Deinstitutionalisation in the mental health system: How far have we come?

1. Deinstitutionalisation in the mental health system:How far have we come? Focus Ireland Policy Conference 25th September 2014 Shari McDaid, Director

3. Our goal is for an Ireland where people with mental health difficulties can recover their well-being and live a full life in their community.

4. Unite – inform - advocate

5. Recovery = Social Inclusion Recovery is not just about becoming well - it’s about recovering your life. €

6. Recovery = social inclusion “personal responsibility must be matched with social responsibility.” Mary O’Hagan, Survivor Activist

7. MHR advocating for housing supports • National Disability Strategy Stakeholders Group • Housing Strategy for People with Disabilities sub-group on mental health • MHR’s Homeless Sector Advisory Group • Pre-budget submissions • Tenancy sustainment support • Designated places for people transitioning from HSE mental health service accommodation • Protecting rent supplement

8. Deinstitutionalisation in Ireland Inpatients in Irish psychiatric units and hospitals 1956-2013 adapted from Health Research Board: Irish Psychiatric Units and Hospitals Census 2013 Bulletin

9. Where did people with enduring mental health difficulties go? • 2,790 beds in HSE high, medium and low support accommodation in 2011 • Rise in prison population • 2.6% of sentenced prisons with severe/enduring mental disorder • 7.6% of remand prisoners • Ireland commits over 300 people to prison each year w/ six month prevalence of severe/enduring mental disorder • 66% of homeless service users in Cork Simon Community have a mental health difficulty • Living with parents? • Living in isolation in the community?

10. Current issues • Impact of the wider housing crisis • Difficulties discharging people from inpatient units • Lack of appropriate accommodation • Discharged into homeless hostels • Gaps in mental health support within homeless services • Lack of in-house or on-tap mental health expertise • Difficulties accessing support in a crisis • Difficulties accessing support for people with a dual diagnosis (mental health and addiction)

11. Policy on housing for people with mental health difficulties • A Vision for Change • Little to say • Equal right to housing • Housing for people with mental health difficulties should be the responsibility of local authorities

12. Housing Strategy for People with a Disability 2011-2016 Strategic Aim 5: “To address the specific housing needs of people with a mental health disability, including through the development of frameworks to facilitate housing in the community, for people with low and medium support needs moving from mental health facilities, in line with good practice.”

13. Housing strategy for people with a disability 2011-2016 Commitments: • Local authorities to include pwmhd in housing plans • Framework for transition from HSE accommodation to appropriate community settings • Identify a funding stream for accommodation needs • Examine potential for transfer of low and medium support residences to local authorities/VHAs • Ensure HSE provides mental health supports • Examine potential of tapered, ‘Housing First’ supports

14. Housing strategy for people with a disability 2011-2016 Commitments (cont’d): • Guidance for local authorities and VHAs • National data system for homeless services • Effective discharge plans for people leaving residential, acute or prison settings • Support befriending services • Mental health awareness training for local authority staff • Etc.

15. On MHR’s current pre-budget campaign • Campaign for €50m investment in community-based mental health services and 24/7 crisis supports. • Target: 20,000 signatures. So far: 13,000. www.mentalhealthreform.ie/petition2014 #MentalHealthLifeSaver

16. www.mentalhealthreform.ie • Twitter - @MHReform • www.facebook.com/mentalhealthreform • Email: info@mentalhealthreform.ie • Tel: 01 874 9468 • Coleraine House, Coleraine St., Dublin 7