28th November 2008

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The provision and delivery of mental health services in Northern Ireland has not improved with devolution, according to University of Ulster academic Professor Deirdre Heenan.

Speaking at her inaugural professorial lecture at the Magee campus this week, Professor Heenan, who is Professor of Social Policy, suggested that despite the rhetoric, service users still have no real influence over the decision-making process.

‘Devolution and Social Policy: More say for the Citizens of Northern Ireland?’ looked at the provision of mental health services in the context of devolved administration in Northern Ireland to illustrate how the government’s avowed commitment to service user involvement had translated into reality.

Professor Heenan said that while devolution was warmly welcomed – as it was widely believed that it would bring government to the people, putting them in control of their own affairs, – the reality for users of mental health services in Northern Ireland was very different.

“One of the first major decisions of the newly devolved government in 2002 was the Review of Public Administration (RPA).  In the broader policy context of modernising public services, the RPA was to ensure help that services were to be driven by, planned for, and responsive to, the needs of patients,” she said. 

As part of the RPA, Northern Ireland’s health and social services have been reorganised but Professor Heenan suggested that this radical rationalisation and centralisation of service delivery may actually have an adverse affect on the responsiveness of services.  

She says that whilst there is a consensus that user involvement is desirable, it can be problematic.

“The nature and extent of involvement varies enormously.  At one end of the spectrum is the token involvement when a few service users might be asked to comment on or react to an agenda, project or document which has already been developed. The other end is characterised by an ideology in which clients' expertise and knowledge is valued. 

Pointing out that involving service users did not necessarily mean that their contribution is valued or used constructively, Professor Heenan continued: “It is possible to argue that user involvement is a sham, something which can be held up as representative of authenticity and reality but something which has no real influence over decision-making. It can be employed by managers to illustrate that they are in touch with users.  The ideology of user involvement is a way of illustrating management’s empathy and demonstrating that they are actually on the side of the user. 

“The story told is back in the ‘bad old’ days, users had no say and were simply told by professionals what to do. Now users are told they can be involved and influence the design and delivery of services. This is in fact a myth because all the decisions about how users are involved are controlled by professionals on the one hand and government and welfare bureaucracy on the other hand. The latter have control over finance which is crucial in all these situations.

Professor Heenan concluded that although devolution should have improved user participation and helped make services more patient centred, in key areas of social policy, quangos have been replaced by super quangos, largely unaccountable, remote and non-responsive. 

“User participation is a key theme in policy and strategy development but the nature and extent of this participation is controlled by professionals and for many is synonymous with consultation where the outcomes also controlled by policy makers. The example of mental health demonstrates the difficulties associated with meaningful engagement.    

Despite examples of new ways of working based on users experiential insights of distress, professionals and policy makers remain extremely resistant. It is this resistance based on the desire to retain power, status and security that needs addressing in depth if there is to be equality based partnership that could lead to fundamental transformations in services. Without these fundamental changes, service users will remain comparatively powerless and ‘Innovation without change will continue’.

For further information, please contact:

Trina Porter
Telephone: 028 71675511
Email: Trina Porter