Assessing the implementation of Sharing the Vision

Paul Mulholland examines the progress and shortfalls in the roll-out of the national mental health strategy

Ireland’s 10-year mental health strategy, Sharing the Vision, was launched in 2020. The strategy is currently in its second implementation phase, which covers the period 2025–2027.

Speaking about the evolution of mental health services under the strategy, Consultant Psychiatrist Prof Brendan Kelly said the emphasis on community-based, person-centred, integrated care has been “particularly important”.

“The continued development of early intervention services, clinical programmes, primary care supports, and better transitions between child and adult services is very welcome,” Prof Kelly, Professor of Psychiatry at Trinity College Dublin, told the Medical Independent (MI).

“The inclusion of people with lived experience in planning and oversight is also significant. It will be important, however, to demonstrate how that involvement changes services in practice.”

Prof Kelly’s main concern “is the continuing gap between national policy and the experience of services on the ground”.

“Staffing shortages, recruitment and retention difficulties, limited access to psychological therapies, inadequate infrastructure, and variations between different parts of the country all impede implementation,” he said.

The continued shortcomings in child and adolescent mental health services (CAMHS) are a notable example of this gap.

In February, the HSE South West published a report, including an external lookback review, into the standards of care provided by CAMHS in north Kerry.

This report arose from the publication of the Maskey report, which documented significant concerns regarding diagnosis and treatment – in particular prescribing and medication safety – in CAMHS in south Kerry.

Of the 374 files assessed in the north Kerry review, a risk of potential harm was found in 209 files (52 per cent).

The report found a high rate of prescribing of psychotropic medication, failures in compliance with recommended physical health assessment and monitoring, and a disproportionately low rate of individual or family/systemic psychotherapeutic interventions.

According to the HSE, the findings were inconsistent with standard practice in CAMHS nationally.

At the time of the report’s publication, Consultant Psychiatrist Prof Matthew Sadlier, who is the current IMO President, said: “The findings of this CAMHS report are devastating for the many children and adolescents who accessed services in north Kerry and their families.”

Prof Sadlier argued that poor governance and under-resourcing were “at the heart of the issue”.

“None of the teams in north Kerry was staffed at appropriate levels, denying patients the high-quality standard of care they needed.”

Implementation reports

Sharing the Vision contains a number of recommendations to improve CAMHS, along with other areas of the mental health service. Since Sharing the Vision was launched, regular reports have been published by the strategy’s national implementation and monitoring committee.

The latest implementation progress report for May 2026 showed that 21 recommendations had been ‘completed’ and were now termed ‘business as usual’. In addition, 58 recommendations were ‘on track’. A further 21 had ‘minor delivery issues’, while three recommendations were ‘paused’.

The report highlights the significance of the Mental Health Act 2026, which was signed into law in May. The Act fulfils a recommendation in the strategy, which called for a more person-centred legislative framework and, for the first time, regulation of community mental health services.

The report also notes the publication in February of the first Digital Mental Health Strategy, which covers the years 2026–2030.

In relation to CAMHS, an updated operational guideline was published in December 2025 to set standards for high-quality care and improve consistency in service delivery nationally.

“Significant progress” has been made on the design of an integrated crisis response pathway, incorporating 24/7 end-to-end service delivery for children and young people with crisis response support needs.

Also, a new CAMHS hub in Louth-Meath opened in March 2026, bringing the total to five hubs nationally. These multidisciplinary hubs provide intensive, brief interventions to support CAMHS teams in responding to children and young people experiencing acute mental health difficulties, as well as supporting families and carers.

A national child and youth mental health outcomes framework has been completed, with work underway to introduce routine outcome monitoring in CAMHS and support continuous quality improvement.

A draft model of care for child and youth mental health services has also been developed and is under review, while a ‘single point of access’ (SPoA) model is being tested and refined through learning from pilot sites. The SPoA model involves the design and development of a single integrated pathway for all child and youth mental health referrals.

In relation to adult services, the report states there has also been progress in crisis and community services.

A total of seven crisis resolution teams are operating nationally, while six Solace Cafés provide out-of-hours support. An additional two Solace Cafés are planned to be in place before the end of the year.

