Health Services In Ireland Research Articles

The development of Health Services Executive Best Practice Guidance for Mental Health Services in Ireland

The Health Services Executive Best Practice Guidance for Mental Health Services are being introduced to assist in the development and implementation of appropriate practices and guide continuous quality improvement in mental health services across Ireland. These guidance are based on legislation and best available evidence, developed in consultation with service users, family and carers and staff. They set out the key principles of quality and safety that should be applied in any mental health setting. In striving to deliver quality care across a mental healthcare system, assessing against these HSE Best Practice Guidance forms the foundation for services to improve quality and create an impetus for change. Having best practice guidance for mental health services implies the need to self-assess against them in order to identify good practice and areas where improvement can be made. They provide an opportunity for mental health services to get a shared understanding of the quality of care being provided in their area. The Quality & Service User Safety (QSUS) department within the HSE Mental Health Division developed the Best Practice Guidance for Mental Health Services. The QSUS team was established with a focus on examining current practice in mental health services and supporting these services to provide safe, effective and high quality care services. The development of HSE Best Practice Guidance commenced in May 2016, in consultation with service users, carers, family, advocacy groups and staff from mental health services, so that they can be implemented in all mental healthcare services, settings and locations. The project was supported by a steering and a project group, consisting of experts by profession or lived experience. The Best Practice Guidance will support services with the implementation of the, Mental Health Act, Approved centre Regulations 2006 and the Mental Health Commission Quality Framework and the Judgement Support Framework. The areas covered by the guidance are considering all other national and international evidence and reviews, regulations, codes, rules and policies. The HSE Best Practice Guidance for mental health services aims to provide a roadmap for improving the quality, safety and reliability of mental health care services in Ireland. Methodology for standards development : The development of the Health Services Executive Best Practice Guidance for Mental Health Services has three phases to their development. Phase 1. A literature review was completed. The development of draft guidance informed by the steering and project group. An online Self-Assessment Tool is being developed. A Public consultation process was held in August 2016. Phase 2. Piloting the Draft guidance and Self-Assessment tool. There were four Pilot sites across Ireland. Training was provided to the teams prior to the pilots. Next Steps Phase 3. Post Pilot review and roll out of project nationally. This includes launch of the best practice guidance, training of staff, development of a range of support documents and a phased approach to implementation.

Taking a coproduction approach to integrating recovery orientated care in Irish Mental Health Services

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Evaluating music therapy in adult mental health services: Tuning into service user perspectives

ABSTRACTMany statutory mental health services worldwide have adopted a recovery-oriented rhetoric. These acknowledge that those who use mental health services have acquired valuable expertise through their contact with services and that such expertise should be used to inform health provision. The focus of this study was to tune into the perspectives of adult service users who have attended music therapy in statutory mental health services in Ireland. This aimed to furnish holistic descriptions of practice so as to augment existing understanding of what may be afforded to those who attend music therapy sessions. Six service users participated in semi-structured interviews in which they described their lived experience of attending music therapy sessions. Interview transcripts were analysed using interpretative phenomenological analysis. Six common themes were found across each of the six participant cases. These included “Music therapy offers an opportunity to be meaningfully occupied”, “Involvement in music therapy can pose challenges”, “Music therapy offers an agreeable process”, “Group music therapy fosters reciprocity”, “Music therapy is flexible and adaptable” and “Lack of musical instruction can cause frustration”. Findings relating to meaningful occupation, challenge, reciprocity and frustration broaden understanding of what music therapy can offer to service users in mental health provision.

The healthcare system and the provision of oral healthcare in European Union member states. Part 7: Republic of Ireland.

