Ulster prescribes more pregabalin and diazepam than any other UK region - meet the Mental Health Champion advocating for addicts

Our intermin Mental Health Champion tells Joanne Savage why we must act now to address widespread drug and alcohol misuse
Professor Siobhan O'NeillProfessor Siobhan O'Neill
Professor Siobhan O'Neill

The research also found that each day 200 hospital beds here are occupied by patients with issues related to alcohol and drug misuse, while the province prescribes more of the anti-anxiety drugs diazepam and pregablin per capita than any other region of the UK. In addition to this, the number seeking treatment for drug misuse has grown significantly, doubling from 2,107 people in 2007 to 4,183 people in 2019. Meanwhile, and most alarmingly, drug misuse deaths have more than trebled in the past decade. The level of harm is most acute in areas of high deprivation, where deaths related to drug and alcohol misuse are around four-and-a-half times that seen in the least deprived areas.

Of the estimated £900m cost of the substance crisis, the auditor states that £250m falls on an already massively stretched Health and Social Care sector.

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On release of the damning report, Donnelly revealed that despite these significant costs, the Department of Health allocates a “relatively small budget” to tackling the problem - £8m for implementation of its Drugs and Alcohol strategy, and a further £8m for statutory addiction services from the mental health budget (around five per cent of the total annual budget).

The University of Ulster’s Professor Siobhan O’Neill, an expert in suicide prevention and inter-generational trauma, who was appointed interim Mental Health Champion for Northern Ireland by Health Minister Robin Swann at the end of last month, has vowed to make tackling addiction and substance misuse a lodestar of her campaigning work.

The 45-year-old from Claudy, Co Londonderry, who has been involved in vital research about the intimate relationship between high rates of mental illness in Northern Ireland and the legacy of the Troubles combined with socioeconomic deprivation, sees substance abuse as a hugely significant factor contributing to this higher prevalence of mental pathology: addiction to alcohol and drugs can be a consequence of mental illness and also a catalyst for its development. And as the research has made clear, such addictive behaviours are found to be highest among those on the lower end of the socio-economic spectrum, with underpaid work or unemployment, and the particular challenges of the ongoing pandemic which has left many more on benefits, likely to see rates of alcohol and drug misuse escalate further.

“Let’s face it, people have been drinking more and likely using more drugs since lockdown for a variety of reasons, boredom being one of them,” said Professor O’Neill.

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“The problems Northern Ireland is facing with alcohol and substance misuse are huge. The cost of £900m a year to the economy is extremely troubling.

“You have to consider that the impact of alcohol and drug addiction is widely felt by communities and by families. The figures are really the tip of the iceberg because they don’t give us any sense of the damage that substance abuse really does to children and families where parents are habitually taking drugs or drinking.”

Though so much of our socialising rituals are tied up with alcohol consumption, O’Neill says it is by far the most damaging substance, causing untold harm to relationships, jobs, mental and emotional wellbeing, childhood development and, as is distressingly clear, economic health.

“It’s such a part of our culture and it’s also how we celebrate here, how we cope with pressure and stress. For the most part it is used sensibly, but it is so readily available and so ubiquitous that so many develop problems with it and as I said, since the start of the pandemic with many not having to get up for work in the morning or being stuck at home, consumption is likely to be higher and there has been some research which has confirmed this.”

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The rates of prescription medication use in Northern Ireland, higher than the rest of the British Isles, are not at all surprising to Siobhan, who has a deep knowledge and appreciation of the province’s mental health epidemic, with reports showing that 30 per cent of the population here suffer with some form of mental illness and Ulster possessing the highest regional suicide rate - largely seen as a hangover from the Troubles, when violence, trauma and often untreated post traumatic stress disorder were predominant.

With more suicidal ideation, depression, anxiety and experience of trauma and deprivation through either low educational achievement leading to unemployment or the absence of opportunities to climb the social ladder, it is understandable why GPs have been prescribing more antidepressants and anti-anxiety medications than elsewhere.

