Swann makes NI mental health a priority with new strategy

As has been well documented for a long time now, Northern Ireland has the highest rate of mental illness compared to any other part of the UK, with a 25 per cent higher prevalence than England.

The primary reason for this is the fraught legacy of the Troubles, which has led to a high incidence of post traumatic stress disorder, depression and anxiety; a 2008 study found that 39 per cent of the population in Northern Ireland reported experiencing a traumatic event relating to the conflict.

Other contributing factors to Ulster’s global mental malaise are its higher levels of socioeconomic deprivation, alarming rates of addiction to alcohol and other substances and a marked lack of adequate provision of mental health services, which also extends to provision for children and adolescents, perinatal women, older people and those experiencing isolation in rural areas who, across Ulster, also exhibit higher levels of mental malaise than other UK regions.
The recent publication of the Draft Mental Health Strategy, 2021-2031, which health minister Robin Swann told the Executive would require £1.2bn to fully implement over the next 10 years, recognises the mass effects of the psychological hangover of the Troubles leading to mental disorders, poverty and lack of employment opportunities instantiating depression and anxiety, the higher occurrence of psychological distress including self-injurious behaviours and eating disorders among children and adolescents, a dearth of psychiatric posts being filled, lengthy waiting lists for those in need of talking therapies and the lack of a cohesive mental health service that would work across all five health trusts - although such a regional service is suggested as a key objective in the report.

The 53-page document makes much of promoting early intervention to prevent people reaching breaking point, a person-centered care model tailored to meet the needs of the individual, and the necessity for more therapists, psychiatrists and improved crisis care.

Minister Swann’s draft strategy, which builds on the prior Bamford Review and other strategies that have talked up the drive to improve mental health provision here, but in reality have improved very little for those across Northern Ireland struggling with a panoply of mental health problems, also acknowledges the profound impact of Covid and subsequent lockdowns as another primary factor in the development of psychological disorder among a series of demographics from children and adolescents - of whom one in 10 have experienced emotional problems with the highest incidence in deprived areas - to adults and older people who have all suffered turmoil because of the disruption to everyday life, social connectivity and resultant isolation which research has shown to be fundamentally deleterious to mental wellbeing; our brains come alive in the presence of others and when starved of contact stress hormones like cortisol rise in the bloodstream causing anxiety to heighten. 
Because of the pandemic, it is expected that there will be a 30 per cent increase in those seeking mental health services over the next three years - amounting to 19,000 more referrals to adult mental health and over 5,000 more referrals to psychological services - and, as it stands, the mental health care system is manifestly lacking in the capability to truly address this. Where, for example, will the required £1.2bn required to deliver the objectives of the strategy come from?
To be fair to minister Swann, he has at least delivered a roadmap for addressing the colossal mental health crisis in Northern Ireland ahead of deadline in the midst of a global pandemic, with admirable targets to improve access to services for those in acute mental distress, early intervention strategies, workforce teams who will collaborate with GPs to help those suffering access the correct services promptly, increased funding for child and adolescent mental health services (CAMHS), and an acute awareness of the ways both the Troubles and Covid have led to a perfect storm in undermining the province’s psychological equilibrium.
He states in his report that he is “committing to significant improvements in primary care mental health services, with greater responsibility for our GPs, working through their GP Federations.

This will involve completing the roll out of psychological therapies hubs and additional investment to increase availability and accessibility of talking therapies at a local level.

This will help to ensure that the system focuses on people and their needs, rather than expecting individuals to conform to a rigid system.”

Of the impact of Covid on mental health here minister Swann added: “Lockdown, shielding and social distancing, the closure of schools, working from home, increased deaths, reduction in face to face services, as well as the restrictions on funeral rites during the pandemic have had an impact on the emotional wellbeing of many, including those with existing mental health conditions.

“It is highly likely that we will see increased levels of need for a number of years due to the ongoing impact of the pandemic on our society’s mental health.” 
He added there remains a stigma attached to mental health: “Mental health is still not viewed or treated in the same way as physical health, and despite the injection of additional resources is still underfunded when compared with other UK jurisdictions: in 2018/19 approximately £300m was allocated to mental health, representing around £160 per person in Northern Ireland.

“During the same period spend in England was £12.2bn, representing around £220 per person, and in Ireland investment equated to over £200 person 
“We consistently hear the same messages from people using mental health services: waiting lists are too long for psychological therapies, crisis support is not available when it is needed, those with specific needs often find themselves outside of service criteria and therefore unable to access the right type of help and support, and that earlier intervention is needed to prevent or delay the onset of more serious mental health problems. 

“Across Northern Ireland targets for access to services are regularly missed, with almost 2,000 people waiting more than nine weeks for access to adult mental health services. 
“We know that if we can provide effective mental health interventions early, the outcomes for individuals and their families are much better.

“Care and treatment must therefore be available when and where they are needed. We must create systems that work together to reduce waiting lists, that support people at their time of crisis so people do not end up in Emergency Departments, that help people in their recovery to promote full participation in society.”

Asked in the assembly about staffing levels in mental health services, Mr Swann highlighted current high levels of vacancies.

There are now over 20 per cent of mental health nursing posts in HSC trusts that are currently vacant and a combined locum and vacancy rate of 22 per cent in psychiatry.
According to the Mental Health Foundation it is estimated that just 40 per cent of those with mental health problems in Northern Ireland were able to access effective mental healthcare; 79 per cent of those with a mental disorder who sought treatment felt they had not received the service they needed.        
The NI chair of the Royal College of Psychiatrists, Dr Richard Wilson, welcomed the ‘ambitious’ 10-year strategy, but added: “Without funding, a strategy is simply a vision. To deliver real change for people, the executive must ensure that this money is delivered.”