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Report for Independent Monitoring GrouponHSE South Mental Health ServicesRegional Director of Operations, HSE SouthBriefing: 23 rd March 2011Developing an integrated Mental Health Servicein line with “A Vision for Change”.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | CorkTel: 021 492 8500 | Fax: 021 492 8515 | Email: RDO.South@hse.ie

1) IntroductionAcross the HSE South, Mental Health services are provided for people of all ages who need specialist assessment, careand treatment for mental illness. The priority for HSE South is to ensure the provision and delivery of a first class mentalhealth service for all. The ‘Vision for Change’ National Policy document on Mental Health details a comprehensive model ofmental health service provision for Ireland and in keeping with this policy direction, the HSE South plan for Mental HealthServices includes a range of measures aimed at improving service user health, independence and experience and, at thesame time, continuing to reconfigure service delivery to ensure increased efficiency. In line with the modernisation andreconfiguration of services envisaged in Vision For Change, HSE South continues to accelerate the programme of closureof old long-stay institutions, reduce dependency on inpatient beds and prioritise the development of community basedMental Health Services across the four extended Catchment Areas.In doing so, our strategic objectives are to:Support people’s recovery from mental illness so that they can gain as much independence as possible.Continue to develop community-based services.Provide access to appropriate primary/ community and secondary care services in a timely manner.Work in partnership with service users, carers, primary care and colleagues both statutory and voluntary.Advance the national and local governance arrangements.Develop the workforce, buildings and information systems to support improved and cost-effective care andtreatment.HSE South is committed to ongoing consultation and engagement with all key stakeholders in relation to the development ofMental Health Services including service users and representatives, staff, and local representatives. Consultation andengagement will continue in 2011 and will continue to be a critical element in the development and roll out of plans. Visionfor Change advocates a move towards a recovery orientation: ‘A recovery approach to mental health should be adopted asa cornerstone of this policy’ (A Vision for Change, p. 15). This is where it recognises that the primary knowledge of mentalhealth is with the service users and the secondary knowledge is supported by the providers. HSE South is committed to thedevelopment of a recovery orientation in the development of services. The promotion of positive mental health spans all lifestages, and in conjunction with early intervention and treatment can facilitate improved outcomes. HSE South MentalHealth Services include a broad range of acute, community and specialised inpatient services for children and adolescents,adults and older people.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 2 -

2) ResourcesThe financial allocation for mental health services in HSE South is in the order of €186m which supports the provision of thefollowing services:352 Acute inpatient beds509 Long stay beds709 Community Residential Places: 456 High Support, 137 Medium Support, 116 Low Support208 Day Hospital places639 Day Centre placesThe table below shows the population, budget and wholetime equivalents for Mental Health Services in HSE South for 2011by expanded catchment area/integrated service area.Expanded Catchment Area Population Budget 2011 Total WTE'sNorth Lee 167,701 32,014,065 383.2North Cork 80,769 22,732,537 346.26Total ECA 248,470 54,746,602 729South Lee 179,260 13,459,753 180.47West Cork 53,565 7,504,519 105.33Total ECA 232,825 20,964,272 286Total Cork 481,295 75,710,874 1,015Kerry 139,835 22,558,644 298.83Total Kerry 139,835 22,558,644 299Wexford 131,749 18,738,803 256.72Waterford 123,844 16,894,028 243.47Total Wexford / Waterford 255,593 35,632,831 500C/KK 120,631 31,681,808 466.5Sth Tipp 84,614 20,461,667 298.51Total Carlow / Kilkenny / South Tipperary 205,245 52,143,475 765Overall Total 1,081,968 186,045,824 2,5793) HSE South Governance of Vision for Change ImplementationIn HSE South the recommendations of Vision for Change form the key priorities for the development of HSE South MentalHealth Services. The HSE South Regional Management Team recently reaffirmed its commitment to the implementation ofVision for Change in the HSE South Regional Service Plan 2011 which states:‘The ‘Vision for Change’ National Policy document on Mental Health details a comprehensive model of mental healthservice provision for Ireland and in line with this policy direction, the HSE South Regional Service Plan 2011 includes arange of measures aimed at improving service user health, independence and experience and, at the same time, continuingto reconfigure service delivery to ensure increased efficiency.’HSE