The Irish oral healthcare system is a hybrid model with a public/private mix of service provision, predominantly organised on the basis of fee-per-item remuneration. The system is structured around three long standing publicly funded schemes: the Public Dental Service (PDS) for all children and adults with special needs and provided by salaried dentists, the Dental Treatment Services Scheme (DTSS) for low income adults, and the Dental Treatment Benefit Scheme (DTBS) for insured persons, the latter two both provided by private independent dental practitioners. Ireland introduced systemic water fluoridation in 1963 and currently 73% of the population has access to fluoridated water. Ireland currently has a dentist density ratio of 6.1 dentists per 10,000 inhabitants and on average, 43% of the population (30% for those aged 70+ years) visit a dentist annually. In 2014, 83% of expenditure on oral healthcare was from out-of-pocket payments by patients, with less than 1% of overall government expenditure on healthcare allotted to oral healthcare. After the economic downturn of 2008 and the severe recession that followed in Ireland, substantial cutbacks in government expenditure resulted in extensive cuts to the public sector supply of dental services and to the extent of cover provided by the publicly funded schemes. The Department of Health has recognised the major post recessionary challenges facing the Irish health system, not least, significantly reduced budgets and capacity deficits, and acknowledges the need for change in Ireland's health service. In 2014, a three-year project commenced at the Department of Health, to develop a new national oral health policy for Ireland.

What Works Best for Reducing Symptoms and Improving Quality of Life? A 6-Months Follow-up Study on the Effectiveness of Group Cognitive Behaviour Therapy and Group Information and Support for Adults Suffering from Depression

A non-randomized effectiveness trial was conducted in an urban secondary care public mental health service in Ireland. The effectiveness of an 8 session group cognitive behavior therapy program (gCBT-8), where the focus was on behavioral activation and cognitive restructuring, was compared with that of an enhanced 12 session group cognitive behavior therapy program (gCBT-12), which contained additional sessions on schema work, and a 12 session information and support control group program (gIS-12) in which there was no CBT skills training. One hundred and eighty-one adults with unipolar mood disorders were allocated to gCBT-8 (N = 67), gCBT-12 (N = 62), or gIS-12 (N = 52). Before and after treatment, and at 6 months follow-up participants completed the Beck Depression Inventory II (BDI-II), the Beck Anxiety Inventory, the Clinical Outcome and Routine Evaluation, the Dysfunctional Attitudes Scale, and the brief World Health Organization Quality of Life Scale. An intention-to-treat analysis of mean scores showed that the three programs had similar outcomes. There were significant improvements on all dependent variables with post-treatment gains maintained at follow-up. The three programs also led to similar remission and combined reliable improvement and remission rates on the BDI-II. It was concluded that all three programs had similar levels of effectiveness.

Gender Sensitivity, Mental Health Care Provision and Minority Communities in Ireland: A Realist Analysis

The Irish Government has adopted “Gender Mainstreaming” as a strategy to promote equal opportunities between women and men in its National Development Plan. While current mental health policy addresses the principle of partnership and social inclusiveness as a way forward for mental health service provision, it still does not explicitly deal with the notion of gender and gender sensitivity. For some minority groups a lack of trust is a key issue that affects their uptake and meaningful use of services resulting in inadequate and gender insensitive care provision. Aim: The aim of this paper is to describe and analyse service providers’ views in relation to the gender sensitivity of mental health care provision particularly as it relates to minority (Traveller and gay) communities. Method: A qualitative social realist design was used guided by Layder’s adaptive theory and ontological theory of the social world – ‘social domains theory’. In-depth interviews with twenty eight service providers were conducted within one mental health service in Ireland. Data was analysed using NVivo software. Results: The findings are presented in relation to tolerance and responsiveness of service providers towards the gay and Traveller communities. Service providers suggested that prejudices were held in relation to both indigenous and immigrant minority groups and this impacted upon care provision. Categorical intersectional understandings of gender were used by service providers to describe Travellers. Conclusion: Belonging to a minority group was a potential or actual threat to gender sensitive care and service providers managed such threats within a lay socialisation context. Arguably, a move towards developing gender-sensitive mental health care provision requires greater collaboration, education and understandings in relation to minority groups, their cultural differences and gendered identities.