“For the most part people are being prescribed these medications, such as the predominant diazepam and pregabalin, appropriately, due to mental health problems,” she adds. “ I myself have used medication for mental health problems in the past and found it very helpful, and if you are prescribed medication by your GP then you should take heed of that and use the medication appropriately.

“However, for a lot of people, medications are only part of the solution and perhaps because we have such long waiting times for talking therapies we are seeing higher rates of prescribing than is ideal.

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“Counselling is very useful for many people and a lot of people do want to talk about their problems and are ready for that sort of help. But this is underfunded and another issue is that we do not have enough trained counsellors. That is something I will be highlighting as Mental Health Champion.”

Commenting on the figures showing a doubling of those seeking help for drug misuse from 2,107 people in 2007 to 4,183 people in 2019 and the devastating statistic that drug misuse deaths have more than trebled in the last decade. Professor O’Neill feels this is largely to be explained by the increasing availability of prescription drugs online.

“This is an extremely worrying trend because there is no control over what people are taking and there is also little knowledge of what is actually contained in a lot of these medications. Police are doing an amazing job trying to test and intercept drugs and find out what they are, but this new world of all kinds of substances being readily available via the internet is very scary and opens the door to all kinds of abuse that could result in premature death if people do not know exactly what they are taking. The figures show this is exactly what is happening.

“Ordering medications over the internet is so, so risky and I cannot emphasise this enough. You are always better talking to your GP. Prescription medications should be ordered through a pharmacist. The problem arises when someone has become addicted to a drug, their doctor no longer sees fit to prescribe it and they then turn to online suppliers.”

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Siobhan supports a ‘harm reduction’ approach to drugs and alcohol, mindful that for many the idea of total abstinence is just not a realistic or feasible goal.

“How do we implement controlled access to substances where there is a dependency or risk of problems with withdrawal? People with drug addictions, for example, will need help and support in gradually tapering off a drug often with the help of addiction services or counselling.

“But addicts have to want to co-operate with a treatment programme. There is no amount of treatment that we can give them unless they decide that they want to give up drugs or alcohol.”

O’Neill sees tackling social inequality as an essential part of any attempt to combat both mental illness and substance misuse; lifting people out of deprivation, helping them find employment and pursue meaningful lives so that the temptations of the bottle or pills do not have the same escapist thrill, is the difficult goal.

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“We know that if people are depressed or anxious or living in poverty they are more likely to abuse substances, so we have to ask as a society how do we address that? How do we help lift people out of despair? During the Troubles a lot of people exposed to trauma drank or took drugs in order to cope because they did not know how to talk about it or how to ask for help. We need to try to understand why people make the decision to take these substances and why they become addicted to them.

“We have to look at the root causes in order to develop more effective treatment programmes. And we need to empower people to help build more positive lives so that they see that they do not have to be dependent on these substances in order to deal with their problems.

“But this requires joined up thinking across government departments. It’s not just about telling people not to take drugs or alcohol, it’s about trying to work out why they are doing this and help to change that.

“It’s a big challenge but it’s something that we in Northern Ireland really need to face up to.”

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Rather than allocating only five per cent of the annual budget in tackling substance abuse despite the cost of alcohol addiction alone standing at £900m a year, O’Neill, naturally, believes we need to see as much funding allocated to addressing these problems as we can possibly afford.

“The cost of not doing so, as we can see, is huge. It is certainly money well spent if we can reduce this cost to the public purse. The problem is competition for funding for different health services and to be honest a lot of voters on the doorstep will have very little sympathy with people who abuse drugs and alcohol. We need to break down the stigma. And help people realise that this could be any one of us faced with a certain set of adverse circumstances.

“People who are addicted are not addicted because they are bad people, they are addicted because of things that have happened to them. Once we get that message out there then people might understand that it is worth helping addicts get support, and it is also of massive benefit to the economy.

“There’s hardly a house in Northern Ireland that hasn’t been touched by this issue in some way,” adds Siobhan, a committed advocate in the battle to address what we may easily term Ulster’s epidemic of substance abuse.

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