy Prison, through providing an alternative environment that is less restrictive and provides increased observation and interaction with staff.

The High Support Unit is staffed by trained prison officers who expressed an interest in working in this area. There is regular input by staff from the Central Mental Hospital, which includes a weekly multi-agency meeting between clinical and prison staff. Each prisoner’s treatment plan, progress and future placement is reviewed on a weekly basis.

To-date over 70 prisoners have benefited from this facility. Many of these prisoners were mentally ill and are now able to access treatment much earlier in more humane conditions:

Most importantly, since the setting up of the HSU, there has been a significant reduction in the frequency and duration of use of SOCs in Mountjoy prison. The average monthly rate of occupancy of SOCs has fallen by 35% since the High Support Unit became operational.

Speaking about the success of HSU, Dr Damian Mohan the unit’s consultant forensic psychiatrist and said, “The High Support Unit signifies a change in custom and practice in how individuals who are mentally ill are dealt with in the prison population. The advent of the unit improves conditions for those prisoners waiting for admission to the Central Mental Hospital – these prisoners can now be cared for in much more humane conditions”.

The team from the National Forensic Mental Health Service included Dr. Damian Mohan, Consultant Forensic Psychiatrist, Dr. Yvette Giblin, Registrar in Forensic Psychiatry and Mr. Andy Kelly, Community Psychiatric Nurse. Mr. Enda Kelly, Senior Nursing Manager with the Irish Prison service and clinical lead for the project said, “This award recognizes the collaborative effort of everybody involved in this initiative - it wouldn’t have been possible to establish the High Support Unit without the support of the, Governor Edward Whelan and the willingness of a select group of highly motivated prison officers who expressed an interest in training and working with prisoners with mental


health needs”. He added, “The Award is for best practice within the establishment, and recognises the achievement of Mountjoy prison as a whole rather than any individual”. The HSU has recently been visited by the Inspector of Prisons, Judge Michael Reilly. It is the inspector’s intention to propose that the Irish Prison service should adopt the Mountjoy Prison HSU model as a template for the other prisons within the service.

Notes to editor: � Reasons for admission to the HSU

A third (34%) of all patients accommodated on the HSU reported psychotic symptoms. A further 29% were referred due to the immediate risk of self-harm. 19% were accommodated on the unit due to the need for various medical treatments and increased observation. 9% of prisoners were referred for specialised treatment by the Addiction Psychiatry team. 8% of prisoners presented with emotional distress in the context of stressors. One prisoner was accommodated on the HSU due to the acute risk he posed to others.

� Outcome of Assessment in the HSU The majority (30%) of patients accommodated on the HSU were diagnosed with a major mental illness. 22% required short-term increased support but did not have a mental illness. A further 11% were deemed to be feigning symptoms of mental illness in order to seek refuge on the HSU. 6% were diagnosed with a personality disorder and 3% of prisoners had a learning disability.

� The initiative has been cost neutral to both the HSE and IPS with no net change in total staff allocated to Mountjoy by either service.

More information on the WHO Best Practice Awards is available on: http://www.euro.who.int/en/what-we-do/health-topics/health-determinants/prisons-and-health/news2/news3/2011/06/2011-best-practice-awards

Mental Health Service model of good working as result of Croke Park agreement: Sligo/ Leitrim /South Donegal /West Cavan A Vision for Change Chapter 9

Backround Sligo Leitrim Mental Health Service while having a history of innovative change did encounter difficulty

in recent years with implementing some change around roster change, service development , which caused the service to freeze in time for approximately 5 years .To address and unfreeze the situation an initiative around ‘work life balance’ under the mentorship of Billy Gallagher Partnership facilitator and his team was developed which allowed staff and management to develop and grow in terms of meeting around issues that had benefits for all. This process set the tone for what has become a more positive working environment and has now been given a more structured framework under the terms of the Croke Park agreement. The Croke Park Agreement has facilitated and enabled such working with the result Sligo Leitrim Mental Health Service is implementing Vision for Change and reconfiguring existing service to meet the needs of patients into the future. The process involved the reconfiguring and redeployment of resources from existing high, medium & low support client accommodation provided by the service in the community to provision of independent accommodation by local authorities/providers and supported by appropriate health staff. It involved the redeployment of staff to different locations to facilitate change and continue to provide service in an environment of reducing resources To ensure we as a service were in line with best practice a full multi-disciplinary review of all long term residents/patients and their needs was undertaken in and as a result patients are being more appropriately placed in the community. This process and positive engagement by staff represented has resulted in our service developing two multidisciplinary community mental health teams with clinical team meetings and reviews of patients


taking place in the community, coordinated on interim basis by Assistant Director of Nursing to benefit of patients, staff and service. Outcome: We have as result of good working facilitated by Croak Park reconfigured three supervised residences which released resources to:

• Develop the provision of team base to enhance team functioning, ensure appropriate treatment and care planning in community.

