Mr. Hugh Kane:

Good morning. I thank the committee for inviting me to attend. As members know, I chair the oversight group that will review A Vision for Change, the national policy on mental health. I am doing this in a voluntary, no-fee capacity and I am not an official in the Department.

The Joint Committee on the Future of Mental Health Care and our oversight group share many of the same concerns. We are both concerned with ensuring that there is a long-term vision for mental health care. We are both aware of the responsibility to meet the mental health needs of all of the citizens of Ireland. Perhaps crucially, we are both aware of the need to ensure that our recommendations are informed by the realities of our mental health services while also balanced by the improvements that we must see forthcoming.

The starting point is the background to both of our discussions, namely, A Vision for Change, which set out a ten-year policy framework for Ireland's mental health services. While its term came to an end last year, its recommendations helped to shape our current mental health system and many of these remain at the heart of effective and appropriate mental health services. The policy proposed an holistic view of mental illness, recognising that biological, psychological and social factors contribute to mental health problems. It proposed a person-centred approach, recognising a need for the voice of the service user to be heard, and highlighted the importance of community and social inclusion in recovery, with interventions aimed at maximising recovery.

We cannot ignore the fact that issues exist within the mental health system. Difficulties in recruiting staff, such as consultant psychiatrists across all specialties and psychiatric nurses, have had a significant impact on the delivery of services. We can also see disparity in the HSE performance reports, with some areas enjoying excellent levels of staffing and low waiting lists while others are not so fortunate. However, it is important to note that progress has been made in implementing many of the recommendations contained in the report. A number of service improvements have been implemented in parallel with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities that are better suited to modern mental health care. Service improvements include the development of adult and child and adolescent mental health services, coupled with shorter episodes of inpatient care, the adoption of a recovery approach in the delivery of services and, crucially, the involvement of service users in service planning and delivery. The importance of working collaboratively with service users and their family members and carers was formally recognised in 2016 with the establishment of the Mental Health Engagement Office within the HSE.

Other ongoing developments include the development of counselling services at primary and secondary care levels, for example, early intervention at primary care level; a greater awareness of fostering mental health promotion in society through campaigns like Let's Talk and #LittleThings; the publication last year of the expert review group report on the Mental Health Act 2001 and the suicide prevention strategy Connecting for Life; a reduction in the child and adolescent mental health service, CAMHS, waiting lists for those waiting more than 12 months, although there is still more work to be done in that respect; and the commencement of work on the new national forensic hospital to replace the Central Mental Hospital in Dundrum.

These achievements are all steps in the right direction. However, in taking any further substantive step towards positive change, we need to first ensure that we are all travelling in the right direction. Any action taken must be evidence based and continue to carry the ethos of person-centred care that was originally espoused in A Vision for Change.

With this in mind, an evidence-based expert review was commissioned by the Department of Health in September 2016 from Work Research Centre. This evidence review examined the implementation of A Vision for Change and considered how future policy and services might be better directed. The review was completed in February and provides evidence to determine the policy direction for a revision of A Vision for Change in terms of international best practice and the experience of implementing the policy. The report covers the following main topics: mental health situation, policy and services in Ireland today; prioritising mental health as a major societal issue; primary prevention and positive mental health; recovery, social inclusion and living well with mental illness; mental health care provision; and mental health system governance and financing. It presents a broad overview and mapping of evidence and developments in the mental health area that may be helpful in guiding policy development and practice. It does not present recommendations. Rather, it provides an unbiased resource from which information can be drawn.

The next step was the establishment of the oversight group to oversee additional policy priorities for mental health based on the outcome of the expert review. I was appointed to chair that group on 18 July and its membership will be finalised by the end of this month. We held an initial meeting of the group on 5 October to discuss our final terms of reference and finalise our membership. Further to this group, we will have a stakeholder consultation and appropriate additional advice and input will be sought throughout the process.

The priorities of the oversight group will include, but not be limited to, the following: primary prevention, early intervention and positive mental health; the integration of care and delivery systems between primary and secondary services; the development of e-mental health responses, which is important for younger people, who are more familiar with this area; workforce planning, forecasting and skill mix, including mechanisms to attract and retain staff; emerging needs of vulnerable groups, people with comorbidities and specialist needs informed by the relevant clinical programme; and the development of research, data and evaluation capability to ensure that the achievement of the best mental health outcomes can be demonstrated within the resources available.

The oversight group will be requested to produce a high-level policy framework that sets out future service priorities. We will submit our report for consideration to the management board in the Department of Health and the Minister of State for mental health and older people, who may subsequently submit proposals to the Cabinet sub-committee on social policy and public service reform for approval. While the work of the oversight group is just beginning, we must ensure that our final recommendations are implementable and achievable. Initially, we will focus on what will be good outcomes that demonstrate a better life for those who access the services. With this in mind, it is planned that a successor policy to A Vision for Change will include a multi-annual implementation plan to inform the allocation of resources in future years. As committed to in the Dáil, the HSE will be directed to develop a multi-annual approach to the development of mental health services.

I would be happy to address whatever questions or comments that members may have.