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National strategy(ies) National Youth Strategy 2015-202
The National Youth Strategy 2015-2020 (Department of Children and Youth Affairs, 2015) aims to enable all young people to realise their maximum potential, by respecting their rights and hearing their voices, while protecting and supporting them as they transition from childhood to adulthood. It provides for the needs of young people experiencing, or at risk of experiencing, the poorest outcomes. The strategy identifies over 50 priority actions over the period 2015–2017. It includes the commitment for the Health Service Executive (HSE) to develop mechanisms, including consultation and feedback mechanisms, for the participation of service users, families and carers in the decision-making processes of mental health services for young people at local and national levels. It also commits to ‘Promoting quality-assured, online youth mental health services among young people and within youth work and education settings” (Pg. 5). The strategy’s implementation is the shared responsibility of Government, State agencies and other stakeholders who are involved in developing policy and providing services. It sets out the Department of Children and Youth Affairs’ role in providing national leadership in this collective effort, and in ensuring that national policy joins together with local implementation.
Mental Health Act, 2001
The Mental Health Act, 2001 establishes how and why a person can be admitted to a psychiatric hospital, the patient’s rights under the act and their mental health team’s responsibilities towards them. A key element of the Act is that it provides the right for patients to have their involuntary detention automatically reviewed, by an independent group called a Mental Health Tribunal, within 21 days of the person’s admission. The Act applies to both adults and children. Reference to children and young people are spread across parts of the Act, rather than contained within one section. The Mental Health Commission is responsible for implementing the provisions of the Act in relation to involuntary admission, for setting up mental health tribunals and ensuring that the rights of patients are respected.
In 2015 an Expert Group appointed by the then Minister for Mental Health published a Report of the Expert Group Review of the Mental Health Act, 2001. It aimed to bring Irish mental health law in line with best international standards and to better protect people who go into hospital for mental health care and treatment. Among its 165 recommendations to update the Act is to create a new standalone section to outline the rights of children, setting out a list of child-specific guiding principles in line with international human rights standards. The report, implementations of its recommendations and criticism surrounding the Act/the implementation of the report’s recommendations, are discussed further in Chapter 7.8.
Connecting for Life
There is no Irish national strategy to prevent suicide specifically among the youth population. However, Connecting for Life (Department of Health, 2015) is Ireland's national strategy to prevent suicide 2015-2020 amongst the general population. Connecting for Life has a vision of an Ireland where fewer lives are lost through suicide, and where communities and individuals are empowered to improve their mental health and wellbeing. It sets out 7 goals:
- Better understanding of suicidal behaviour
- Supporting communities to prevent and respond to suicidal behaviour
- Targeted approaches for those vulnerable to suicide
- Improved access, consistency, and integration of services
- Safe and high-quality services
- Reduce access to means
- Better data and research
Its aims include better evaluation of suicide prevention strategies, with an emphasis on universal approaches such as building resilience among young people.
Connecting for Life takes a whole-of-government approach. It states that its implementation process “is particularly complex because it is a cross-cutting, whole-of-society strategy, which requires consistent co-operation and communication between relevant stakeholders” (Pg. 36). The strategy establishes a cross-sectoral leadership team, with “expertise and ‘boundary spanning’ skills” (Pg. 37), to drive implementation. This includes:
- Cabinet Committee on Social Policy and Public Service Reform
- National Cross-Sectoral Steering and Implementation Group
- National Office for Suicide Prevention
- Local Cross-Sectoral Implementation Structures Individual Agency and Implementation Systems.
The strategy’s main outcomes aimed for are:
- Reduced suicide rate in the whole population and amongst specified priority groups
- Reduced rate of presentations of self-harm in the whole population and amongst specified priority groups
It also states that the planning process will include Service delivery personnel and professionals from the start and that all stakeholders on whose involvement and co-operation success depends will be involved in implementation. There will be ongoing monitoring and evaluation of the implementation of the strategy to guide the on-going implementation process, with formal systems for capturing and sharing learning put in place.
Sharing the Vision
Sharing the Vision: A Mental Health Policy for Everyone (Department of Health, 2020) is a strategy document setting out a policy framework for the direction of Mental Health Services in Ireland. It is an action-oriented policy, focusing on better outcomes for people experiencing mental health difficulties to bring about tangible changes in their lives and achieve better results. It is a broad based, whole system mental health policy for the whole of the population. The policy assigns a proposed completion timeframe to every recommendation/associated action that is either short (18 months), medium (36 months) or long (36 months – 10 years).