The professional psychiatric/mental health nurse: skills, competencies and supports required to adopt recovery‐orientated policy in practice

Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N=1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care.

A Case Study Exploring the Influence of a Gardening Therapy Group on Well-Being

ABSTRACTIn a climate of improving health-care quality and understanding, this study explored how participation in a gardening group, facilitated through a mental health service in Ireland, influenced well-being. A case study used semi-structured interviews and participant observation to explore explicit and tacit aspects of group participation. Thematic analysis clarified that gardening group participation had a positive influence on well-being for all gardeners and group facilitators. This was through promoting coping, facilitating change, and developing skills. The setting, site ethos and tasks were important in assisting people to make lifestyle changes and to develop skills in order to experience well-being.

Service users' perspective of their admission: a report of study findings.

The 'Service Users' Perspective of their Admission' study examined voluntarily and involuntarily admitted services users' perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study. The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission. A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders. This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.

Is being gay bad for your health and wellbeing? Cultural issues affecting gay men accessing and using health services in the Republic of Ireland

This paper examines how the experience of cultural inequalities affects the health and wellbeing of gay men in the Republic of Ireland. Gay men experience discrimination in the cultural domain when accessing and using the health services in Ireland that reinforce heteronormative values and preferences. Health inequalities experienced by gay men in the Republic of Ireland are strongly influenced by cultural factors: the Catholic Church, institutional heterosexism, heteronormativity and homophobia, which create a stigmatised identity among gay men and have an adverse effect on health and wellbeing. Counteracting cultural inequalities for gay men accessing and using health care services in Ireland requires a commitment to better education, continued funding for dedicated health services for gay men and the creation of an environment of acceptance where health services are provided.

Newly Qualified Doctors’ Views of Medical School Training and Its Adequacy in Making Them “Fit for Purpose” as First Year Doctors

Aim: To assess whether the medical graduates from one medical school felt “fit for purpose” to work as intern doctors in the Health Service in Ireland. In the early nineties documents like “Tomorrow’s Doctors” emphasised the direction and change that undergraduate medical training had to take. It stated that “students must be properly prepared for their first day as Pre-Registration House Officer”. There are current arguments that junior doctors are not fully prepared for working life when they finish university. This study aims to analyse this perceived truth. Methods: I employed use of semi-structured interviews with a purposive sample of medical school’s qualified interns. A grounded theory thematic analysis approach was used. Results: The interviews confirmed the participants’ sense of being ill-prepared for the complexities of being a doctor. Issues such as managing professional relationships, navigating hospital politics, building support networks, knowing when to seek help and dealing with ethically challenging situations were all highlighted. Conclusions: The study has established that the medical school in which the study was situated is teaching its graduates to an acceptable standard with regard to their medical knowledge base, communication skill abilities and the basic tenets of history taking and examination, but it needs to prepare graduates in a more concrete way for working in complex multi-professional clinical environments and for participating effectively in the context of acute medical emergencies. It is arguable that all medical schools should follow up their graduates to assess how well the medical school curriculum has prepared their graduates for practice.

What should dental services for people with disabilities in Ireland be like? Agreed priorities from a focus group of people with learning disabilities

Accessible summary This study asked a group of people with learning disabilities in Ireland what was important to them about their dental services. The group easily ordered their priorities according to five topics: Access, Cost, Information, Quality of Care and Treatment. The group's discussion revealed a disempowered group who had little control over how they interacted with dental services. We suggest ways to empower people with learning disabilities in their interactions with dental services. AbstractBackground: In Ireland, people with learning disabilities have poor oral health. This is in part due to inappropriate oral health services. Recognising the value of inclusive approaches to research and healthcare planning, this study sought to include a group of people with learning disabilities in priority setting for oral health services in Ireland. This study discusses the feasibility of the methods used to promote inclusive approaches in oral healthcare planning.Materials and Methods: A single focus group of six participants with communication and cognitive impairments agreed priorities for dental services using evidence‐based research tools across five topics: Access, Cost, Information, Quality of Care and Treatment. Sorting was recorded photographically and discussion was video‐recorded, transcribed and analysed using deductive content analysis.Results: The group ranked priorities within each topic but found it difficult to meaningfully rank between topics. Across topics, issues of control, empowerment and choice were observed.Conclusions: Participants were largely disempowered in their interactions with dental services. The method used in this study to empower potential service users with disabilities was successful and can be used by others who have an interest in inclusive healthcare priority setting.