• Enhance Community Mental Health Nursing Team with Community Mental Health Nurses

• Develop Liaison Mental Health Nursing in Sligo General Hospital

• Enhance working with North Leitrim Mens Group

• Enhancement of provision of Cognitive Behaviour Nurse Psychotherapy (CBT) provided to Primary Care ( G Ps)

• Enhancement of Occupational Therapy • Automation of switchboard out of hours to

release clerical resources to focus on provision of clinical support

• Centralisation of account/financial reporting • Provision of Community based

Rehabilitation and Recovery Multidisciplinary Assertive Outreach Team

Who was involved?

• The multidisciplinary team including Medical i.e. Consultant Psychiatrist NCHD, Nursing, social Work, Occupational Therapy, Administration

• The clients/patients • Families and relatives of clients/patients • Staff Representatives of SIPTU,PNA.

Obstacles overcome

• Development of vision by all stakeholders • Resistance to change • Ensuring optimum appropriate service for

clients/patients • Client/patient distress at having to move

from home • Provision of resource release to assist service

remain within budget allocation and manages the impact of staff retirements and moratorium.

How it benefits clients

• Enhanced service response /provision to patients in most appropriate setting in line with V for C policy.

• More appropriate independent accommodation for patients and facilities for service.

• More appropriate responsive service for patients and families

• Provision of Rehabilitation and Recovery Multidisciplinary Team

• Enhance Community Mental Health Nursing Team with Community Mental Health Nurses

• Develop Liaison Mental Health Nursing in Sligo General Hospital

• Enhance working with North Leitrim Mens Group

• Enhancement of provision of Cognitive Behaviour Nurse Psychotherapy (CBT) provided to Primary Care ( GPs)

• Enhancement of Occupational Therapy

• Local SLMHS staff provide cover for all assisted admissions to the Acute Unit

Cost savings

• Significant cost savings to service with increased provision in community

• Agreed redeployment of nursing ,domestic, and paramedical staff to more appropriate community service

• €40k p.a. cut from Admin overtime budget with installation of automated switchboard and willingness of nursing staff to answer calls in the nursing offices outside 9.00 a.m. – 5.00 p.m. Monday to Friday

• Weekend/Bank Holiday allowances cut from Admin budget as cover for Mental Health Administer role abolished

• Reduction of Locum Consultant costs from €250k p.a. to €50 p.a. as Consultants provide cross cover for all duties except MDTs and OPDs

For further information please contact:

Ms Caroline Flynn P.N.A. Representative - Tel 0860879397 Mr Padraig Peyton S.I.P.T.U. Representative-Tel 0868506221 Ms Joy Synnott Administrator - 0719144834 Dr Owen Mulligan Executive Clinical Director - 0719142111 Mr Patrick Benson Director of Nursing-0872222835


The Out & About Association supporting people suffering from Anxiety related conditions: A Vision for Change Chapter 11 Martin Rogan visits OANDA - A Cork based community mental health resource centre helping People with Panic Attacks and Phobias. Martin Rogan visited the Out and About Association (OANDA) on 19 October at their headquarters in Bishopstown. OANDA is a dedicated voluntary community mental health service that helps people who are afflicted by anxiety related conditions. It operates as a community based resource set up under the Government’s “Vision for Change” health policy.

In his keynote speech, Martin updated senior members of the Cork HSE and Cork mental health practitioners present about the direction of “Vision for Change” in current times. He enjoyed a very lively question and answer session thereafter.

Gretta Crowley, Local Area Health Manager, HSE South, introduced Martin to the participants and facilitated the very lively question and answer session thereafter. OANDA was represented by Robert O’Connell and Martina McElligott and HSE South by Gretta Crowley, Ber Cahill, Cariosa Lynch and Aidan Warner.

For more Information please contact: The Out & About Association, Top Floor, Wilton Park House, Bishopstown, Co Cork 021-4348728 / 087-7928579

Positive Action for LGBT Mental Health: A Vision for Change Chapter 4 By Odhrán Allen GLEN Director of Mental Health Policy The significant social change in Ireland in recent years has had a very positive impact on the lives of