South, since the publication of Vision for Change has sought to develop a robust governance process for theimplementation of the change programme. In early 2008 a Regional Steering Group was established by the assistantNational Director HSE South, chaired by Mr. Dave Drohan, Lead LHM, to oversee the implementation of Vision for Changetaking the National Steering Group recommendations into account. In addition local Vision for Change ImplementationGroups were established in the middle of 2008 in each Local Health Office. A member of each local Vision for ChangeImplementation Group was on the Regional Steering Group thus providing a clear line of connectivity from local to regionalto national processes. Subsequently as the Vision for Change implementation process has developed the focus now hasshifted to the Extended Catchment Areas with the appointment of Executive Clinical Directors.HSE Organisational Structure DevelopmentThe HSE organisational structure, implemented in 2005, comprised of a hospital pillar and community pillar. While initiallyproviding a focus on acute hospitals and community services it did not enable sufficient integration between hospital andcommunity services to improve our health and social care system. As a result in 2009 the HSE took the first steps towards amore integrated organisation when it established four HSE regions, including HSE South. The rationale for the change was:To drive and support safe, quality care for patients and clientsEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 3 -

To bring decision making close to where services are deliveredTo allow clinicians to shape and assure the services they work inTo get the best health outcomes for the money spentTo plan and organise around what we know people need and what we know works to give the best resultsTo organise to meet increasingly complex patient and client needsTo remove barriers to integrated careWhilst maintaining national direction for the organisation, and in order to deliver a uniform approach across the country,operational and certain support services are now organised within four regions, HSE Dublin Mid Leinster, HSE Dublin NorthEast, HSE South, HSE West and responsibility for the delivery and management of services at a regional level rests withRegional Directors of Operations (RDOs). These regions operate within nationally determined priorities and parameters. Inrelation to care groups, priorities and parameters are determined by the Care Group Leads.Dr. Philip Crowley has recently been appointed National Director of Quality, Risk and Clinical Care as a result of a strategicdecision by the Health Service Executive to provide a greater leadership focus for two critical and complementarychallenges. These challenges are:- the development and implementation of national clinical programmes and- the strategic management of risk and quality in clinical care.Dr. Barry White will continue to lead the development of a series of National Clinical Programmes as part of the strategy toimprove the quality, access and cost of clinical services in Ireland. Given the strategic importance of these national clinicalprogrammes and the scale and scope of the implementation challenge associated with them, the Health Service Executivehas assigned Dr. Barry White full-time to lead the implementation phase in his new role as National Director of ClinicalStrategy and Programmes.Mr. Gordon Jeyes, has been appointed as National Director Children and Families Social Services, which will ensure theacceleration of the change process in Children and Families Services. In the South Mr. Dermot Halpin has been assigned toa full-time role as Local Health Manager with lead responsibility for Children and Families Services in HSE South. Mr Halpinwill have a key role in the coordination and integration of services across the South and in providing leadership and directionfor the effective implementation of the NSP requirements in relation to Children and Families Services across HSE South.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 4 -

Fig.1 Organisational Structure of the Health Service ExecutiveHSE BoardChief ExecutiveOfficerNationalDirector InternalAuditNationalDirectorCancerControlProgramme(NCCP)NationalDirectorCorporatePlanningandCorporatePerformanceRegional Directorfor OperationsHSE Dublin MidLeinster(RDO DML)NationalDirectorClinicalStrategy &ProgrammesRegionalDirector forOperations HSEDublin NorthEastNational Directors:Integrated Services Directorate (ISD)Performanceand FinancialManagement(P&FM)RegionalDirector forOperations HSESouth(RDO South)ReconfigurationNationalDirectorFinanceRegionalDirector forOperations HSEWest(RDO West)NationalDirectorHumanResources(HR)Care Group andNational LeadsNationalDirectorCommunicationsNationalDirectorCommercial andSupportServices(CSS) Estates Legal Procurement Contracts Information andCommunications TechnologyKerry ISACork ISAWaterford /WexfordOperationalAreaCarlow /Kilkenny /SouthTipperaryOperationalNote: Mr. Gordon Jeyes, National Director for Children & Families