Mr. Hugh Kane:

I thank the Chair and members of the joint committee for inviting us to today's meeting. I recognise the work the committee has completed thus far. The members of oversight group, including me, have read with interest the two reports published by the committee.

As I indicated during my previous appearance, the work of the Oireachtas Joint Committee on the Future of Mental Health Care and the oversight group share many of the same concerns. The work of the oversight group has, in the first instance, concentrated on assessing A Vision for Change, our national mental health policy, to determine what changes are needed to this foundation to refresh it in today's context. While the term of this policy came to an end last year, many of its recommendations helped to shape our current mental health system and remain at the heart of effective and appropriate mental health services. With this in mind, it was important to take a considered and staged approach to this work. In line with the oversight group work plan, consultation is taking place will continue in the coming weeks and feedback will be incorporated into the final report. This approach is similar to that taken by the joint committee, which has heard from different stakeholders over the course of its work. It is with interest that the group has observed the insights provided by the committee meetings. Our group will consider the stakeholder feedback in our discussions as we deliberate on how best to include it as we proceed.

My purpose this evening is to share with the committee the work of the oversight group of which I am chair. While I am sure members are familiar with the context within which the oversight group was created, I will nonetheless begin at the initial stages of the group. A Vision for Change was published in 2006 and set out a ten-year policy framework for Ireland's mental health services. It recommended that interventions should be aimed at maximising recovery from mental illness and building on service user and social network resources to achieve meaningful integration and participation in community life. It was welcomed as a progressive, evidence-based policy which guided the development of our mental health services towards a new model of service delivery, one which would be service user centred, flexible and community-based.

A Vision for Change highlighted many areas which were in need of increased attention in the shift from a service with an institutional focus to a community-based service, and many of the recommendations are still valid today. However, A Vision for Change came to an end in 2016 and preparations for a review and updating of policy have been under way since early 2016. The initial step was the commissioning of an evidence-based expert review in September 2016. This looked at the implementation of A Vision for Change and how future policy and services could be improved. The review provides evidence to inform the policy direction for a revision of A Vision for Change, both in terms of international best practice and the experience obtained since the adoption of the policy. It presents a broad overview and mapping of evidence and developments in the mental health area that are helpful in guiding policy development and practice in Ireland. Coincidentally, the report was published on the same day as the joint committee was established in July 2017.

In October 2017, the Minister for Health established the oversight group which was tasked with producing a high-level policy framework setting out future service priorities. I was honoured to be appointed by the Minister to chair the group. In considering the appropriate membership, it was decided to keep the group small, efficient and inclusive of leaders in the area to ensure a clear focus on the task of producing a refreshed policy in a timely manner. The oversight group, in line with its terms of reference, is overseeing the development of this refreshed policy for mental health, based on the recommendations arising out of the expert review and other relevant contributing documents. Work is scheduled to conclude in December of this year.

The oversight group engaged in a detailed consideration of current policy actions and recommendations.

It established a number of subgroups to focus on specific areas of attention, including child and youth mental health, the mental health of the over-65 age group and examination of policy outcomes. The outcomes subgroup focused on how outcomes can operate as a paradigm shift within the system to work better and more efficiently and to serve the service user in a better way, drawing from existing research and practice. The oversight group has determined that its work will have a focus on developing measurable outcomes within an outcomes focused framework.

An ecological framework will also inform the refreshed policy. This approach focuses on both population level and individual level determinants of health and interventions. It is acknowledged in much recent research that health is determined by influences at multiple levels, such as public policy, community, institutional, interpersonal and intrapersonal factors. An evaluation of the current context and how that relates to A Vision for Change and other current mental health related policies was also deemed necessary. This document examines whether specific actions have been implemented and, if so, to what success. The evaluation also examines whether specific actions have been implemented through other policies in this area and considers whether actions are still relevant if they are not implemented. I understand this is the document the committee referred to in its second interim report. A preliminary report has been received and is tabled for discussion at the next meeting of the group which takes place tomorrow. Following this meeting, the researcher will be asked to finalise the report. When this final version is received it will be shared with the members of the committee.

I also note that the committee has referenced engagement with the Department of Health as an area for action in its second interim report. As mentioned in my letter to the committee last December, the oversight group agreed to report further to this committee when the initial part of our deliberations was completed. As members will have seen in the oversight group's work plan furnished to the committee in March 2018, these deliberations have taken place mainly within the oversight group up to this point. While we have not been in a position to share working documents, I reassure the committee of our shared goal and the oversight group's ongoing commitment to this goal.

We are currently engaged in a stakeholder consultation process and we have just left the first advisory group meeting this afternoon. For this part of the process two half-day meetings have been scheduled - one today and the other, which was due to be held in June, will be in September. At these meetings we will gather input from mental health clinical experts who currently work in front-line services and service user representative organisations. It has been important to the group that the positive aspects of A Vision for Change would not be lost. The group is attentive to its mandate which is to complete a refresh of A Vision for Change. The oversight group is working on developing a framework document that will both guide the stakeholder process and assist the oversight group to work within a shared vision. Stakeholder feedback received is extremely important to us and it is hoped that all relevant information received will inform the recommendations in the refreshed report.

While the final domains have yet to be decided, it is anticipated that the following five domains will be considered: social inclusion and recovery; prevention and early intervention; access, co-ordination and continuity; improvement and innovation; and accountability and transparency. Outcomes and specific actions will then flow from these domains. Enablers that exist will also be explicitly recognised, as it is important to note what has contributed to the positive aspects of current service provision in order to ensure it continues. Wider public consultation is also set to take place in Dublin, Cork and Sligo in August. All of this feedback will be incorporated into the work of the group, with the group ultimately producing "an updated draft policy framework which sets out current and future service priorities within a time-bound implementation plan". The feedback from these stakeholder sessions and the working document mapping recommendations against current context, alongside any other completed items of work, can be provided to the committee once available.

The oversight group acknowledges the good work completed by the Oireachtas committee. In several of our meetings it was agreed that the existence of the Oireachtas committee was a very positive development because its work would assist greatly in ensuring that the policy refresh would have political support. The oversight group is clear that the terms of reference ask it to focus on refreshing policy. Policy determines outcomes for individuals in need of mental health support and shares a vision of what good mental health outcomes should be. This differs from the work of the joint committee, whose focus is on service improvement, staff shortages and funding. There is certainly a role for both groups and working together will result in a real shift in prioritising mental health in government, resulting in positive changes in policy and service provision.

Once again I thank the committee for inviting us to today's meeting. I will be happy to take any questions.