Sharing the Vision: A Mental Health Policy for Everyone is the successor of A Vision for Change (AVFC) (Expert Group on Mental Health Policy, 2006). It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness. The policy was developed by an expert group, which combined the expertise of different professional disciplines, health service managers, researchers, representatives of voluntary organisations, and service user groups. AVFC recommends that the National Directorate should be comprised of mental health service managers, clinicians and service user representatives, charged with responsibility to coordinate and implement the recommendations. 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. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, and evolved and agreed with service users and their carers.
Several reviews were conducted following AVFC, including:
- From Vision to Action? An Analysis of the Implementation of a Vision for Change was published in 2009 by the Mental Health Commission.
- Implementation of 'A Vision for Change' for Mental Health Services was commissioned by Amnesty International Ireland and Mental Health Reform, to provide an economic assessment of the progress on A Vision for Change.
- The Psychiatric Nurses Association of Ireland (PNA) commissioned the Faculty of Nursing and Midwifery, RCSI to explore the progress of implementation in An Impact Evaluation of “Vision for Change” (Mental Health Policy) on Mental Health Service Provision: A national Descriptive Evaluation project in 2012.
- Mental Health Reform published a progress analysis, A Vision for Change Nine Years On: A Coalition Analysis of Progress, in 2013.
- Mental Health Reform submission on review of A Vision for Change was published by Mental Health Reform in 2017, with the support of the Department of the Environment, Community and Local Government’s Scheme to Support National Organisations 2016-2019.
Well-being in post-primary schools: guidelines for mental health promotion and suicide prevention
The Department of Education, the HSE, and the Department of Health produced Well-being in post-primary schools: guidelines for mental health promotion and suicide prevention in 2013. The guidelines aim to support schools in developing a whole-school approach to mental health promotion and suicide prevention. They promote building and integrating school self-evaluation processes, implementing the Social, Personal and Health Education (SPHE) curriculum, developing the whole-school guidance plan, adopting the National Educational Psychological Service continuum of support, and building effective inter-agency relationships. No specific target groups within the youth population is identified by the guidelines. It specifies that a guidance counsellor or other designated member of the student support team should liaise with other staff members, student support team, class tutor, year head, subject teachers, etc., in order to monitor and review the intervention’s effectiveness. It is also necessary to document the outcomes arising from the monitoring and review process.
Child and Adolescent Mental Health Services (CAMHS) provides assessment, specialist treatment and care for young people up to 18 years and their families who are experiencing mental health difficulties through a multidisciplinary team. It aims to provide timely high-quality assessment and treatment of mental health difficulties for young people and their families. Some conditions treated in CAMHS include:
- moderate to severe depression
- moderate to severe anxiety
- eating disorders
The service is provided by the HSE.
Youth Mental Health Signposting tool
A key finding from the Rapid Mental Health Needs Consultation: National Youth Health Programme, a Mental Health Needs Assessment carried out by the National Youth Health Programme in 2015, was the need to support organisations, practitioners and young people to access appropriate mental health services. In response to this need a Youth Mental Health Signposting tool was developed and launched in 2017 by the National Youth Council of Ireland (NYCI). It provides information on available youth mental health services, training programmes, community supports and children’s rights. It includes four sections:
2. Training Programmes
3. Community Supports
4. Children’s Rights
It is available from the NYCI.
The HSE’s website Yourmentalhealth.ie provides free mental health support resources which can be filtered by age group.
Covid-19 health campaign
In response to Covid-19 the Government launched several mental health related initiatives. These included a mental health and wellbeing initiative to support people during COVID-19 launched by the Minister for Mental Health. This campaign, developed by the Department of Health and HSE, in collaboration with a range of cross-Government partners, offered support and resources to help to cope with the stress, anxiety and isolation experienced during Covid-19 restrictions. The campaign is supported by the local authorities. An online resource, In This Together, offer advice to help people cope at home and promote the mental health supports and resources available on the HSE’s YourMentalHealth.ie. Minding your mental health during the coronavirus pandemic is a web-resource offered by the HSE, which specifically includes a section on Young people's mental health during the Covid-19 pandemic. The HSE Health and Wellbeing also began offering a free Stress Control programme online from the 11th May 2020. Stress Control is an evidence-based programme that teaches participants practical skills to deal with stress, with Clinical Psychologist, Dr Jim White, live-streaming 6 sessions, free-of-charge. The programme helps participants recognise the signs of stress. Its topics include how stress affects bodies and thoughts. It teaches skills to overcome panicky feelings and tips to getting a good night’s sleep. The Department of Education also published Advice to Young People while Schools are Closed during 2020 in relation to coping with Covid-19 measures.
Childline and Teenline
The Irish Society for the Prevention of Cruelty to Children operates the helplines Childline andTeenline, which provides services on a 24/7 basis where young people affected may turn to for advice and guidance. It is co-financed by the European Union’s Connecting Europe Facility.