Services, & Dr. Philip Crowley National Director ofQuality, Risk and Clinical Care have been recently appointed to the National Management TeamThe organisational model has at its core a move to regional management of health services, based on the need to delivereffective local services, centred on the needs of patients and clients.4) HSE South – Regional Management TeamThe Regional Director of Operations (RDO) supported by the Regional Management Team (RMT) is fully responsible for allservice delivery and reconfiguration of all hospital and community services within the region. The Regional Director ofOperations is responsible for ensuring that all the resources available to the HSE in this region will be used in the bestmanner possible to meet the needs of people living in this region for health and personal social services.The Regional Director of Operations and Regional Management Team has the authority to make decisions locally,consistent with nationally defined policy, frameworks, performance targets, standards and resources. The RegionalManagement Team is comprised of Pat Healy, Regional Director of Operations, Richie Dooley, Operational Manager –Waterford/Wexford, Anna Marie Lanigan, Operational Manager – Carlow/Kilkenny and South Tipperary, Ger Reaney, ISAManager - Cork, Michael Fitzgerald, ISA Manager – Kerry, Raymonde O’Sullivan, Assistant National Director Finance, BarryO’Brien Assistant National Director HR, Prof. John Higgins, Director of Reconfiguration of Acute Hospital Services –SouthEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 5 -

West Acute Hospital Network (Cork & Kerry), Angie O’Brien, Area Communications Manager, and Geraldine CrowleyBusiness Manager. Arrangements are being made to provide for appropriate clinical involvement in the South East.5) Integrated Service AreasIn 2010 the priority was to design the structure below Regional Management Team level. This has now been finalised andthe implementation of Integrated Service Areas is now proceeding The intention is that, within the national & regionalgovernance framework to devolve decision to the next level of organisational management and delivery to be calledIntegrated Service Areas, which will continue to operate within national standards and frameworks for services i.e. bestpractice for specific service settings. These areas are based on primary care team and acute hospital catchment areas. InHSE South Integrated Service Areas were established for Cork and Kerry while work is continuing on determining theappropriate catchment areas for the South East. Mr. Ger Reaney has been appointed ISA Manager for Cork and Mr.Michael Fitzgerald has been appointed ISA Manager for KerryThe Integrated Services Area Manager is responsible for the safe and effective operation of all services at local level.Moving to the area management model has resulted in a significant reduction in senior management numbers, many ofwhom have left under the recent exit schemes.The ISA provides a new organisation structure for governance and accountability and supports the implementation ofsignificant change in the overall delivery of integrated services for the public. Key elements of the new model are:The ISA Manager is the single accountable person for all health and social care services in the Integrated ServiceArea.Executive Clinical Directors will be developed over time in acute hospital and hospital groups to strengthen clinicalleadership.Continuing care services for older persons will be managed by the Acute & Continuing Care Group with agreedprotocols for access from Primary Care. Community services for older people will be delivered and managedthrough Primary Care.Each Acute and Continuing Care group will have a strong management team of Executive Clinical Director,Operations Director & Director of Nursing.There will be a single point of accountability for each Acute & Continuing Care group. Initially this will be theOperations Manager with the intention to transfer to the Executive Clinical Director in time.An Executive Clinical Director for Mental Health to be a member of the ISA Management Team.Some services will be managed at national level, integrating locally to support service delivery, e.g. theAmbulance Service and the Environmental Health Service.A small group is currently finalising the arrangements for the establishment of ISAs in the South East. This group includesparticipation by senior staff from Hospitals and Community including Clinical Directors, Nursing and Allied HealthProfessional Representatives in the South East. As we progress the implementation of this model across the HSE Southwe will work closely with staff at all levels, as well as the staff associations and the wider community to ensure effectiveimplementation.While the ISA structure is being worked through, it is critical that we ensure that the existing arrangements are organised todeliver appropriate governance, accountability and quality assurance as we proceed to implement the Service Plan for 2011across HSE South. In this context Mr Richard Dooley has being assigned as Operational Manager for the Waterford /Wexford and Ms Anna Marie Lanigan has being assigned as Operational Manager for the Carlow / Kilkenny & SouthTipperaryEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 6 -