A national survey of offending behaviour amongst intellectually disabled users of mental health services in Ireland.

Offenders with an intellectual disability pose a major challenge to Intellectual Disability Service providers in the Republic of Ireland. This is especially so as no national Forensic Intellectual Disability Service currently exists. The Forensic Intellectual Disability Working Group of the Irish College of Psychiatrists was established in order to take steps to address this issue by establishing the level of need for a Forensic Intellectual Disability Service in Ireland and developing a college position paper. No previous study has been carried out to measure offending behaviour amongst persons with an intellectual disability attending mental health services in Ireland. A postal survey was undertaken targeting the lead clinicians of all Intellectual Disability Psychiatry, General Adult Psychiatry and Forensic Psychiatry Services in the Republic of Ireland. This survey requested anonymous data regarding service users with an intellectual disability and offending behaviour in this population. Data relating to 431 service users was returned. Those reported to engage in offending behaviour were predominantly young males. Assault was the most common offence type. A significant number of serious offences such as unlawful killing, sexual assault and arson were reported. There is an urgent need for the development of a Forensic Intellectual Disability Service in the Republic of Ireland. The current efforts of the National Forensic Mental Health Service to establish such a service by the creation of a post of Consultant Forensic Psychiatrist (special interest in intellectual disability) are to be welcomed.

SEQUenCE: a service user-centred quality of care instrument for mental health services.

To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups.

Review of clinical guidelines for children and adolescents with attention deficit hyperactivity disorder and their application to an Irish context.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with international prevalence rates estimated to be 5%. It is currently the most common disorder treated in Child and Adolescent Mental Health Services in Ireland. There have been a number of guidelines worldwide produced to aid clinicians in the diagnosis and treatment of ADHD; however, there are no guidelines available specifically for the Irish population and healthcare system. The aim of this paper is to review the available clinical guidelines for the diagnosis and management of ADHD in children adolescents across North America, Canada, Europe and the United Kingdom and to apply these to an Irish context. A number of international guidelines were reviewed. A proposed pathway for the assessment and treatment of children and adolescents with ADHD has been devised with the recommendation that a formalised consensus guideline should be implemented. This review paper has highlighted that there is consensus between the guidelines for the diagnosis of ADHD with a thorough clinical history remaining the gold standard. They further agree on the importance of identifying co-morbid disorders. When it comes to the treatment, the guidelines are less unified. This current paper has devised a proposed care pathway for ADHD in Ireland to ensure high quality cost effective care within its healthcare system.

The implications of regional and national demographic projections for future GMS costs in Ireland through to 2026.

