This is the 6th Annual Report of the Independent Monitoring Group for A Vision for Change (IMG) and the final report of the Second Group. It is clear to the IMG that the implementation of A Vision for Change (AVFC) to date including 2011 has been slow and inconsistent.

There is a continued absence of a National Mental Health Service Directorate with authority and control of resources. Such a body has the potential to give strong corporate leadership and act as a catalyst for change.

The absence of a comprehensive, time lined and costed Implementation Plan has made it difficult to put in place a consistent framework for the development of all mental health specialities and has led to a lack of coherency in the planning and development of community based services.

Existing community mental health teams are poorly populated with an estimated 1,500 vacant posts. These are mostly allied health professional posts. Consequently, the service that is delivered through medical and nursing posts is not based on multiple interventions as envisaged in AVFC. The effects of the HSE recruitment embargo and the Public Service Moratorium have disproportionately and indiscriminately reduced the availability of professional mental health service staff and reduced the overall volume of financial resources.

There is an absence of the ethos of recovery and poor development of recovery competencies in service delivery resulting in a reactive rather than proactive approach to the needs of individuals and their families.

The development of the National Mental Health Programme Plan (Clinical Programmes) is welcome although the IMG is greatly concerned that the principle of “Specialist within Generalist” framework will obstruct the development of specialist mental health care services and result in a modified version of AVFC.

On a positive note, there is evidence of many local and regional initiatives being developed in line with AVFC. These are principally “bottom-up” developments led by local leadership. The HSE in combination with the Mental Health Commission has driven the continued closure of unfit for purpose facilities in favour of modern community based approaches. In respect of capital developments, progress has and is being made in the area of general adult mental health services, child and adolescent mental health services and forensic mental health services.

What is still required to achieve full implementation of AVFC is an operational framework for the development of recovery competencies for all staff both at entry training level and ongoing in-service development.

As a matter of urgency, the specialist mental health services for older people, rehabilitation and recovery, eating disorders, intellectual disability, co-morbid severe mental illness and substance abuse problems and others described in AVFC need to be fully developed and delivered.

Government Departments, other than the Department of Health and the Department of the Environment, Community and Local Government need to focus on their responsibilities for the implementation of AVFC.

In order for all of these actions to be achieved there needs to be a cultural shift in how mental health services are delivered. This involves moving from professional dominance towards a person-centred, partnership approach.

There is also a requirement to move from a largely medicalised and maintenance approach towards one based on recovery competencies within the biopsychosocial model as envisaged in AVFC. Service responses to individuals and their families need to be proactive instead of reactive and be able to provide multiple interventions, as required.

The principles and practices of a recovery oriented service appear to be developing in localised services and this needs to be encouraged and reinforced by a clear national corporate policy implementation framework.