M e n ta l H e a lth S e r v ic e s H o s p ita l S e r v ic e s P rim a ry & C o m m u n ity S e rv ic e s 2B u s in e s s M a n a g e m e n tV 2 .1 – 2 2 /1 0 /2 0 1 0 - N P M OIS A M a n a g e m e n t T e a mR D OIS A M a n a g e rE x e c u tiv eC lin ic a l D ir e c to rM e n ta l H e a lth1D ir e c to r o fN u rs in g( P r im a r y , A c u te &C o n tin u in g C a r e )E x e c u tiv e C lin ic a lD ir e c to rA c u te &C o n tin u in g C a r eG ro u pO p e r a tio n sM a n a g e r A c u te &C o n tin u in g C a r eO p e ra tio n sM a n a g e r P rim a ry , &C o m m u n ity C a reG r o u pE x e c C lin ic a lD ir e c to r P r im a r yC a reF in a n c eM a n a g e rH RM a n a g e rM e n ta l H e a lth S e r v ic e sw ill b e d e liv e re d fo r ac a tc h m e n t a re a le d b y a nE C D . T h e E C D w ill h a v e aN u rs e M a n a g e r a n dB u s in e s s M a n a g e r.F u rth e r w o rk is n e e d e d o np ro p o s e d ro le s fo r k e yA llie d H e a lth P ro fe s s io n a lsin M e n ta l H e a lthH o s p ita l S e rv ic e sIn a H o s p ita l G ro u p w ith ala rg e T e rtia ry C e n tre(M o d e l 4 H o s p ita l) s e rv ic e sw ill b e d e liv e re d th ro u g hC lin ic a l D ire c to ra te s e .g .W o m e n a n d C h ild re n ’sD ire c to ra te .P r im a ry & C o m m u n ityS e rv ic e sT h e O p e ra tio n s M a n a g e rP rim a ry & C o n tin u in g C a reG ro u p w ill b e re s p o n s ib lefo r th e d e liv e ry o f P rim a ryC a re S e rv ic e s th ro u g hP C T s (5 -1 0 ,0 0 0 ). H e a lth &S o c ia l C a re N e tw o rk s (3 0 -5 0 ,0 0 0 ) a n d fo r a nIn te g ra te d S e rv ic e a re a(1 2 0 ,0 0 0 )B u s in e s s M a n a g e m e n tE m b e d d e d F in a n c e & H Rre s o u rc e s w ill b ec o n s o lid a te d to p ro v id es u p p o rt th e IS A1 . N u rs in g ro le s to b e d e te rm in e d2 .T h e Q & C C D a re d e v e lo p in g th e m o d e l fo r Q u a lity & R is k a t lo ca l le v e l6) Implementation ApproachThe model will be implemented in a phased manner. The HSE is committed to implementation of these changes using therecent public services agreement.Each ISA area will develop its own implementation plan for the national model influenced by geography, population size,existing and future configuration, but adhering to the principles of this management model. A single nominated ProjectManager will be appointed who will be responsible for implementation in each ISA. This will be supported by the IntegratedServices Programme Team and led by each Regional Director of Operations.7) Developing Clinical Leadership in the ISAThe ISA management model is based on a strong management team approach of clinical leadership, operationalmanagement and nursing leadership.A number of ISAs will be identified for early implementation of Executive Clinical Directors in Acute and Continuing Care fora defined period to enable full evaluation of the role and to identify any adjustments that are needed.It is recognised that as the existing Clinical Director role has only been in place for less than two years, it may take sometime for Clinicians to develop the necessary skills and experience to take on the Executive Clinical Director role in somehospitals. Indeed in some hospitals Clinicians may prefer to assume or continue in the Clinical Director role. The ECD roleshould only be put in place when a clinical leader emerges in a hospital or hospital group combined with a strong CEO,Director of Nursing and the necessary supports to ensure the role is a success.As we progress the implementation of this model we will work closely with staff at all levels, as well as the staff associationsand the wider community to ensure effective implementation, for example work is ongoing on aligning our nursemanagement structures with the model.8) Development of Mental Health ModelIn line with VFC recommendations four Executive Clinical Directors (ECDs) have been appointed in the HSE South. Theyhave been selected to lead on the development of executive clinical directorates in mental health based on revisedcatchment areas serving populations of approximately 300,000 as recommended in VFC. This is one of the most significantchanges to occur in Irish Healthcare for many years. Within the Mental Health Service, the development role of ExecutiveClinical Directors and the related clinical directorate will provide a pivotal point to drive service quality and theEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 7 -

