Health Services In Ireland Research Articles

Exploring the Experiences of Physical Activity among Key Stakeholders in Rehabilitation and Recovery Mental Health Services

Physical activity has therapeutic benefits for mental health service users. To date, there is limited evidence that has brought together the experiences of physical activity for service users and key multi-disciplinary service providers that support activity in outpatient settings, particularly in contexts where activity is not well integrated into policy and care structures. Previous research has relied on homogenous samples of either service users or service providers of a specific discipline, and key stakeholders like peer-support workers are under-represented. This research explored and thematically analysed multi-stakeholder (service users, n = 6; and service providers, n = 8) experiences of physical activity in outpatient mental health service in Ireland using phenomenologically influenced qualitative interviews. Two salient themes were identified; ‘The challenges of being physically active in recovery’ and ‘Physical activity is a tool for recovery’. This research presents an account of the experiences of some of these poorly represented stakeholders such as carers, peer-support workers, doctors and nurse management, in addition to other well represented stakeholders.

ADHD and Covid-19: current roadblocks and future opportunities.

Attention deficit hyperactivity disorder (ADHD) is the commonest disorder presenting to Child and Adolescent Mental Health Services in Ireland. This article considers the impact of the Covid-19 pandemic on the provision of mental health services for young people with ADHD with specific reference to the difficulties that have been experienced in ADMiRE, a specialist ADHD service in Dublin, since the outbreak of Covid-19 in Ireland. Current guidelines and alternative ways of ensuring adequate service provision are discussed. Restrictions to mitigate the spread of Covid-19 are likely to continue for many months, and child and adolescent mental health services need to find new ways to provide a sustainable service to young people in Ireland. There is a growing evidence base for the use of telepsychiatry in the assessment and management of ADHD. Factors that should be considered when developing a telepsychiatry service for children and adolescents with ADHD are highlighted.

Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff

Patients leaving inpatient psychiatric care without informing staff can have serious consequences for patient welfare, their families and staff. Even in cases where there are no serious outcomes and patients return, treatment can be interrupted and staff morale compromised. Given these potential deleterious effects, it is important to have an in-depth understanding of why people leave when they do. The aim of this study is to examine the profile of service-users who leave in-patient psychiatric care without notifying staff and to determine their reasons for doing so, what they did when they left the hospital setting and reasons for returning. This is a prospective descriptive study of service users leaving without notifying staff from a national mental health service in Ireland. It investigated the frequency, timing, and motivations of these absconding events among a sample of in-patients over a 12-month period. This year-long review identified 75 episodes of leaving without notifying staff, 55 of which met this studies criteria. 22% of episodes were from a locked unit, 58.2% were repeated episodes. 89% of service users returned to hospital following the episode and 11% were discharged against medical advice. Although no fatalities, three service users were seen in an emergency department as a result of activity during leave. Upon return from leave, all service users were reviewed and their care plans were updated where necessary.

An exploration of whether mental health nurses practice in accordance with The Family Model

BackgroundThe Family Model is increasingly used as a framework to promote a whole family approaches in mental health services. The purpose of this qualitative study was to (i) explore whether nurses practice in accordance with the Model when providing services for parents who have mental illness, (ii) determine whether components of the model are employed more in some workplaces (i.e. acute in-patient units versus community settings) and (iii) ascertain reasons as to why this may be the case. MethodA purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews. ResultsFindings indicated that nurses' practice incorporated most key components of The Family Model, including supporting service users' dependent children. However, some practices were not explicit in the Model, such as supporting other adult family members (i.e. grandparents). While nurses' practice in community settings was more aligned with The Family Model than in acute in-patient units, there was a notable absence of reference to domain six (cultural considerations) in both settings. A holistic and family-centered philosophy, coupled with collegial and managerial support and a focus on prevention were the main features that enabled family focused practice in community settings. ConclusionAs only a subgroup of nurses practice in accordance with The Family Model, efforts are required by nurses, their organisations and the broader system to promote family focused practice. The Family Model may be a useful framework, with further refinement, for guiding nurses' practice.

An Open Dialogue-informed approach to mental health service delivery: experiences of service users and support networks

Background Open Dialogue (OD) is a needs-based, service-user initiated approach to mental health service delivery that emphasises dialogue, and shared understanding between service users, and their support network. Aims The aim of this study was to explore the lived experience of being part of an OD-informed mental health service in Ireland. Method Data were collected through semi-structured group interviews and analysed using thematic analysis. Results Three primary themes were identified across the data set namely: diversity across practice; unpacking the taken-for-granted and mental health as shared experiences. Participants experienced enhanced communication, improved relationships with mental health staff and developed shared understandings of mental health. Conclusions This small-scale implementation demonstrates the received value for service users and their networks of an OD-informed approach within a traditional care pathway. As a relational and collaborative way of working, it requires a shift in clinical practice for mental health staff and service users that is experienced as a welcome change from treatment-as-usual (TAU).

Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service.

Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM. To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores. Data from outpatient clinics were collected at each contact over 2years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores. A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20-F29 (Schizophrenia, schizotypal and delusional disorders) F30-F39 (mood disorders) F40-F48 (neurotic, stress-related and somatoform disorders) and F50-F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = - 0.919, p < 0.001). This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient’s symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

Implementing co-production in traditional statutory mental health services

Since the publication by the Department of Health and Children in 2006 of A Vision for Change, which sets out the direction for mental health services in Ireland, new approaches to interacting with people who have lived experience of mental ill health have emerged. Co-production is one such approach. Co-production is a word used to describe the creation of a dialogical space where the service user, family members, carers and service providers enter a collaborative medical partnership to improve their own care and also service provision. Co-production is a cornerstone in the delivery of a recovery-oriented service and when implemented correctly it has the power to achieve positive change.The aim of this article is to provide background information and guidance on how to implement co-production in traditional mental health services. It is in line with the publication and implementation of the Irish recovery guidance document, A National Framework for Recovery in Mental Health, by the Health Service Executive in 2017.

Voter participation among people attending mental health services in Ireland

People with mental illness experience social and political exclusion but there is limited understanding of voting behaviour in this population. This study assessed voter participation and attitudes towards voting among people attending mental health services in Dublin, Ireland. Psychiatry outpatients and inpatients were studied over2months following Ireland's 2016 general election (n = 117). Characteristics of participants who did and did not vote were compared and reasons for voting choices explored. Over half of participants (52.1%) voted (national rate 65.1%) although more (83.8%) were registered. Forty-one percent had insufficient information about voting: the most common information deficits related to voting rights (31.6%) and voting in hospital (18.8%). Inpatients (20.0%) were substantially less likely to vote than outpatients (63.2%). Majorities endorsed the importance of people with mental illness voting. The most common reasons for not voting were being in hospital (32.1%) and not being registered (30.4%). Politicians should note that a majority of people with mental illness are outpatients and a significant proportion vote. Voting among inpatients has improved since 2011 but more information and support are needed to optimise voting rates in this population.

Health system changes needed to support people consulting general practice out of hours services in Ireland

BackgroundMental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties.AimTo establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral.Design and settingDescriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc).MethodsAn anonymous extraction of retrospective data from 1 year of the out of hours’ electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care.ResultsOver a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend.ConclusionsThere are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.

Borderline personality disorder: resource utilisation costs in Ireland.

Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs. This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty. Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18-65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million. There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.

Predictors and enablers of mental health nurses' family-focused practice.

Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family-focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses' personal characteristics and work setting are key factors in determining family-focused practice. This study extends current research by clearly highlighting predictors of family-focused practice and reporting how various enablers promoted family-focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.

An analysis of group cognitive behavioural therapy for depression

This study evaluates the effectiveness of group cognitive behavioural therapy (gCBT), enhanced with psychoeducation and peer support (gCBT-IS) for people experiencing depression in a secondary adult mental health service in Ireland.

Venous thromboembolism prophylaxis in mental health in-patient services: a qualitative study.

Background Venous thromboembolism (VTE) is an important and potentially preventable cause of morbidity and mortality in hospitalised patients. It is a significant, international patient safety issue affecting medical, surgical and mental health in-patients. There is a paucity of published evidence on the incidence of VTE, and the role of VTE risk-assessment and prophylaxis, in mental healthcare settings. Epidemiological evidence indicates that antipsychotic medications are an independent risk factor for VTE. Objective To explore healthcare practitioners' experiences and perspectives regarding VTE prophylaxis for in-patients in mental health services in Ireland. Setting This study was conducted in two national teaching hospitals in Dublin, Ireland. Method This experiential, qualitative study was conducted using face-to-face, semi-structured interviews. Purposive sampling was used to allow strategic selection of participants from the pharmacy, medical and nursing disciplines. Data was analysed using inductive thematic analysis. Consolidated criteria for reporting qualitative studies guidelines were used as a reporting framework. Main outcome measure Participants' views on VTE prophylaxis for mental health in-patients. Results Five key themes were derived: risk factors in mental health, attitudes to risk-assessment, challenges with VTE prophylaxis, lack of awareness, and lack of evidence in mental health. Conclusion The results indicate considerable diversities in perceived risk of VTE, and in experiences with VTE risk-assessment and prophylaxis. VTE risk was considered in practice specifically for immobile, older adults and eating disorder patients on bed rest. Specific research is required to address this area of clinical uncertainty in mental health.