BackgroundAs the health services in Ireland have become more resource-constrained, pressure has increased to reduce public spending on community drug schemes such as General Medical Services (GMS) drug prescribing and to understand current and future trends in prescribing. The GMS scheme covers approximately 37% of the Irish population in 2011 and entitles them, inter alia, to free prescription drugs and appliances. This paper projects the effects of future changes in population, coverage, claims rates and average claims cost on GMS costs in Ireland.MethodsData on GMS coverage, claims rates and average cost per claim are drawn from the Primary Care Reimbursement Service (PCRS) and combined with Central Statistics Office (CSO) (Regional and National Population Projections through to 2026). A Monte Carlo Model is used to simulate the effects of demographic change (by region, age, gender, coverage, claims rates and average claims cost) will have on GMS prescribing costs in 2016, 2021 and 2026 under different scenarios.ResultsThe Population of Ireland is projected to grow by 32% between 2007 and 2026 and by 96% for the over 70s. The Eastern region is estimated to grow by 3% over the lifetime of the projections at the expense of most other regions. The Monte Carlo simulations project that females will be a bigger driver of GMS costs than males. Midlands region will be the most expensive of the eight old health board regions. Those aged 70 and over and children under 11 will be significant drivers of GMS costs with the impending demographic changes. Overall GMS medicines costs are projected to rise to €1.9bn by 2026.ConclusionsIreland’s population will experience rapid growth over the next decade. Population growth coupled with an aging population will result in an increase in coverage rates, thus the projected increase in overall prescribing costs. Our projections and simulations map the likely evolution of GMS cost, given existing policies and demographic trends. These costs can be contained by government policy initiatives.

Resource allocation in the Northern Ireland health service: consensus or challenge?

The Northern Ireland health service faces major restructuring at a time of extreme fiscal austerity. This paper assesses the capacity of the service's administration to meet this challenge, focusing on past distribution of resources across programmes of care. The central finding is that resources generally appear to be distributed on a pro rata basis with little evidence of strategic direction. Within a context of generally poor performance against previous targets, and low productivity compared to England, the outlook for major restructuring is not sanguine. That the administrative structure is embedded in a political framework that favours consensus over leadership is a further cause for concern.

An examination of childhood trauma in individuals attending an adult mental health service.

Childhood sexual abuse has previously been associated with adult mental health difficulties, however, few studies have evaluated all forms of childhood maltreatment in individuals attending adult mental health services. Consequently, this study investigates the association of five forms of childhood trauma with a range of clinical symptoms and mental health disorders in 136 individuals attending a mental health service in Ireland utilising the Childhood Trauma Questionnaire (CTQ). One hundred and thirty-six patients attending the Roscommon Mental Health Services completed the CTQ and a number of additional psychometric instruments evaluating illness severity, impulsivity, disability and the presence of a personality disorder(s) (PD) to ascertain the prevalence of childhood trauma and any potential associations between childhood trauma and a range of demographic and clinical factors. Result Seventy-six per cent of individuals reported childhood trauma, with emotional neglect most frequently reported (61%). Individuals who had experienced childhood trauma had higher rates of clinical symptoms, distress and impulsivity. Substance abuse and paranoid, borderline and antisocial PDs most associated with childhood trauma. This study demonstrates the need to routinely elicit information on all forms of childhood traumatic experiences from patients.

Gender awareness, symptom expressions and Irish mental health-care provision

Irish mental health policy and care provision is criticised for being gender-neutral despite gender being present in almost every aspect of illness; from risk to protection; symptom interpretation; diagnosing, ideology and knowledge of illnesses. The aim of this paper was to present the views of Irish service users and providers in relation to symptom expressions, gender awareness and care provision. A qualitative social realist design was used using Layder's (1998) adaptive theory and social domains theory. In-depth interviews (n = 54) with 26 service users and 28 service providers were conducted within one mental health service in Ireland. Dominant societal expectations for men and women are described in response to symptom expressions that reflect ‘categorical’ and ‘performative’ understandings of gender. A return of interest to symptoms-based research and practice from a gendered perspective is argued for.

Managing a National Health Repository

Institutional repositories are becoming part of mainstream scholarship in many academic libraries. Subject based repositories are well suited to disciplines such as the health sciences, where repositories are evolving rapidly. In Ireland, as in other countries, the healthcare sector produces a vast quantity of research and grey literature. This article examines how a national subject repository for Ireland's health services was established and managed by a Regional Library Service. It explores the rationale for the repository, established amid massive organizational change with a declared aim of preserving and promulgating Ireland's health literature in all its forms. Key to the success of the repository was involvement of health professionals from the outset and a continued dialogue with researchers within the healthcare system.