Jigsawis The National Centre for Youth Mental Health. It provides supports to young people with their mental health by working closely with communities across Ireland. Jigsaw Online offers mental health information via articles, videos, and audio recordings to support young people, parents or those working with young people. Jigsaw support lineis a helpline for 15- to 25-year-olds and parents or concerned adults who live in the Republic of Ireland. It was developed as a response to Covid-19. Jigsaw is funded by the Health Service Executive, donations, fundraising and pro-bono support.
SpunOut.ie is an Irish youth information website created by young people, for young people. Its offers articles and factsheets for specifically targeting youth, around mental health, alongside other health and wellbeing related topics. More information about SpunOut.ie is available in Chapter 7.4.
Bodywhys provides support to people affected by eating disorders and their family. It is described in Chapter 7.4.
Pieta supports people and communities in crisis by providing freely accessible, professional services to all. There are 15 Pieta Centres and five Outreach services. Its services include an LGBTI+ Outreach service for 14- to 23-year-olds within the LGBTI+ community. Pieta offers a free 24-Hour Support helpline, texting service and up to twelve free counselling sessions with a therapist to work through suicidal thoughts. It also runs The Resilience Academy, a six-week programme for second-year students aimed at equipping students with emotional resilience tools. It is a skills training programmes aim to increase protective factors such as coping skills, problem solving, decision making, and cognitive skills. By targeting risk factors and giving youth important skills, its goal is to prevent the development of suicidal behaviour. The Pieta Amber Flag Initiative recognises the individual efforts of primary and secondary schools, companies, and groups to create healthy, inclusive environments that support mental well-being. Its objective is to unite these groups in their efforts, to work together toward a happier, healthier Ireland and eradicate the stigmas associated with mental health issues. Pieta receives funds through fundraising, corporate donations, and statutory funding from the National Office of Suicide Prevention, regional HSE initiatives, and TUSLA.
The Samaritans offer multiple service to support mental health in Ireland, including:
- free listening service,
- email and letter writing support,
- school talks about emotional health, the value of listening, coping strategies (including self-harm) or about Samaritans and the importance of accessing support and where it can be found.
- Step by Step; a programme providing practical support to help schools, colleges, and higher education communities to prepare for and recover from a suspected or attempted suicide.
- DEAL (Developing Emotional Awareness and Listening); a free resource for teachers and other educational professionals designed to help develop resilience in young people.
The Samaritan’s work in Ireland is funded through the Health Service Executive, corporate sponsorships, and fundraising.
Aware provide support and assistance to people affected by depression, bipolar and mood disorders. Aware runs support groups around the country, a freephone helpline and a next-day email support service. Its website includes information specifically tailored to young people and it runs a free, positive mental health education programme Life Skills for Schools for 15- to 18-year-olds. The programme is designed to help young people learn new ways to deal with challenges in life, using principles based in cognitive behavioural therapy. Life Skills for Schools contains eight modules delivered over four weeks in 75-minute sessions.
turn2me is an online counselling service. It receives support from several sources, including the Health Service Executive (HSE) National Office for Suicide Prevention, and the Department of Health's SlainteCare Integration Fund. It offers counselling, online peer support and support groups for 12- to 17-year-olds and for those over 18 years. It also offers wrap around support for parents and guardians. The HSE provides some funding for free sessions to people resident in Ireland.
Youth Work Ireland
Youth Work Ireland is the largest youth organisation in Ireland and its work includes running initiatives to support young people’s well-being. Be Well: Supporting Young People to Identify and Address Anxiety is its one-hour workshop which supports young people to identify and address anxiety. The workshop aims to introduce the issue of anxiety with young people, and explore the signs and symptoms of anxiety, personal triggers, and coping skills. Youth Work Ireland also run Friends Resilience, a cognitive behavioural therapy based early intervention and prevention programme focusing on reducing anxiety and depression through building resilience.
National Office for Suicide Prevention
The Connecting for Life Education and Training Plan 2019-2020 (Health Service Executive’s National Office for Suicide Prevention, 2019) provides the National Office for Suicide Prevention (NOSP) with an overarching framework to support the coordination, quality assurance, monitoring and evaluation of education and training actions identified in the strategy. This work builds the capacity of government departments, funded agencies, the HSE, community organisations, groups and individuals to identify and respond appropriately to people at risk of suicide and self-harm. The Department of Education and the National Office for Suicide Prevention (NOSP), in partnership with the network of Education Centres, offers teachers a continuous professional development training programme in safeTALK, ‘suicide alertness for everyone’ training. safeTALK is available to a limited number of Further Education Colleges. In 2018 the Minister for Education announced that by 2020 teachers in every post-primary school in the country will receive training on how to respond when a critical incident occurs in their school community. In this context, a critical incident was defined as an incident or series of events that overwhelms the normal coping mechanism of the school.