many lesbian, gay, bisexual and transgender (LGBT) people. This change has enabled LGBT people to participate more fully and openly in their families, their communities, their work and in society in general. With the introduction of Civil Partnership for gay and lesbian couples this year and the government commitment to enact gender recognition legislation, Ireland is becoming a more inclusive country for LGBT people, couples and families. However, it’s clear from research in Ireland that LGBT people can still experience stress related to their identity - often termed minority stress - which can impact negatively on their mental health. Experiences such as concealing one’s LGBT identity, homophobic bullying in school, negative reactions to coming out and past negative reactions to LGBT people can put a strain on LGBT people’s mental health and well-being. Reach Out, the national strategy for suicide prevention, identified LGBT people as a group vulnerable to depression, self-harm and suicidal behaviour because of their experience of stigmatisation and marginalisation. Reach Out also identified the need for more research on LGBT mental health. With the support of the National Office for Suicide Prevention, GLEN (Gay and Lesbian Equality Network) and BeLonG To Youth Service commissioned the Supporting LGBT Lives study. This study was conducted by the Children’s Research Centre, Trinity College Dublin, and the School of Education, University College Dublin. Supporting LGBT Lives is the most comprehensive study of LGBT mental health and well-being in Ireland to date. Over 1,100 people participated in the online


survey and 40 in-depth interviews were carried out. Below are some of the key findings from the study: • Coming Out: Most young people know they are LGBT at age 12 and start coming out at age 17. The period between knowing you are LGBT and telling others can be particularly stressful for young people because of fear of rejection and isolation. For a significant minority of young LGBT people, the adolescent years are a time of particular vulnerability for depression, self-harm and suicidal behaviour.

• School: 58% reported homophobic bullying in their schools, with 40% having been verbally threatened by school peers and 25% physically threatened. 34% reported homophobic comments by teachers, 20% missed or skipped school because they felt threatened or were afraid of getting hurt because they were LGBT and 5% left school early because of homophobic bullying.

• Victimisation: 80% had been verbally threatened in public because they were LGBT while 40% had been physically threatened. 25% had been punched, kicked or beaten in public at least once. 25% had been called abusive names at work and 10% missed work because they felt threatened or were afraid of being hurt because of their LGBT identity.

• Mental Health: 27% had self-harmed and 85% of these did so more than once. 18% had attempted suicide and 85% saw their first attempt as related in some way to social and emotional stresses they experienced related to being LGBT. Over 1/3 of those aged 25 years and under had thought seriously about ending their life within the past year.

• Resilience: 81% of LGBT people are now comfortable with their identity and the majority

have developed good self-esteem and are satisfied with their lives. Friends and family, but parents in particular, play a crucial role in supporting young people as they come out and this support acts as a protective buffer against LGBT-specific stresses. Forming a positive LGBT identity developing positive coping strategies also helps people to deal with LGBT stresses. Professional support is another critical factor.

The Supporting LGBT Lives report identified a number of recommendations for a comprehensive approach to LGBT mental health promotion and suicide prevention work in Ireland across a number of sectors. With the support of the National Office for Suicide Prevention and HSE Health Promotion, the GLEN mental health programme is currently focused on implementing the recommendations of the Supporting LGBT Lives which details an evidence-based approach to LGBT mental health promotion and suicide prevention in Ireland an Irish context. This work includes building the capacity of mainstream agencies and service providers and LGBT organisations to better respond to the mental health needs of LGBT people in Ireland, through the provision of LGBT training and the development of good practice guidelines. It also includes the development of services, supports and information/education resources to improve the mental health and well-being of LGBT people and to reduce their risk of suicidal behaviour. One of these services is the national LGBT Helpline launched in November 2010 by the RTE newsreader Michael Murphy. This confidential, non-judgemental helpline provides listening, support and information to LGBT people, their family and friends 7 days a week. It was established with the support of the

Community Foundation for Ireland and is run by a network of seven regional volunteer-run helplines. The LGBT Helpline website www.lgbt.ie is a great resource for LGBT people who are looking for local support options or information. The website is also a very useful resource for professionals, support workers, counsellors or others who want to know more about LGBT issues and support options available in Ireland for LGBT people. The Supporting LGBT Lives report and other resources are available at www.glen.ie The LGBT Helpline number is 1890 929 539.

Michael Murphy of RTE launching the LGBT Helpline

Garda Liaison Inspectors (Mental Health) –Education programme:-A Vision for Change Chapter 15.1


Staff from the Health Service Executive (HSE), National Service User Executive (NSUE), and the Gardaí, delivered a one day education programme to Garda Liaison Inspectors (Mental Health) in the Garda College, Templemore. The programme focused on the legal responsibilities of both agencies under section 13 of the Mental Health Act 2001(removal and return or persons to an approved centre) and the Memorandum of Understanding (MOU), developed by both agencies detailing how this function is conducted. The ethos of both the MOU and the National Assisted Admission policy is the right of the person to dignity, bodily integrity, privacy and autonomy. This was reinforced throughout the education programme. Included in the programme was a review of the involuntary admission process of the 2001 Act, Delivered by Amelia Cox HSE- and the National Assisted Admission Policy delivered by Anthony Fitzpatrick HSE-West. Professor Harry Kennedy Clinical Director, Central Mental Hospital delivered a very interesting session on the Criminal Law (insanity) Act 2010 and Garda Philip Ryan delivered a detailed session on the MOU. John Redican, National Executive Officer, NSUE and Jennifer Kelly NSUE, delivered a session on the service users experience of mental illness. This reinforced the need for a person centred approach to this function. The days information was then put to the test using a number of case scenarios which replicated potential situations where staff of the HSE and the Gardaí have to remove or return a person to an Approved Centre. The MOU was signed on the 15th of September 2010 by the Garda Commissioner Fachtna Murphy