In general, Ms Niamh Fahy, Communications and Engagement Manager, Mental Health Reform, told MI that the report shows significant steps have been taken in implementing Sharing the Vision. She said it was encouraging that most recommendations are either ‘on track’ or have been ‘completed’ and transitioned into routine delivery.

“There have been key developments including investment in digital mental health services, greater availability of talk therapies, and the expansion of crisis supports,” according to Ms Fahy.

“There are also positive signs that lived experience is becoming more embedded in policy implementation and service design.”

The College of Psychiatrists of Ireland also welcomed the progress outlined in the report.

Speaking to MI, President of the College Dr Lorcan Martin pointed to the various community projects rolled out to improve early intervention and support for psychological distress and difficulty.

He highlighted investment in free talking therapies for men; online peer-to-peer mental health support for young people (aged 16–30); and the resourcing of additional crisis resolution teams.

“Additional support for services to meet the complex needs of minority and ethnic groups, such as the Traveller community and Ukrainian people, is highly timely,” according to Dr Martin.

Delivery issues

A total of 21 recommendations have ‘minor delivery issues’, according to the progress report. They include: Provisions for those presenting at emergency departments (EDs) who additionally require an emergency mental health assessment; services for individuals with a dual diagnosis (meaning a combined substance misuse issue and mental illness); and access to appropriate advocacy supports in all mental health services.

In addition, the report identifies the roll-out of three recommendations as having stalled. The development of a national stigma-reduction programme remains ‘paused’ after an unsuccessful application for research funding to the Health Research Board Applied Partnership Awards. The HSE is now exploring a revised proposal with the RCSI.

In a joint statement, the Department of Health/HSE told MI that since the May 2026 report was published, the Executive “has identified opportunities” for further embedding stigma reduction within the Public Health Strategy 2025–2030, as well as in the implementation planning for Ireland’s Strategy to Reduce Suicide and Self-harm, Connecting for Life 2026–2035.

“It is also important to note that the HSE continues to work closely with funded partners to address mental health stigma, including through public campaigning,” according to the statement.

“…. However, the requirement under [this] recommendation goes far beyond public information provision and campaigning with the intention being that a more systematic, whole-of-government approach be undertaken to address the social-structural determinants of mental health stigma and inequality in the realms of education, housing, employment, and the wider public sphere.”

Another recommendation regarding individualised support packages for children and young people with complex needs is also ‘paused’. As part of the HSE’s restructuring, any funding previously held centrally by national disability services has transferred to the health regions to support ongoing service delivery, according to the report.

“The reason this recommendation is paused is therefore not related to resources and local service provision, but a need to establish an approach for the development of nationally agreed criteria, including action owners,” stated the document.

“The HSE plans to prepare a position paper on how the outstanding work should proceed.”

According to the Department/HSE statement, the Executive is currently engaging with relevant programme leads to “finalise an agreed approach for delivering outstanding actions”, so that this recommendation can transition to ‘business as usual’.

Work in relation to polypharmacy has also reached an impasse, according to the report. Sharing the Vision outlined the need for GPs, mental health service prescribers, and other relevant stakeholders to collaborate to actively manage the issue.

According to the progress report, an analysis of data on people prescribed two or more psychotropic medications has been completed, based on anonymised information provided by the Central Statistics Office.

“Considering the complexity of this policy recommendation, there is a need to plan a programme of work to effectively manage polypharmacy, which aligns with initiatives already underway,” the report states.

A steering committee had been established to oversee work in relation to the recommendation. However, its Chair has since retired and a replacement has not been identified.

“Given the need for an integrated whole-of-system response across the wider health service, an alternative delivery structure is now being explored, including the potential for standing up a specialist group,” states the progress report.

The joint Department/HSE statement said: “The HSE is in the process of establishing an appropriate and effective delivery structure.”

Staffing

Staffing remains one of the biggest barriers in implementing the national strategy. Mental health staffing increased by 46 whole-time equivalent (WTE) posts between December 2023 and February 2026. However, the report notes that increases in medical and student nurse numbers have masked decreases in other staff categories.

The report acknowledges the efforts of the HSE Recruitment, Reform, and Resourcing Programme to increase capability and capacity across services.

For example, it notes “considerable work” has been conducted in the marketing of “difficult-to-fill medical consultant posts”.