Home treatment services for acute mental disorders: an all-Ireland survey.

To determine the distribution, functioning and perceived impact of home-based treatment (HBT) teams for acute mental disorders on the island of Ireland. A 28-item questionnaire exploring the structure, staffing and operation of HBT teams was emailed to all clinical directors of mental health services in Ireland (n=26) and Northern Ireland (NI) (n=5). Quantitative data was analysed using the Survey Monkey package, while free-text responses to open questions were analysed for thematic content. In total, 11 of 16 (68%) mental health services in Ireland and four of five (80%) in NI confirmed the presence of HBT teams. For 80% of respondents the primary function of HBT was as an alternative to inpatient admission. All NI respondents reported provision of a 24/7 HBT service. A 7 day a week service was reported by 82% of Republic of Ireland respondents. In total, 70% of respondents reported a gate-keeping role for their teams. Staffing levels and multidisciplinary representation varied widely. Most respondents perceived HBT as improving patient/carer experience and cost-effectiveness. Our findings suggest that the implementation of the HBT model in Ireland has not fulfilled the aspirations set out in mental health policy in both Irish jurisdictions. Many areas have no HBT services while wide variations in staffing levels and functioning persist. However, mental health services with established HBT teams appear convinced of their positive impact. An All-Ireland forum on HBT may help to define the model in an Irish context and standardise its future resourcing, operation and evaluation.

The Physical Health of Individuals Receiving Antipsychotic Medication: A Qualitative Inquiry on Experiences and Needs

ABSTRACTIndividuals with a mental illness are reported to have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as cardiovascular disease and Type 2 diabetes. This inquiry sought to identify the physical health beliefs, experiences and needs of individuals with mental health problems in receipt of antipsychotic medication who live in the community. A qualitative inquiry was undertaken using three focus groups in a community mental health service in Ireland with 21 participants with mental health problems who were treated with antipsychotic medication. The participants were clear about the importance of good physical health as well as good mental health. They disliked the adverse effects of antipsychotic medication and experienced many barriers in accessing general practitioners/primary care services. They also preferred to receive health advice and self-management advice from the mental health services. The participants in this study were aware of the need to engage in health protective behaviours but were often overwhelmed by their comorbid health issues and the organizational and communication barriers in accessing their general practitioners.

Evaluation of a computerized cognitive behavioural therapy programme, MindWise (2.0), for adults with mild-to-moderate depression and anxiety.

To investigate the acceptability and utility of a newly developed computerized cognitive behavioural therapy (cCBT) programme, MindWise (2.0), for adults attending Irish primary care psychology services. Adult primary care psychology service users across four rural locations in Ireland were invited to participate in this study. A total of 60 service users participated in the MindWise (2.0) treatment group and compared to 22 people in a comparison waiting list control group. Participants completed pre- and post-intervention outcome measures of anxiety, depression, and work/social functioning. At post-intervention, 25 of 60 people in the MindWise (2.0) condition had fully completed the programme and 19 of 22 people in the waiting list condition provided time 2 data. Relative to those in the control group, the MindWise (2.0) participants reported significantly reduced symptoms of anxiety and no change in depression or work/social functioning. The newly developed cCBT programme, MindWise (2.0), resulted in significant improvements on a measure of anxiety and may address some barriers to accessing more traditional face-to-face mental health services for adults in a primary care setting. Further programme development and related research appears both warranted and needed to lower programme drop-out, establish if gains in anxiety management are maintained over time, and support people in a primary care context with depression. There is a growing evidence base that computerized self-help programmes can assist in a stepped-care approach to adult mental health service provision. These programmes require further development to address issues such as high dropout, the development of equally effective transdiagnostic content, and greater effectiveness in the country of origin. This study evaluated the acceptability and utility of a brief online CBT programme for adults referred due to anxiety or low mood to primary care psychology services in the national health service in Ireland. Results indicate that 42% of people completed the programme and experienced a significant reduction in anxiety but not depression and no improvement in work or social adjustment compared to similar adults on a waiting list for services. This study suggests the programme warrants further development and research and may in time become a useful and suitable intervention within the national health service in Ireland.

