After spending the semester abroad in Ireland to study public health, I took a great interest to public health objectives overseas. I took a special interest in mental health policies and procedures, given the ever-increasing amount of global attention that is paid to mental health awareness and stigma. Several of my Irish professors were involved in mental health advocacy, and so with their help and research of my own, I decided to delve into aspects of mental health advocacy that are currently pertinent in Ireland.
Ireland has placed mental health service improvement high on their health agenda, paying particular attention to increasing mental health service user participation. Service user participation is when people who have at some point accessed mental health services actively partake in the formation of mental health policy, service development, and implementation. In other words, those who have used mental health services actually become a contributing part of the service system.
The involvement of service users in mental health policy and service is a relatively new trend. The idea originates with the characteristic lack of autonomy experienced by many mental health service users. Oftentimes, service users have little to no say in their treatment process, and are instead subject to the decisions of mental health professionals. What’s more, service users are typically bound to the policies and procedures developed by these professionals, again experiencing little to no influence in the policymaking process which effects them so greatly. Based on this premise, service users in Ireland aim to expand their influence.
Unfortunately, as more service users involve themselves with mental health policy and service development, they are met with discrimination. Irish mental health advocate Dr. Shari McDaid plays an active role in exposing and combatting these inequalities, which include lack of access to economic, social, physical, and mental resources, little influence in decision making, lack of respect, and lack of emotional support.
In response to the increased involvement of service users and the inequalities they face, Irish mental health advocates have swiftly propositioned for increased service user participation and equal opportunity in their work. Dr. McDaid proposes professional training for working service users, emotional and technical support, establishing a national Service User Executive board, and appointing users to the Mental Health Commission.
Despite the setbacks service user participants encounter as they work to empower themselves within the mental health system, Ireland has still celebrated many noticeable successes. For instance, service user participation has begun to transform ineffective mental health policy into successful guidelines that improve treatment options and delivery. Service user participants first identify policies which are most unproductive, as evidenced by their personal experiences. They then pinpoint the specific reasons the policies are ineffective and suggest ways to correct these ineptitudes or propose suitable alternatives. Ultimately, involving service users can create a system of internal feedback wherein user employees offer their experiences and preferences to continually develop and improve mental health services that better cater to patients.
Ireland’s increased service user participation has also had a positive effect on service delivery. User employees act as “expert patients:” those with enough experience with mental health and mental health services that they understand the best ways to reach out to patients and make services as accessible and beneficial as possible. Regardless of the role they fill, participants who personally provide mental health services and come into direct contact with patients act as a solid support system and exemplar of the benefits of mental health services. An Irish study found that service users’ patients exhibited increased quality of life, higher social functioning, and fewer and shorter hospital visits post-treatment in comparison to non-service users’ patients.
Though there is still progress to be made on service user participation and mental health services and stigma in general, Ireland has shown great leadership in improving health services and combatting mental health stigma from the inside out.
It was a pleasure to see the issues about mental health in Ireland highlighted on your Global Health blog. You probably did not realise that I, myself, am an NU alumna (B.A. in philosophy) and so it’s great to make the connection back to my old stomping grounds in Evanston. Good luck with your initiative. Shari