Treating alcohol-related problems within the Irish healthcare system, 1986–2007: An embedded disease model of treatment?

Abstract

This article assesses the implementation of the policy on the treatment of alcohol problems in Ireland during the period 1986–2007. At the commencement of this period, a major policy statement in relation to the treatment of alcohol within the mental health care system presaged radical change – in effect it proposed a shift from the then dominant disease model of alcoholism to one that was focused on public health principles. Towards the end of the period, a further statement made the rather sanguine claim that many of the intended changes had taken place. This article adopts a more critical approach. Using epidemiological data from annual reports on the activities of mental health centres and also drawing from a recently conducted action-research project that focused on addiction treatment within a regional health authority, the article highlights that change has been slow and that some of the main tenets of the disease model remain in place.

Notes

Notes

1. See, for example, Keogh and Walsh (1995) and Daly and Walsh (2003).

2. The health board that was the focus of this study is based outside the greater Dublin region and has a current catchment population of just over 460,000, a growth of 8.7% over the period 2002–2006; the region is mixed urban and rural: it has one city (population 50,000), four medium sized towns (population 17,000–23,000) and six smaller towns (population 5000–11,000) (Census 2006: Volume 1 – Population classified by area, 2007). The distance from one end of the region to the furthest is 160 km. During the period of study, the health board along with nine other statutory regional authorities (three in the capital, Dublin, and six in regions outside Dublin), which had responsibility for the overall, regional management of health and social services since they were established under the provisions of the Health Act (Ireland, 1970), were abolished, in the context of a protracted health reform process, and were replaced by a single, centralized Health Services Executive, under the Health Act (Ireland, 2004).

3. Under a regional structure of 10 health boards, Irish health services, between 1972 and 2004, were organized under three separate programmes, each of which had a regional executive management team (Curry, 2003). These programmes were: • Community Care Programme (community health, general practitioner services, public health nursing, community welfare, child welfare, care of the elderly). • General Hospital Programme (inpatient hospital services, out-patient consulting services undertaken in hospitals across all categories of medical need other than psychiatric services and mentally handicapped). • Special Hospitals (Psychiatric Care) Programme (all hospital and non-hospital services for persons who are psychiatrically ill or have a mental handicap).Under the Community Care Programme, community care areas were designated in each region, usually, but not always with populations of 100,000 approximately. Some of these are coterminous with established geographic counties, depending on the population and size. Under the Special Hospitals (Psychiatric Care) Programme, psychiatric services are organized from county-based psychiatric hospitals, which in turn are structured into sub-county sectors. As a result of re-organization following the Health Act (2004) two service programmes were established under the central management of the new Health Services Executive (HSE). The first of these, Acute Services, incorporates the General Hospitals Programme and all other acute hospital services; the second combines the Community Care Programme and all non-acute services in the Special Hospital Programme, including non-acute, psychiatric services. Previous Community Care Areas have been designated Local Health Areas, each of which has an overall Local Health Manager. The transition from the regional structure to the new National–Local structure commenced in January 2005.

4. During 2009, the Irish Government announced that alcohol and drugs were to be integrated into a new National Substance Misuse Strategy – http://www.pobail.ie/en/PressReleases/htmltext,9777,en.html (downloaded 24 April 2009).