implementation of the recommendations of VFC. The ECD (named below) will provide leadership and shape the direction ofMental Health Services within the expanded catchment areas of:Carlow/Kilkenny and South Tipperary - Dr Frank KellyWaterford and Wexford – Dr. Noel SheppardSouth Lee/West Cork/Kerry – Dr Eamonn MoloneyNorth Lee/North Cork – Dr. Maeve RooneyWith the development of Integrated Service Areas (ISAs) in both Cork and Kerry there will be a transition of the currentmanagement structures to reflect the new arrangements. Therefore Cork and Kerry Mental Health services will bemanaged separately by end of 2011.HSE South will accelerate the implementation of the Executive Clinical Directorate Model across the four extendedcatchment areas with appropriate integrated management and service delivery arrangements being implemented. The ECDs and management teams will be implemented in South Tipperary/Carlow Kilkenny andWaterford/Wexford in Q1 2011 where significant progress has been made in leading the reconfiguration ofservices, particularly the reduction in acute beds and the development of appropriate community and alternativefacilities in line with Vision for Change. The process for implementation in Cork and Kerry ISAs will be developed in Q1 and implemented in Q2.Currently negotiations are underway nationally with Trade Unions, within the context of the Public Service Agreement, tofinalise arrangements to facilitate the implementation of the model. Those discussions are progressing and while they havetaken a little longer than originally planned we would hope to bring them to a conclusion on the near future.9) HSE South Implementation of Vision for ChangeAs part of the early stages of this process each Local Health Office was required to undertake a Benchmarking Exercise inrelation to cross referencing existing resources with the requirements of Vision for Change. This work supported decisionmaking across the region in a context where key priorities had to be established and limited capital and revenue resourcestargeted at implementation of a Vision for Change across the four extended catchment areas.In planning the implementation of Vision for Change in HSE South there were significant challenges to be faced in the SouthEast which required urgent reconfiguration of the service both to meet the standards of Vision for Change, and to addressthe deficiencies identified in a number of key reports including the Section 55 Report, the Annual Reports of the Inspector ofMental Health Services and in ongoing engagement with the Mental Health Commission.In this regard a decision was made to target the South East initially for development. This focus on the South East hasresulted in significant levels of progress in the development of Implementation Plans, the development of the ExecutiveClinical Directors, and significant closure of wards in old institutions and transfer of patients to more appropriate settings.This has proved challenging in terms of getting buy in from staff and others but significant levels of progress have beenmade with the result that we now have two well developed management teams coming into place under the clinicalleadership of the two Executive Clinical Directors, Nursing, Management & Allied Health Professionals as well as serviceuser involvement.Given the significant change process which has been undertaken both areas are at an advanced stage, with timeboundplans and resource commitment in place for the implementation of Vision for Change.It is important to acknowledge that in progressing the implmentation of Vision for Change, choices have had to be madearound the prioritisation of developments and in that context HSE South has prioritised South Tipperary, Waterford andWexford over other areas in the region as the need was greater there. In particular the capital funding has been prioritisedto these locations to support the change programmes in these locations and we have not had available to us the resourcesrequired to finalise the closure of St. Finan’s Hospital in Kerry or the development of community based infratsruture in SouthLee. At the same time we have made progress across the whole region in terms of the development of teams and some keyspecialist services. These are summarised below:Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 8 -

• Five Psychiatry of Old Age Teams developed.• Six Rehabilitation Teams developed.• One Liaison Psychiatry Team developed• Enhancement of existing Community Mental Health Teams across the South• Development of Home Based Crisis Treatment Team/s• Consultant led Homeless Service (Cork City)• Twenty four new community Child & Adolescent Posts• Interim Child & Adolescent Inpatient Unit opened• New 20 bed Child & Adolescent Inpatient Unit opened.• Service User Involvement in development of MHS• Introduction of Peer Advocacy across the MHS• Primary Care Integration – close liaison between G.P and CMHT’s• Closure of long stay continuing care beds in traditional psychiatric hospitals and development of more appropriatecommunity facilities.• Reduction in Acute Inpatient Beds across the South.• Development of new Acute Inpatient Unit to replace existing unit in Cork University Hospital.