Irish Association of Social Workers’ (IASW), assessment of the progress of the implementation of A
Vision for Change,
To Margaret McGuinness,
Secretary to Independent monitoring Group,
Department of Health,
Hawkins House,
Dublin 2
Dear Ms McGuinness,
On behalf of the Irish Association of Social Workers (IASW), I would like to thank the Independent
Monitoring Group for once again inviting us to submit a report. The report was prepared by
members of IASW’s special interest group in adult mental health.
Introduction
In November 2010 IASW acknowledged that some progress had been made, but also listed areas of
perceived deficit in the implementation of A Vision for Change.
Of increased concern in the current financial climate is the risk, once again, that funding for mental
health services will be reduced disproportionally to other services. IASW believe that it is important
to ensure that mental health funding is ring-fenced to avoid this
Other key areas
1. Leadership:
 IASW believe that the absence of a body that has the authority and budgetary control to
prescribe key elements central to the implementation of A Vision for Change to all mental
health services is a significant deficit.
 The establishment of a Mental Health Directorate, with authority, autonomy and funding
responsibility to sets standards in the delivery of care nationally across all areas of mental
health is key to the successful implementation of Vision for Change On a positive note, the
Vision for Change Implementation Group, chaired by the National Director of Mental Health
Services Martin Rogan, which has representation from all core disciplines and service user
groups, has developed a number of national policy documents and guidelines for services,
 The IASW believes that a National Mental Health Service Directorate could be developed
from existing senior staff and service user representatives, with suitable clinical and
management experience and proven commitment to the policy A Vision for Change, there is
no significant cost to this. IASW argue that the body should have more than an advisory role,
with real authority to require services to implement key elements in A Vision for Change.
This directorate should provide clarity in relation to key changes and set targets for their
implementation working along key groups such as the Executive Clinical Directors, the
National Service Users Executive, the Mental health Commission and the professional
bodies. This should reduce duplication and provide an avenue to ensure that pockets of
innovation and best practice are spread across the service in the most efficient way
2. Team Co-ordinator
 While some progress has been made since 2010, it is limited with the implementation of this
valuable role in only a few services. However it is a positive development that the Vision for
Change Implementation Group has recently signed off on guidelines for the implementation
of the Team Co-ordinator. Nonetheless unless a national body dictates the implementation
with clear deadlines, IASW does not expect the implementation nationally of this role as
outlined in the document.
3. Primary Care and Mental Health:
Vision for Change recommendations regarding the effective partnership between primary
care and mental health services are not in place despite the relatively neutral cost involved,
as stated above. The Team Co-ordinator role is not in place and mental health professionals
and primary care staff are not meeting on a regular basis, despite the potential benefits.
The GP to Consultant referral remains the main source of contact. As a key
recommendation in Vision for change mental health promotion should be available for all
age groups, to enhance protective factors and decrease risk factors for developing mental
health problems. IASW sees an effective primary care service as the essential foundation
upon which an effective mental health service can be developed
4. Multi-Disciplinary Teams: IASW believes it is unacceptable that certain services have not
addressed the recommendations to recruit all the recognised disciplines that make up a full
multidisciplinary team. IASW recognise that at times some key disciplines may cover more
than one team, but there is evidence that depending on the views of a management team
some disciplines are not prioritised. The evidence is outlined in the Mental Health
Commission Reports.
5.
Each Service User should have access based on need not geographical area to all the core
disciplines: As vacancies arise in the future and subject to the HSE Moratorium being lifted,
staff replacements need to reflect the need of the service as a whole and not existing
disciplines. Services need to ensure not only that all the required disciplines are in place but
arrangements are agreed to cross cover in the temporary absence of a particular discipline.
The reality is that all mental health professionals have both shared skills and knowledge, and
those unique to their professional training, so while each professional can take on the role of
keyworker, having each professional’s perspective in discussing the needs of service users is
key to achieving the best comes for service users.
6. Performance Management and Supervision to Ensure Continuous Professional
Development: IASW is concerned that many staff working in the mental health service do
not receive supervision or appraisal. Training is often ad hoc and usually not monitored to
ensure all staff access required training.
7. Recovery Orientated Care Planning: IASW believes that the sign of effective change in our
mental health services is the achievement of effective recovery orientated care planning for
service users who are vulnerable and need support for a short or longer period of time.
There needs to be clear leadership in relation to standards in care planning that incorporate
the principles of Recovery and Users Involvement. There are pockets of excellent practice in
some areas but progress in many areas is slow.
8.
Training in Recovery: Knowledge of recovery orientated principles and how to implement
them into practice with different client groups is essential. IASW has no doubt that this
involves a change in culture and a commitment from service leaders. Unfortunately IASW
believes that there has been a failure to provide training on the important subject of
recovery principles and how to implement them in practice. IASW, is of the opinion that the
philosophy of recovery, as advocated for in A Vision for Change, has not been engaged with
in any meaningful way by a significant numbers of professional staff in acute, outpatient and
long term care settings, and as a result there has been a limited shift in the culture of
services to ones that are service user centred and recovery orientated
On a positive note it is recognised that some capital funding has been allocated to Mental
Health Services especially the development of inpatient units for Children and Adolescents and
the recent announcement that capital funding will be made available to replace the Central
Mental Hospital and develop regional Intensive Care Rehabilitation Units as outlined in A Vision
for Change. IASW are aware that funding is a now more than ever a significant impediment to
implementation of A Vision for Change, none the less there are a number of priorities that can
be implemented with relatively limited cost..
Yours sincerely
Frank Browne