4 Richmond Lunatic Asylum St Brendan’s Hospital 1814-2013.
5 1945 Mental Treatment Act1945 Mental Treatment Act; allowed for the voluntary admission of people in Psychiatric Hospitals, made the first step towards Community care allowing patients to be paroled..
7 1966 Commission of Inquiry on Mental Illness Goffmann’s characteristics of total institution - asylum(1) all aspects of life are conducted in the same place under the same authority;(2) the individual is a member of a large cohort, all treated alike;(3) all daily activities (over a 24-hour period) are tightly scheduled;(4) there is a sharp split between supervisors and lower participants;(5) information about the member's fate is withheld.
8 Planning for the Future 1984 Planning for the Future (DoH, 1984) provided the strategic framework that enabled the adult mental health services to evolve from an institutional to a community-based service model and approach.It directed that the psychiatric services should be comprehensive and community-orientated, and aimed at delivering care that was coordinated, integrated, and multidisciplinary (DoH, 1984).Countrywide, mental hospital services embarked on programmes of ward closure that resulted in a decrease in the number of in-patients in mental hospitals from a total of 19,801 in 1963 to 3,556 at the end of A significant rise in community-based facilities paralleled this decline in bed usage, giving rise to over 3,100 community residential places under the care of the mental health services in 2004 (O’Regan and Keogh, 2005).
9 Psychiatric in-patient beds in Ireland 1896 to 2013
10 St Brendan’s Hospital Rehabilitation and Resettlement Programme’ In SBH a formal ‘rehabilitation and resettlement programme’ was established in The primary aim of the programme was to decant the mental hospital of long-stay in-patients to more ‘appropriate’ community residential environments in order to facilitate the closure of the hospital.In conjunction with this programme, comprehensive and integrated community psychiatric services were planned to provide alternative treatment options to people at home.The Programme for the Homeless, ‘NFA Unit’Sector CMHT, Cabra, Finglas and Blanchardstown.Over a nine-year period the number of in-patients residing in the hospital steadily fell each year from a high of 1200 inpatients in 1986 to 257 in 1994.
11 Community ResidencesThe provision of residential facilities largely depends on two key variables:(1) the extent of informal family support, which can substitute and replace the formal support granted by residential facilities;and(2) the availability of comprehensive community resources, including assertive community treatment programmes (Girolamo et al., 2004; Thornicroft, 2003).
12 Continuum ModelThe Continuum model posits that there are different residential settings, such as ‘group homes’ and hostels, with various levels of support and restrictiveness; the most intensive treatment is offered in the most restrictive environment.Residents can move along the continuum, from more restrictive to more open settings, the level of supervision is based on the level of assessed need and level of functioning, thus providing a pathway from institutional care into independent living in the community (Girolamo et al., 2004).The ‘continuum’ model has been criticized because it bonds housing and treatment needs, and this may lead to unnecessary dislocations through successive moves as improvement in functioning often requires a move to another setting (Carling 1993).Furthermore, housing is frequently not available at precisely the time when the person’s needs change and skills acquired for independent living in an artificial environment, such as residential facility, may not be transferred and used in another setting (Girolamo et al., 2004).
15 Mental Health Act 2001Involuntary Admission of persons to approved centreIndependent Review of DetentionEstablished the Mental Health Commission“to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services”.Inspector of Mental Health Services
16 Vision for Change 2006Vision of Change details a comprehensive model of mental health service provision in Ireland. It proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems.Principles and values underpinning the Vision include Multidisciplinary; community based; comprehensive; active participation and recovery;
17 RecoveryThe Recovery approach is a shared philosophy which draws upon evidence concerning the importance of values social roles, such as employment while also emphasizing user determination and positive risk-taking.Personal ResponsibilityHopeRebuilding programmeContentmentRoles and relationships.Leighton (2005)
19 Church Ave 2011 Structure: Small 8 ensuite / bedrooms residence System:Self staffing / NursingMDT input / OTSkill mix/sleepoverSelf catering
20 Turnover 30 individuals admitted in three years 12 moved back Home 118 episodes of respite2 Individuals at risk of homelessnesssubstance misuse / anti-social behaviour / non-payment of charges14 have moved to lower supportedaccommodation provided by HSE.7 have progressed to independent living
21 DorasGenio funded:Collaboration between HSE Dublin North City Mental Health Services and HAILAim:To build a sustainable model of Community Mental Health Rehabilitation that will deliver a range of recovery focused supports
22 The challenge Housing Connections Project Source high quality secure housingMaintain and support tenancyIndependent living as a realistic goalConnections ProjectSocial Roles ValorizationMeaningful roles
23 2016 Target High Supported Community Residential Places.
24 Supported Community Residential Strategy 2014-2019 Reduce the number of residents to between 8-10; individual roomsLocate community residences across the catchment area; Cabra, Finglas and Blanchardstown.
25 Homelessness Factors contributing to increased homelessness Lack of affordable housingReduced entitlementsGrowing numbers in povertyIndividual vulnerabilitiesMental IllnessSubstance Misuse.
26 Comparison between Homeless and Homeless Mentally Ill Both groups share backgrounds marked by:PovertyDependency on welfareChildhood hungerFamily unemployment .Homeless Mentally Ill had a higher instanceFamily violence and abuseFoster careChildhood homelessness
27 Programme for the Homeless Established in 1979 comprised‘The Willows’‘NFA Day Centre’ moved off campus to Ushers Island in 1997Three supported Community Residences24 hr self referral assessment unit, SBHAcute In-patient beds
28 Changes to the programme Closure of Community ResidencesClosure of in-patient unitClosure of self-referral assessment unitAssertive OutreachAcess TeamOutpatient Clinic 2011 Park Gate Street.Day Hospital 2012Reconfiguration 2014.
30 MissionThe Programme for the Homeless Mental Health Service provides specialist community mental health care and treatment for registered homeless adults with severe mental illness living within Dublin City Centre.
31 Optimism for the future Primary Care Strategy;strengthening links with MHSNational Clinical Care ProgrammesFor episode psychosisFamily educationBehavioural Family TherapyEolas ProgrammeRecruitment of full compliment of MDT members.National Housing Strategy for People with Disabilities