Dr. Shari McDaid:

Maternal mental health has been very neglected partly because A Vision for Change did not speak to it. A review of A Vision for Change needs to keep the good parts and we need to continue the implementation of its good parts while addressing its significant gaps. A Vision for Change does not mention gender even once in its hundreds of pages. It is out of step with the mental health policy we need, which would recognise that there are particular issues for women, men, the LGBT community and everybody else.

A Vision for Change is also not very helpful in the area of dual diagnosis with an addiction or substance misuse issue. It speaks very lightly around the issue of cultural sensitivity to mental health services and does not suggest what this should look like. We have had a lot of conversations about gaps in mental health services but we have huge undercapacity in our primary care system in the context of mental health and that is partly because A Vision for Change did not get specific enough about what primary care for mental health should look like. In the absence of such a policy, what happens? The service provider goes off and does their own thing, or nothing. The HSE responds to criticism but without a policy basis and it may not even respond where a particular focus is not placed on an area.

We need an updating of A Vision for Change. It needs to be a consultative process and to happen quickly. The document specified that a review should happen between seven and ten years after the policy has been published but we are now in the 11th year since A Vision for Change was published so we are overdue. We are looking for the continued implementation of A Vision for Change but also a fairly rapid and pragmatic review which involves consultation with people to address the gaps.

It is not just the policy that needs to be reviewed. The mechanism for implementation must also be reviewed. The HSE has been reconfigured numerous times during the lifetime of A Vision for Change and it is being restructured again at the highest management level. Those of us in mental health reform fought hard for a senior manager in the health service to be designated as responsible for mental health, the national director for mental health whom we now have. However, we are now going to lose that role as it will be combined into a number of other areas. Historically, mental health has persistently suffered from being the Cinderella in the wider health system and it is still under-invested in terms of the overall health budget, with just 6% of that budget going towards mental health care. Mental health has to be visible in the new structures of the HSE and in what comes after the HSE, if we every get beyond it. It has to be designated as having its own space. We are at risk of going backwards to a stage where mental health was not particularly visible and was a soft touch for savings when savings were needed.