A Standards Approach to Embedding Rights in Mental Health Services

Quality Framework Mental Health Services

in Ireland

Patricia Gilheaney

Director Standards & Quality Assurance

MHC statutory mandateSection 33, Mental Health Act, 2001

“The principal functions of the Commission shall be to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under this Act”.

[Section 33(1)]

MHC statutory mandateSection 33, Mental Health Act, 2001

“The Commission shall undertake or arrange to have undertaken such activities as it deems appropriate to foster and promote the standards and practices referred to in subsection (1). [Section 33(2) ]

“The Commission shall have all such powers as are necessary or expedient for the purposes of its functions." [Section 33(4)]

1

The process beyond the consultation

Mental HealthCommission

Strategic Plan

Consultationprocess for the

Qualityframework

Development ofa quality

framework

Identifying components

within the framework

Implementation & ongoing evaluation of quality framework

Timeline:

Mar 2004 Aug 2004May 2004

Ongoing involvement from stakeholders throughout the process

Key stages in developing the quality framework for mental health services in Ireland

Quality in Mental Health – Your Views

A Quality Mental Health Service is one that:-

1. Facilitates respectful and empathetic relationships between people using the service, their families, parents and carers, and those providing it

2. Empowers people who use mental health services, and their families, parents and carers

Quality in Mental Health – Your Views

3. Provides a holistic, seamless service and encompasses the full continuum of care

4. Is equitable and accessible

5. Is provided in a high quality environment, which respects the dignity of the individual, his/her carers and family

Quality in Mental Health – Your Views contd.

6. Has effective management and leadership

7. Is delivered by highly skilled multidisciplinary teams

8. Is based on best practice and incorporates systems for evaluation and review

International MHS common problems/deficiencies

A lack of focus on mental health Inadequate system capacity and workforce

resources and competencies Insufficient involvement of consumers &

caregivers in service planning. Variability in service provision and in the

quality and effectiveness of care provided Delays in application of evidence-based

practices, quality improvement tools & I.T.

Quality Framework (QF)- Scope A framework for continuously improving quality in

mental health services in Ireland

Q.F. is applicable to all mental health services irrespective of the speciality or whether they are being delivered in:

Service user’s homeCommunity settings In-patient facilities

Q.F. is flexible:Diverse needs of service usersDifferent nature and scale of

organisation Standards are not prescriptive

Standard

A broad statement of the desired and achievable level of performance against which actual performance can be measured

– Overall goal– Outlines the objective that is expected

Standards in the Q.F. adhere to the International Principles for healthcare standards.

Criteria

Measurable elements of service provision

Relate to desired outcome or performance of staff or services

Include – SI 551 of 2006 [Mental Health Act 2001 (Approved Centres)

Regulations 2006– Rules & Codes of Practice

Standard is achieved when all associated criteria are met

RUMBA rule (relevant, understandable, measurable, behaviourally stated & achievable)

Standards Approach: Strengths

Service users/families– Know what to expect from a MHS– Opportunity for service user feedback at all

levels in system MHS

– Quality improvementStandards facilitate self monitoring of

performanceDriver for change –

policies/legislation/practice/structuresProvide consistency

– DevelopmentFocus on resultsGenerate real improvements in MHS

Standards Approach: Strengths (contd.)

Monitoring– Transparent mechanism for evaluating

quality of MHS provision in Ireland for the first time

– Service users / MHC / service providers

Profile– Platform for increasing the profile of mental

health

Comparative Analysis: Vision for Change

– Themes and standards in QF compared with the

207 Recommendations

- Highlights the overlap between current Government mental health policy – A Vision for Change & Quality Framework for Mental Health Services in Ireland

Framework, standards and associated criteria informed by:

– “Mental Health – Your Views”– Review of quality frameworks in health systems in

other countries– International principles for healthcare standards– International experts

Healthcare qualityMental health care services

– Recommendations from CommissionInspectorate of Mental Health Services

Legislative framework to support standards

Legislation √ Appropriate enforcement √

Panacea?

What else do we need?

Implementation & Sustainability

“For Clinical Improvements to be anything other than a fad, the improvements we make must be lasting….”

Langley et al (1996)

Langly G, Nolan K, Nolan T, Norman C, Provost L. (1996) The Improvement Guide. San francisco: Jossey Bass.

System Level Change

In order for reform to succeed changes must occur at

all of the following 4 levels

1. The experiences of individuals, families and communities

2. Microsystems of care – the point of patient / health professional interaction

3. Larger healthcare organisations and systems

4. External environment of care, including policy, financing and legislation / regulation

Berwick,2002

Implementation:– Receptive context for change

– Clear plan Critical success factors Achievable specified timeframes Multilayered (service user, professional,

managerial) Provision of infrastructure to facilitate

sustainability– Maintaining improvements in terms of

targets– Sustaining the changes– Aligning financial systems– Discontinuing ineffective quality initiatives

Implementation Critical Success Factors

Attainment of “buy in” at senior management levels and commitment from all stakeholders to the quality framework

Provision of appropriate resources in accordance with the costed implementation plan

Devolved budgets to strengthen accountability and effective resource utilisation

Effective planning that permeates from the macro / strategic level to the point of service delivery

Strong leadership at all levels to implement the changes required.

THANK YOU

www.mhcirl.ie