• Development of day hospital servicesIn addition we have continued to support voluntary sector partners who are a key element of the overall change programme.10) Reduction in bed complement in line with Vision for ChangeA key priority for the HSE South has been to close the old long stay institutions and thereby reduce long stay beds and toutilise the resource freed up to support the development of community based services. At the same time we have continuedto focus on the reconfiguration of acute inpatient services in line with Vision for Change recommendations. Progress isbeing made on all these fronts.In respect of HSE South, Vision for Change recommendations indicate a requirement of 180 acute inpatient beds for thepopulation of the South that is 50 beds per 300,000 population, we currently have 352 (172 above the recommendednumbers). An important priority here is to reconfigure this service and associated resources in line with Vision for Change tosupport the delivery of community based services.The following table shows a reduction of 49% in Long Stay Beds over the last number of years. We have reduced ourcomplement by 435; from 887 in 2006/2007 to 435 in 2010 (this included high dependency and rehab beds). We arecontinuing to progress this in 2011.HighDependencySecureTOTAL2010Bedsas perVFMReport2007Total BedReductions% BedReductionsLHO/ ExpandedCatchment Area PopulationLong StayBedsRehabInpatientWaterford 123,844 54 16 0 70 132 -62 -47%Wexford 131,749 41 13 0 54 123 -69 -56%Total 255,593 95 29 0 124 255 -131 -51%Sth Tipp 84,614 55 0 0 55 133 -78 -59%Carlow/KK 120,631 45 0 0 45 109 -64 -59%Total 205,245 100 0 0 100 242 -142 -59%North Lee 167,701 51 0 18 69 76 -7 -9%North Cork* 80,769 78 0 0 78 138 -60 -43%Total 248,470 129 0 18 147 214 -67 31%South Lee** 179,260 34 0 0 34 87 -34 -39%West Cork 53,565 0 0 0 0 0 0 0Kerry 139,835 20 10 17 47 89 -42 -47%Total 372,660 54 10 17 81 176 -95 -54%Overall Total 1,081,968 378 39 35 452 887 -435 -49%*Excludes Mt. Alvernia (70) ** Excludes Heatherside (57)Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 9 -

11) Community/Specialist Mental Health TeamsIn relation to the development of Community/Specialist Mental Health Teams in HSE South as per Vision for Change, thetable below shows the number of Community/Specialist Mental Health Teams required using Vision for Change norms andthe number currently in place in HSE South. Some of the key developments have included:Services• Five Psychiatry of Old Age Teams developed.• Six Rehabilitation Teams developed.• One Liaison Psychiatry Team developed• Enhancement of existing Community Mental Health Teams across the South• Development of Home Based Crisis Treatment Team/sChild & AdolescentMental HealthServicesNo. of TeamsRequiredNo. of ConsultantledTeams in PlaceMinimum no. ofWTEs requiredper teamTotal no. ofWTEs requiredApprox no. ofWTEs in PlaceRemaining WTEsto be filled22 12 13 286 81 (28%) 205General Adult MentalHealth Services 22 1 35 2 21 468 308 (66%) 160RehabilitationMental HealthServices for OlderPeopleMental HealthServices for Adultswith IntellectualDisability10 6 22 220 44 (20%) 17611 5 12 132 38 (28%) 948 1 10 80 5 3 (13%) 75Total 72 58 N/A 1,186 476(40%) 7101 Note: This is the number of teams required as they are described in “A Vision for Change” where each CMHT has twoconsultant psychiatrists2 Note: The majority of existing CMHTs have only one consultant psychiatrist, hence the apparent excess in the number ofteams currently in place3 Note: By and large, these WTEs comprise consultant and NCHD posts associated within-patient facilities voluntaryproviders and/or stand alone community based consultant provided services12) Development of Community Mental Health Facilities in Primary CareIn the development of Primary Care Centres in HSE South facilities for Mental Health are being accommodated whererequired, this can be dedicated space in some Primary Care Centres or bookable rooms for visiting clinicians. Centres in anumber of areas have been completed and Mental Health Services has dedicated accommodation in Mallow Primary CareCentre and access to bookable rooms if required in Gorey Primary Care Centre.Developments in the following areas are progressing and are at different stages of development: Macroom, Clonakilty,Fermoy, Charleville, Schull, Ballincollig, Blackrock, Listowel, Newmarket, Kilkenny, Callan, Waterford City, Dungarvan,Enniscorthy, New Ross, Tipperary, and Clonmel. As Centres are completed facilities for Mental Health services will beaccommodated where requiredAs an example of this, developments in Kilkenny have progressed to a stage where a Psychiatric Liaison Clinic where theRegistrar for the Hospital is attending the Primary Care Centre, now runs on a fortnightly basis in Dean St. Primary CareCentre. A total of 53 patients and 59 consultations have been successfully completed since April 2010. Several of thepatients that attended the Clinic would not have attended a hospital and would therefore not have received prompt experttreatment e.g. travellers and people with perceptions regarding stigma and psychiatry. All the patients referred were of aserious and complex nature as the vast majority of patients with mental illness are treated effectively by their GP. It is worthnoting that none of these patients needed eventual inpatient treatment or even presented with severe long term illness.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 10 -

