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3 General points
3.1 Overall, respondents were very much in agreement with the general approach outlined in TAMFS. Respondents were in favour of shifting the focus from mental illness to mental wellbeing and strongly supported the move towards greater action at a local level. In addition, they welcomed the focus on early years and the attention given to families and parenting. Respondents also strongly supported the emphasis on reducing inequalities. The consultation document was clearly well-received, and one individual described it as "positive and inclusive." Several others commented on the enthusiasm with which the document was received at a local level.
Positive points
3.2 Respondents also:
- Welcomed the recognition of the relationship between mental and physical health, and in particular, the relationship between mental health and drug / alcohol use
- Supported the shift away from the 'medicalisation' of mental health issues and towards an emphasis on promoting mental health and wellbeing across a range of services
- Supported a population-based approach, but also agreed with the need to target certain groups
- Supported the links made between self-management and recovery
- Supported the need to build capacity and 'mental health literacy' within primary care and wider community services
- Agreed that staff attitudes, the accessibility and responsiveness of services, and the availability of social and psychological (as well as a medical) support were issues needing to be addressed.
- Agreed with the need to monitor progress and measure outcomes in relation to improving mental health and wellbeing.
3.3 There was a suggestion that TAMFS could be used as a tool for proofing other national and local policies for their contribution towards mental health improvement.
3.4 In addition, respondents largely agreed with the three broad themes for action proposed in the document - promotion, prevention and support. However, one individual commented that they would have liked to see some consideration of the idea of maintenance - i.e. how people can be supported to remain mentally healthy.
Issues needing attention
3.5 Other respondents would have liked the document to include:
- More explicit information about the evidence base for the strategy (This is discussed further below.)
- Some recognition of the relationship between spirituality and mental health
- A discussion of the levels at which mental health improvement operates - individual, community and structural - at an earlier stage in the document
- Greater emphasis on promoting links between services and sectors, and in particular, making use of the skills and expertise available in the voluntary sector
- Links to a wide range of other relevant policy initiatives and related health and non-health policy documents
- An explicit discussion of equality impact assessment - to ensure that the proposed plan and delivery modes do not exacerbate existing inequality
- Clarification of terms such as "mental health literacy" and "emotional literacy"
- Clarification of roles and responsibilities ( e.g. of the health service, local authorities, Community Health Partnerships, government departments and the voluntary sector) and performance management processes
- SMART objectives ( SMART = specific, measurable, achievable, relevant, timed).
3.6 While respondents welcomed the emphasis on local action, many were also concerned that this should not be at the cost of national support activity. (This issue will be discussed in more detail in Chapter 5.)
3.7 Some respondents (particularly service users / carers and their representatives and those in the voluntary sector) expressed the opinion that TAMFS did not go far enough in its proposals. However, it was more common for respondents to suggest that the strategy was trying to do too much, and to ask for greater focus in relation to priorities.
3.8 At the same time, a concern was also expressed that some of the actions may be unachievable at a local level - particularly those concerning early interventions with children and young people and their families - since in some areas, there are no clear systems or processes for identifying children at an early stage of risk in social / community settings such as schools and colleges, nor were there sufficient services available to address needs for early intervention.
Evidence base for the action plan
3.9 A recurring theme in comments on the TAMFS document was a request for more explicit information about the evidence base for the proposals. One respondent made the point that, although the document included a long list of research funded by the National Programme, the outcomes of this research were not discussed. Nor was there any critical reflection on the evaluations of initiatives such as Choose Life, 'see me,' and others.
3.10 Respondents wanted assurance that the outcomes and recommendations of the research and evaluation funded by the National Programme over the past few years were being used to inform the direction of future policy and action. It was suggested that the final action plan should be more explicit about its evidence base, and also about how current gaps and needs in relation to knowledge transfer might be addressed. One individual felt it would be helpful if the action plan included examples of (evaluated) good practice.
3.11 Another individual felt that TAMFS should include an economic argument for its proposed actions. Several respondents suggested that reference should be made to a report published by the Northern Ireland Association for Mental Health (Friedli & Parsonage 2007), which identifies cost-effective interventions in this area. 1
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