Overall, the HSE has approved 300 additional WTE posts for 2026. But the report says there has been little progress in developing a broader skills mix for community mental health teams.

“While mental health services have been effective in filling new development posts, the recruitment and resourcing landscape of the broader health service remains challenging,” according to the report.

“Services are experiencing a range of social, environmental, and service developments that are significantly increasing the demand for a qualified healthcare workforce, while simultaneously managing a tightening of the supply of this workforce in local and international markets.”

While the document says the impact of the health regions on mental healthcare is uncertain, it notes that the transition to population-based funding aims to align resources with need to deliver integrated, responsive care.

Challenges

Ms Fahy said that Ireland’s changing health landscape presents “considerable challenges” to policy implementation in mental healthcare.

“Workforce shortages, greater public demand, and the transition to the new HSE regional structures continue to affect service delivery,” she said.

While acknowledging that progress has been made in expanding access to counselling and talk therapies, including the €1 million community talk therapies fund provided in Budget 2026, Ms Fahy argued that mental health supports at primary care level remain underdeveloped.

“Long waiting lists for primary care can leave people without timely support and result in additional pressure on specialist services,” she said.

Ms Fahy noted that the voluntary and community sector plays an essential role in the delivery of Sharing the Vision.

“The sector is facing growing demand, while sustainable funding remains a significant challenge,” she said.

“Budget 2027 must deliver ringfenced, multi-annual funding for the sector to support long-term planning, workforce stability, and service sustainability.”

Regarding legislation, Ms Fahy said the enactment of the Mental Health Act 2026 represents a significant milestone. She said the Act provides a modern legal framework to strengthen the rights and protections of people accessing mental health services.

“The focus must now turn to effective implementation,” she said.

“Substantial investment in workforce capacity, staffing and training will be required in Budget 2027 to begin implementing the legislation.”

MI has previously reported on the concerns of the College of Psychiatrists about aspects of the Mental Health Act.

At its Spring Conference in March, Dr Martin described the Act as “the biggest challenge” facing psychiatry.

While acknowledging that the legislation has improved following consultation with the College, it still had concerns about several issues, such as the potential of the courts to be involved in patient treatment.

In relation to Sharing the Vision, Dr Martin told MI the progress report provides “excellent updates and data on implementation success”, including numbers on specialist mental health teams.

However, the College believes there is a lack of focus in the strategy for those with enduring and severe mental illnesses.

He said there needs to be more of an emphasis on developing secondary and tertiary services for this cohort.

“Progressing the promotion of good mental health and the management of mild mental illness/psychological distress is welcome and necessary, but the College remains concerned that equal focus in the policy is not afforded to those with moderate to severe mental illness,” according to Dr Martin.

He said the former national strategy, A Vision for Change, offers the “blueprint” for how such services should be configured.

“In spite of any community measures and supports, which may be put in place, there will always remain those who require specialist secondary and tertiary mental health services,” Dr Martin added.

He suggested a supplementary policy document, outlining requirements and appropriate specialist services for this group, could be developed. “It would combine policy detail with clear data, recommendations, and a corresponding implementation plan with progress tracking.”

More broadly, Dr Martin referenced how the resourcing of mental health services remains inadequate. Currently, just under 7 per cent of the health budget goes towards mental healthcare.

“It is worth noting that this contradicts our other national policy, Sláintecare, which clearly states that 10 per cent minimum is required,” he said.

Prof Kelly also highlighted the need for increased, multi-annual funding.

He said there also needs to be “a realistic workforce plan, investment in suitable facilities and transparent reporting of outcomes that matter to patients and families”.

“Waiting times, continuity of care, access during a crisis, and the experience of service users are at least as important as whether an administrative milestone has been reached,” according to Prof Kelly.

“On that measure, the picture remains mixed.”

Next phase

Among the priorities for the next implementation phase are integrating mental health services within the new health regions, completing the general adult community mental health operating guideline, progressing the Child and Youth Mental Health Action Plan, and developing an overarching mental health operating framework.

Work will also continue on creating alternatives to EDs for people experiencing mental health crises.

Prof Kelly said implementation of the mental health strategy should not be judged solely by the number of actions described as completed or on schedule. “It must also be judged by whether a person experiencing mental illness can obtain timely, appropriate, continuous care,” he said.