13) HSE South Capital DevelopmentsIn recent years HSE South has completed a number of significant Capital Projects in Mental Health Services. Theseinclude:Project – Brief description Year Capital Spend Additional ServiceClients ServedHSE/OtherSouthInterim Inpatient Unit for Child& Adolescent Services2009 2.2m 8 beds for Child & AdolescentServicesRegional Unit – forChildren up to 18 years.SouthInpatient Unit for Child &Adolescent Services atBessboroSth TippClonmelMental Day Centre and DayUnit (Morton St)Carlow/KKReplacement of Kelvin Grove,CarlowCarlow/KKCrisis House, KKWexfordMaryville CMHC.WexfordGorey, CMHCWaterfordGrangemore,North CorkKanturkCois Alla Housing ProjectSouth LeeCarrigaline MH ResourceCentre2010/2011 8m 20 Inpatient beds for Child &Adolescent Services (replacingthe interim bed unit)Regional Facility forchildren up to 18 years.2008/2009 1.58m Day Centre Mental Health2008/2009 3.5m Relocation of clientsinappropriately placed inPsychiatric Hosps.17 clients within St.Dympna’s Hospital with comorbidmental health andintellectual disability.2008/2010 2.5 Additional beds Mental Health2006/2007 1.22 Community Mental Health2008/2009 4.22 New Mental Health Day Hospital:Day Hospital and base for multidisciplinarySector team. .2008/2009 2.62 Rehabilitation2006/2007 HSE & CMHA Relocation of clients from St.Stephens.The services provided willinclude outpatientPsychiatrist, Psychology,Social Work, OccupationalTherapy, Counselling andNursing Services14 beds, 4 independentflatlets2010 HSE/Cluid - 1m HSE Day Hospital Mental HealthIn addition to the Capital Projects completed, HSE South is engaged in an ongoing Mental Health Capital programme tofacilitate the completion of reconfiguration of services. In this regard a number of facilities are included in the NationalCapital Plan & National Service Plan 2011 including the following:FacilityProject DetailsTipperary South Provision of a 40Bed ResidentialUnit, on the existingsite, toaccommodatecurrent residents ofSt Luke's.High Support Hostel,Clonmel.Day Hospital/CMHTHQ, Clonmel.Project Q Fully Additional Replacement Capital Cost €mCompletion Q operational BedsBeds 2011 TotalQ3 Q4 0 40 7 9Q4 Q4 0 8 1.3 2Q4 Q1 2012 0 0 2.5 4St John’s Enniscorthy Rehab House Q4 Q4 0 12 3.0 3.2High Support HouseMill View2 ID Houses HavenView 1 & 2Q4 Q4 0 13 1.5 1.85Q4 Q4 0 14 2.2 2.44Gorey Day Hospital Q`1 Q1 0 0 0.8 0.8WexfordExtension of Day Q4 Q4 0 0 0 Funded via HSEHospitalSouthEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 11 -

Waterford CityDungarvanFacilityProject DetailsDay Hospital (withPrimary Care)Day Hospital (withPrimary Care)Project Q Fully Additional Replacement Capital Cost €mCompletion Q operational BedsBeds 2011 TotalQ2 Q2 0 0 Funded via PCQ3 Q3 0 0 0 Funded via PCWaterford Day Centre Q4 Q4 0 0 0 Funded via HSESouthWaterfordRefurbishment ofRegional HospitalQ4 Q4 0 44 1.5 1.514) ChallengesThere are a number of challenges in relation to the implementation of Vision for Change:ResourcesOne of the ongoing challenges with the implementation of Vision for Change is to provide same level of service with ashrinking resource and the protection of core service elements in a reduced environment. The remodelling of the existingservices will entail significant change for the staff, including retraining, redeployment, changes in skill mix etc. Critical to thereconfiguration of any services is a stable resource base. The Employment Control Framework/Moratorium coupled with thelarge numbers of psychiatric nurses retiring from service poses a particular challenge here.The work achieved within HSE South to date demonstrates a capacity within the service to positively respond to thesechallenges which we will have to continue to support clinical leadership.Recovery ModelIt is important to recognise that while there is a clear legal need to adhere to Policy and Procedures under the MTA 2001,the Quality and Framework Mental Health Services document and Capital infrastructure initiatives, we must underneath thetechnical aspects of this care, develop a recovery oriented organisational direction as well. When we use the term ‘recoveryorientation’ we are talking about developing a focus on these priorities and learning from both the empirical evidenceproduced by service users and the messages that have emerged from the recovery literature. When we talk about services‘moving in a recovery orientation’ we are talking about services that seek to make the non-technical aspects of mentalhealth of primary importance. The recovery agenda involves a radical rethink of how we should understand mental healthproblems and what our priority should be. It is not anti-drugs or anti-psychiatry but it does reflect a desire to place theconcerns of service users centre stage. Vision for Change explicitly advocates a move towards a recovery orientation: ‘Arecovery approach to mental health should be adopted as a cornerstone of this policy’ (A Vision