Search results

This paper provides an historical perspective on dual diagnosis and current developments in the delivery of mental health and addiction services to people with dual diagnosis in Ireland. In light of government policy, it describes attempts made to improve the standards of care provided, recognising deficits in services, and not just those services provided to clients with a dual diagnosis. It identifies a number of issues that need to be addressed, including training, research, service developments, co‐operation between different service providers, information availability and measurement of client outcomes. It concludes that, although there is increasing awareness of the issue of dual diagnosis, this has not resulted in significant relevant policy implementation and improvements in services provided to clients with a dual diagnosis. Yet there is sufficient evidence available for a meaningful response to dual diagnosis, given the state of play in policy and service delivery in those settings with which people with dual diagnosis engage.

This paper aims to describe a novel community development and how the synergies arising from the interaction of diverse perspectives (including arts and health, person centredness, co-production and shared leadership) have led to a transformative initiative for individuals and a local community in the Republic of Ireland.

This is a descriptive case study. It includes the personal narrative of an expert by experience who is one of the co-authors. Links to short digital films are also included along with references to internal evaluation documents and published literature. Reflections from the nurses who contributed to the initiative and a university academic are also incorporated.

A space in the community built around the principles of relational practice has evolved into an alchemical space, enabling creativity, recovery and well-being. The benefits arising out of this network of social relationships have contributed to personal recovery, integration with the local community and generated social capital. This has enhanced mental health and well-being locally.

Statutory Irish health policy is reflective of developments in health care internationally, with an emphasis on greater delivery of care in the community. This views citizens as active partners in the maintenance of their health and well-being. This case study illustrates how this has unfolded in practice in a rural mental health community context.

This paper adds to the evidence base that demonstrates the potential benefits of participation in the arts to individual recovery journeys. In addition, it shows that when arts and health perspectives coalesce with the wider domain of relational practice, the synergies arising contribute positively to the health and well-being of local communities.

In the early to mid-twentieth century, psychiatrist-led occupational therapy departments emerged in Irish psychiatric hospitals. This marked a transition towards establishing rehabilitative services in institutional settings. This paper aims to examine the development of occupational therapy in Grangegorman Mental Hospital and its auxiliary hospital, Portrane Mental Hospital from 1934-1954.

Historical documentary research methods were used to analyse primary source data from Grangegorman Committee Minutes, Inspector of Mental Hospital Reports, Boroughs of Mental Hospitals, Department of Foreign Affairs documents and newspaper archives. The archival data was analysed using both a chronological and thematic approach.

The main key event emerged in 1935 when four Grangegorman nursing staff were sent to Cardiff Mental Hospital to undergo a six month training course in occupational therapy. The following themes emerged – “establishing occupational therapy in Grangegorman and Portrane”; “the role of short-course trained nursing staff in providing occupational therapy services” and “therapeutic rationales vs hospital management rationales”.

This study throws light on the early practitioners of occupational therapy in Grangegorman and highlights the complexities of occupational therapy’s role origins in mid-twentieth century Ireland. In line with contemporaneous psychiatric hospitals, the occupational therapy activities promoted in Grangegorman were mainly handicraft or productivity based. The absence of patients’ voices means there are limitations to determining the therapeutic nature of this early occupational therapy service.

No occupational therapy outcome measures have been designed specifically for recovery-orientated services.This paper aims to identify occupational therapy outcome measures relevant to mental health practice and assess them against recovery principles adopted by Irish Mental Health Services.

A narrative review methodology was used to appraise outcome measures against CHIME recovery principles.

A systematic search across 13 databases identified eight well-established outcome measures commonly used within occupational therapy mental health literature. The included outcome measures were appraised using a recovery alignment tool.

All outcome measures connected to some recovery processes. Those using semi-structured interview formats and notably the Canadian Occupational Performance Measure (COPM) had the strongest alignment to recovery processes.

This is the first known review which provides some validation that the included outcome measures support recovery processes, yet the measures rely heavily on therapist’s skills for processes to be facilitated. It recommends that ways to better support the process of partnership in occupational therapy mental health outcome measures be explored and further research be undertaken.

This paper aims to describe the establishment and evolution of Ireland's Mental Health Commission including its functions, strategic objectives and the challenges encountered.

This case study is based on an analysis of the outputs of the organisation to date, legislative reviews, and available evidence on the contributions of the organisation to the development of services.

The organisation has a breadth of responsibilities. It has administered reviews of 9,896 involuntary admissions to inpatient units to date since its inception. It has regulatory and enforcement powers in terms of the licensing of inpatient mental health facilities in Ireland. It has issued numerous codes of practice and rules for the guidance of those working across services. It also has an independent Inspectorate arm that inspects the quality of mental health services annually.

There is a risk of potential bias given the authors work for the organisation, however, attempts have been made to support observations with evidence from external sources.

The organisation's work has been seminal in enhancing the protection of the human rights of persons accessing mental health services. Regulatory measures have also led to changes in the behaviour of service providers, but it has proven to be more challenging to change attitudes and culture within services.

The Commission has contributed to the reform agenda by focusing greater attention on rights‐based, participatory and recovery‐oriented models of care provision.

This paper documents the work of the Mental Health Commission and highlights the impact changes have had both for those using services and those providing them.

The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security‐focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients' needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re‐engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi‐ disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.

The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.

Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework.

Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda.

Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.

There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.

The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.

The COVID-19 pandemic transformed the delivery of occupational therapy (OT) community mental health services nationally, resulting in the rapid expansion and delivery of services through telehealth. While telehealth technology and its use are not new, widespread adoption was precipitated by the cessation of face-to-face services due to the COVID-19 pandemic. Research in this field has been conducted previously; however, it is not specific to OT in the Irish context. This study aims to explore service users’ experience of telehealth OT interventions in adult mental health services during the COVID-19 pandemic.

A descriptive qualitative approach was used to explore service users’ experience of mental health telehealth OT services. Five service users were recruited to participate in a focus group to explore their experience of OT via telehealth. The themes identified from this focus group were then further explored via individual interviews. Four of the service users who participated in the focus group chose to complete in-depth interviews. Reflexive thematic analysis was then completed.

Two key themes emerged from the data. The theme of positive telehealth experiences included subthemes of gratitude for the option of telehealth and accessibility. The second theme of learning from experience, included subthemes of human connection, preferred platforms of telehealth methods and future considerations for telehealth interventions.

These findings provide a unique insight into the importance of continuing OT services via telehealth, from the service users’ perspective.

The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users’ experiences.

A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis.

Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual’s recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise.

It is not a representative sample of service users within an Irish context.

To the best of the authors’ knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context.

This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues.

A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis.

Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice.

The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice.

This study offers a unique insight into psychologists’ perceptions of seclusion and considers the implications of these views. Participants’ nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics.