Since the publication of 'Vision for Change' the argument for a radical re-appraisal of the mental health work undertaken by both primary care and community mental health (CMH) teams needs redefining. As effective treatments become available for disorders with high prevalence and low spontaneous remission rates, it is incumbent on policy makers to consider what changes need to be introduced in order to bring effective treatment to the greatest number of patients.
Of the Mental Health Service in the UK it is said: "The cardinal requirement for mental health services in this country is not a large expansion and proliferation of psychiatric agencies but rather a strengthening of the family doctor in his/her therapeutic role."
The key role played by Primary Care in the recognition, assessment and treatment of Mental Health issues is clearly articulated in Chapter 7 of the National Policy Document 'Vision for Change' (2006). The HSE has adopted the 'Vision for Change' as the primary guidance in the development of its mental health services. A patient needs to be treated by the CMH team if he or she requires a skill not available in the primary care team.
The Health Service Executive (HSE) is responsible for providing Health and Personal Social Services for everyone living in the Republic of Ireland. As outlined in the Health Act, 2004, the objective of the Executive is to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.
The HSE has embarked on an ambitious change programme, Transformation 2007-2010. The vision is that everybody will have access to high quality care and services that they have confidence in. More than two thousand GPs provide Primary Health Care services to individuals and families in Ireland. Many individuals presenting to their GPs experience mental health difficulties, ranging from mild and transitory distress to severe, enduring mental illness. International data would suggest that the majority of mental healthcare is provided by GPs, with approximately 10% being referred to Specialist Psychiatric Services.
Variance in referral rates and patterns suggests that there is an information gap between primary care providers and the specialist services.
The HSE proposes changes to the functioning of CMH team's sector area to bring them more closely into line with primary care teams. These changes include alterations to the way in which catchment areas for CMH teams are at present organised
The College of General Practitioners, in collaboration with the HSE, has extended the Mental Health in Primary Care for another three years to build on research carried out in earlier phases and resources developed thereupon.
A National Steering Group, comprising representatives from HSE, ICGP, Primary Care, Mental Health Services, Addiction Services, Psychological Services and the National Counselling Service, will support the National Mental Health in Primary Care group and sub groups to generate resources as per key themes outlined:
The Steering Group has set a number of key priority areas to be advanced in Mental Health & Primary Care:
Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness. For further details click here.
A. Getting there
People living with mental illness often face significant difficulties in travelling to health services due to either their illness or the side effects of medication. This is particularly problematic in remote and rural areas where public transport is limited or unavailable.
B. Communication barriers
People living with mental illness may also experience difficulty in absorbing complex information due to illness and / or medication side-effects, which can affect their understanding of the illness, treatment compliance, and monitoring of their health.