for Change, p. 15). Therecovery agenda involves a radical rethink of how we should understand mental health problems and what our prioritiesshould be. It is not simply something to be ‘added on’ to what we already do. Vision for Change explicitly advocates a movetowards a recovery orientation. The ‘vision’ of Vision For Change emerges from the holistic approach to mental health withthe recovery philosophy is at its core. This is where it recognises that the primary knowledge of mental health is with theservice users and the secondary knowledge is supported by the providers. Therefore to make this happen there are threekey organisational indicators:• Ensuring organisational commitment creating the culture where the importance of leadership plays a significant role tomake it happen- changing hearts and minds.• Changing the nature of the day to day interactions and the quality of the service user’s experience, by identifying theworkforce’s attitudes and values.• To work collaboratively with our partner agencies such as National Learning Network, Rehab care, EmployabilityNSEU, IAN and voluntary agencies.This ensures the mental health services are delivering a quality framework across three key agendas service users,community and service development. This requires clear action and making recovery a reality.A significant recent achievement in HSE South was that the HSE Mental Health Service in West Cork was voted the ‘mostimproved service’ over the past three years in a survey carried out by the National Service User Executive (NSUE). ThisEasy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 12 -

was one of only three awards made by the NSUE. The ‘Second Opinion’ survey was completed at the end of 2010.Individuals and families who had been in contact with mental health services across the country were asked about theirexperiences. Feedback about developments in the service in West Cork was the most positive in the country. In this contextsee the attached document entitled: ‘Moving West Cork Mental Health Service in a Recovery Direction’ which outlines fulldetails of this programme. In West Cork, the team has sought to establish a service that is guided by a commitment toservice users’ involvement, a recovery philosophy embracing a community, orientation and the importance of (partnership)working. There has been a clear commitment and leadership from management at local level to drive these changes inpartnership with Service Users. This signals an example of an organisational direction of care, which is making recovery areality in action.National Clinical ProgrammesImplementation of the new national approaches being developed under the leadership of Dr. Ian Daly will support thedelivery system with the implementation of Vision for Change. The implementation of such national programmes will assistthe service in addressing service variability across each expanded catchment area as well as standardizing our approachesand planned outcomes.Translation of LearningSignificant progress is being made however we need to develop processes that support the translation of learning.15) ConclusionThe guiding principle for the HSE South development of Mental Health services is the implementation of ‘Vision for Change’the National Policy document on Mental Health. The key themes in the Vision for Change include:Involvement of service users in service development;Importance of mental health promotion;Further development of community based Multi-Disciplinary Teams;Recovery orientation to inform all aspects of service delivery;Catchment areas to be realigned;Equitable access to service and new service developments;Plan and deliver a more appropriate range of treatment options through the closure of old mental health hospitalsand reinvestment of the resources released;Development of Mental Health Information Systems;Manpower planning, education and training of key Mental Health Professionals to be further strengthened;Implementation Review Committee established to oversee implementation of policy;Additional funding required in addition to re-orienting existing service delivery.The National Service Plan has identified the following for 2011:Continue to implement elements of a Vision for Change, particularly reconfiguration of services from a model ofcare predicated on inpatient provision to a community based recovery model, reconfiguration of community mentalhealth teams, development of clinical pathways and progressing the capital infrastructureThis paper outlines the overview of Vision for Change implementation across HSE South and gives details on the specificsof progress in each of the four Expanded Catchment Areas.In HSE South the recommendations of Vision for Change form the key priorities for the development of HSE South MentalHealth Services. The HSE South Regional Management Team recently reaffirmed its commitment to the implementation ofVision for Change in the HSE South Regional Service Plan 2011 and is committed to monitoring progress closely.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | Cork- 13 -