Assessing National Practice and Preparedness for Integrated Care Delivery Ireland

Introduction/Theory/Methods: We assess current attitudes, practice and preparedness for Integrated Care (IC) delivery within the publicly-funded health and care services in Ireland. We utilise the framework developed within Project Integrate in conjunction with the International Foundation for Integrated Care and the University of Italian Switzerland. The 7-dimension framework, now in the public domain, assists organisations in identifying facilitators and barriers to IC implementation, based on best practices of successfully implemented IC projects across Europe. This project differs as it uses the framework to assess a complete health and care system, and in sites with no special preparedness or commitment to structured IC. The objective was to conduct a SWOT analysis to assess the current situation within Ireland with respect to IC. The Health Service Executive (HSE) runs all of the public health services in Ireland (population 4 million) with a patient-centred philosophy, and employs over 100,000 people. It delivers services through two service delivery units, 7 hospital groups and 9 community healthcare organisations. The 7-dimension framework is used as a baseline for the SWOT analysis. The research is conducted in early 2017. Ten moderated focus groups are conducted for unit representatives, with discussion guided by the framework, the degree to which these dimensions are in place, and identification of service planning barriers. A survey complements the focus groups with a broadcast view. Outcomes are related to agreed proxy measures of lack of IC (e.g., bedblocking, readmissions). Results: From the focus groups a constructive structured diagnostic of the strengths, weaknesses, threats and opportunities for IC in Ireland is developed. From the survey, a descriptive analysis of the dimensions includes identifying main trends and the extent to which dimensions are consistently rated (or otherwise) across HSE units. A thematic analysis of qualitative comments is presented. Discussion: We report on the current state of practice and preparedness for IC, and identify cases of best preparedness within the HSE. Guidelines are presented for an Action Plan on changing service orientation / attitudes / system organisation / patient-focussed communication and plans. Triangulation with other measures of IC is considered. Conclusion: This study enables local services to assess their state of readiness regarding IC practice. A picture is developed of the factors requiring attention to facilitate achievement of IC across Ireland. Additionally, the terms and concepts are adjusted as necessary for the Irish setting, and the implications of these changes discussed, resulting in a validated tool for further local use. Lessons learned: Learning points are identified on (i) the effort required to implement true IC across a whole system, and, (ii) using the framework outside sites with prior commitment to IC. Limitations: The study’s strength lies in its whole system basis, but this context must be considered carefully in applying the results to other systems. Suggestions for future research: At a National Level, future research should explore best practice cases identified within this study. At a European Level, future research should consolidate the 7-dimension framework as a means of reaching a common understanding on IC implementation.

National policy on access to services for children with disability or developmental delay: Working together to support children and families

Introduction : Health services in Ireland for children with disabilities or developmental delay have developed piecemeal over time, usually with access only for specific cohorts of children with a particular diagnosis. This means there are gaps and inconsistencies with some children unable to access any service. Referrers, including acute services, have had great difficulty in finding out where to refer a child, leading to frustration for families and inefficiency. Furthermore there has been a deficit in connectivity between acute services, disability teams and primary care services. Description of policy context and objective : Children’s disability services are being reconfigured under the Progressing Disability Services for Children and Young People programme into interdisciplinary Children’s Disability Network Teams for all children with complex needs, and Primary Care paediatric services are being planned for children with non-complex needs who require a multi-disciplinary response. The national policy will provide for consistent, equitable access to these services across the country and a smooth care pathway between acute services, disability teams and primary care services. Targeted population : All children aged from birth to 18 years who have a disability or developmental delay and their families. Highlights : The new national policy is based on the principles of the ICF[1]. It was tested in demonstration sites with wide consultation across sectors including parents and peer review. Access to services will be according to the child’s needs rather than bound by their diagnosis. Complexity of the child’s needs will be determined by considering the impact of impairments on function and participation. In each geographic area there will be an Integrated Children’s Services Forum with representatives of Primary Care, Social Care Disabilities, Mental Health and Acute Services, the Education sector and the Child and Family Agency Tusla. The Forum will decide on the best pathway for any child where this is not clear, and on shared care pathways, for instance children with complex medical needs or with co-morbid health issues. The policy will be implemented area by area during 2017. National training is being provided for staff in both Primary Care and Disability services on the operation and decision making process. Monitoring of the implementation will include collection of data to review consistency, and focus groups with staff and families to gather qualitative feedback on effectiveness. Comments on transferability : Joint development of policy progresses co-ordination of care pathways and elimination of gaps and duplication. The model of the Integrated Children’s Services Forum to resolve issues concerning individual pathways is currently being considered by other sectors. Conclusion : This policy represents a significant change of direction for services from separate criteria bound sectors to a cohesive care pathway. The process of developing and implementing the policy is promoting the team approach and bringing staff in different services together to work jointly towards individual child and family outcomes. The implementation of the policy will be subject to detailed monitoring and evaluation of effectiveness and outcomes. References : 1- World Health Organisation. International Classification of Functioning, Disability and Health – Children and Youth Version. World Health Organisation. 2007

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.