(retired) and Cathal Magee, CEO HSE . The MOU was developed collaboratively between the HSE and An Garda Síochána to provide an appropriate response in respect of the two agencies empowered by the Mental Health Act 2001 to remove and return persons to an approved centre. Following this education programme formal Liaison groups will be set up in each of the mental health services to implement the MOU and monitor the interface between the An Garda Síochána. A copy of the MOU can be downloaded from the MHS e-Learning hub @ www.hseland.ie In addition to the programme delivered in Templemore members of An Garda Síochána have been invited to local two day Assisted Admission Training programmes in Ballinasloe (7) and Portlaoise (6). This has proved a valuable exercise as the participating Gardaí meet the staff from the HSE who will be on the Assisted Admission team and gain an understanding of the role of HSE staff involved in this procedure. Likewise HSE staff gain an understanding of the role or An Garda Síochána in relation to the Assisted Admission/Return of a person/patient. A further Assisted Admission programme will be delivered in Naas in November and six members of An Garda Síochána will attend. Following on from the training programme participants are asked to ensure that local liaison groups are set up between An Garda Síochána and the HSE as per the Memorandum of Understanding between the HSE and An Garda Síochána.

Choosing the right suicide prevention training for you: A Vision for Change Chapter 15 AUTHOR: Anne Callanan, National Office for Suicide Prevention There has never been more choice around suicide prevention training in Ireland than there is now. This article focuses on the issues you should consider when seeking the right training programme.


Examples of Suicide specific Training

Level Type Name Audience 1 Awareness Reaching

out General public; staff and volunteers who wish to know more but have no background in this area

2 Alertness safeTALK General public; staff and volunteers who are committed to acting as a link between someone who is suicidal and someone who can provide help in a crisis; often incorporated in an organisation’s or community’s suicide prevention policy

3 Intervention

ASIST Caregivers who are highly likely to encounter individuals who are feeling suicidal

4 Management

STORM Professionals who are currently working with individuals on a long-term basis, generally in a mental health role

Considerations when selecting training programme 1. How much of a problem is suicide within the staff and client group? If suicide has not been a significant problem, but the agency simply wants to be ready should it emerge, then general awareness training for most staff, with some trained in safeTALK should be sufficient to meet its needs. An agency which regularly experiences suicidal behaviour within its client group should aim to equip its staff with the skills to ensure that they can act competently and appropriately. A mix of safeTALK and ASIST may be right for this agency. 2. Core work of the agency. If the core work of staff is around long-term mental health care for clients, then STORM may be required by relevant staff. If the work does not focus on mental health issues, a combination of awareness and safeTALK might be appropriate. 3. Previous experience/knowledge. A good rule of thumb is to start at the beginning, unless the individual has some knowledge and experience to date. 4. Personal readiness. It is recommended that any individual experiencing emotional difficulties (e.g.

recent bereavement) would not attend a training course on suicide prevention. This training can be very emotionally challenging, and it is important that individuals are well informed of the content and demands of the training. 5. Willingness to take on the responsibility conferred by the training. For example, ASIST confers a significant responsibility to ask others if they may be thinking of harming themselves, and to act on that if the answer is ‘yes’. Not everyone is comfortable with this role, and potential candidates need time to consider what is involved during and after a workshop. 6. Will the training be used by the individual? For example, it would be a waste of resources to train someone in STORM who does not provide mental health care on a regular basis. A Final Note Suicide prevention training is never enough in itself. Training is only one part of the whole picture, and agencies should also be seriously considering how to address suicide from a preventative, intervention and crisis response perspective. Only when this full overview is taken, can a complete training needs analysis be conducted to realistically assess what is needed. The training programmes are coordinated by the HSE Resource Officers for Suicide Prevention and some other partner agencies. A list of coordinators is available at www.nosp.ie . Contact [email protected] for information on training programmes


If you have an article(s) that you would like included in the next issue of A Vision for Change Advancing Mental Health in Ireland please forward to [email protected] All articles must be submitted in word format, with 250/300 words per article, photos and contact person for further information.

If you would like to advertise an upcoming event in your area or organisation please email [email protected]

Next Issue Jan 2012. Please send article(s) by January 16th

issue 6, november 2011 - health service executive

Documents