‘We need more talking therapy to tackle NI’s mental health epidemic’

Interim mental health champion Professor Siobhan O’Neill, from the University of Ulster, has lauded the publication of health minister Robin Swann’s Mental health Strategy, 2021-2031, last week.

The 53-page document attempts to address the reasons for Northern Ireland having the highest incidence of mental illness in the UK - much of which can be attributed to the legacy of the Troubles, socio-economic deprivation, higher rates of drug and alcohol dependency and a dearth of adequate service provision for those in need, particularly in terms of talking therapies with are often prescribed in tandem with medication in the treatment of anxiety and depression.

The report also sets out ambitious proposals on how to address this, a regional mental health service operating across all five health trusts being one of them, as well as the creation of a working taskforce aimed at helping those in acute mental distress to access the correct services - something that often does not happen when someone presents with serious depression or suicidal ideation during a standard GP consultation.

“We need to recruit more psychiatrists and psychologists to deal with mental ill health in Northern Ireland,” said Siobhan. “The workforce needs to be enhanced and we need the money to be able to do this. Crisis services need to be improved urgently to save lives. Early intervention is vital. We also need school wellbeing practitioners to safeguard the mental health of children and young people who in particular have been dramatically adversely affected by the pandemic.

“We also want a GP multidisciplinary team. We want mental health workers in GP practices. This will allow people in distress to get an appointment with a mental health practitioner - social workers and mental health nurses - who are obviously better trained in this field and able to more sympathetically understand mental illness and able also to point them more accurately in the direction of the services that they require. We need more of such practitioners. But they are there to refer people to more specialist services. The important thing is that they are well placed to facilitate early interventions which is a priority of the strategy - being able to intervene to help people before their mental state reaches one of crisis.

“If someone, say, presents with depression because of a divorce or a bereavement or because of an addiction problem - they will have enough knowledge of the system to ensure they get the help they need. The same, say, for a child who is self-harming. Mental health practitioners in GP surgeries are just one target within this strategy that could make a real difference to the lives of so many who are struggling and who have maybe found in the past that a 10 minute consultation with a GP is not always helpful in addressing their mental distress.”

As Professor O’Neill points out, even when you get a referral to a psychiatrist on the NHS, a lot of the time you are given say a 15 minute consultation in which medication by be prescribed, and then you might not get another appointment for another six months, not to mention how long it can take for patients to even get anywhere near a psychiatrist’s couch initially.

“We do need more talking therapies here in Northern Ireland and that is an indisputable reality. Psychotherapy and cognitive behavioural therapies are what help people dig into the problems that are so profoundly affecting them and it would be simply wrong to say that we are on top of the provision of such therapies, although in this strategy minister Swann has acknowledged the dearth in service provision here, and his intention to do something about it, and I applaud this.”

Professor O’Neill explains the report’s plan for ‘talking therapy hubs’ which will entail groups of therapists or counsellors, trauma therapists, art therapists, play therapists for children and families - these are people who will work in a community setting and the primary drive to make it easier for people to successfully get referrals to such individuals.

“The problem remains that waiting lists are too long and demand is huge. We need to see massive expansion of proposed therapy hubs. We need sessions of psychotherapy or counselling or play therapy available in different locations across Northern Ireland at flexible times that suit people’s busy lives.”

The proposed regional mental health service working across all five health trusts is a major aspiration, and she believes this is a fundamental part of the strategy because at the moment it is something of a postcode lottery with the quality of care and therapy available varying greatly across different parts of the province - a grave and alarming injustice.

Speaking to the Executive a fortnight ago, minister Swann stated that somewhere in the region of £1.2bn would be required over the next 10 years to fully implement the proposed changes to mental health service provision here. Where do we source this substantial and much needed cash injection?

“We need to see 30 to 40 per cent more of the health budget going towards implementation of this strategy every year, so it isn’t a case of needing that £1.2bn up front. We need it delivered incrementally and with that hopefully incremental change will come. I don’t think it’s an unrealistic ask to approach the Executive in search of this funding because despite Northern Ireland being a post-conflict society with the highest incidence of mental illness of any UK region we are currently spending less on mental health per person compared to England and Ireland.”

People are increasingly more aware and more emboldened to speak out about mental health than they would have been 10 or 15 years ago. So change is happening, but arguably not at the kind of velocity we need to see. And the pandemic and the impact of lockdown is adding yet more pressures with so many now struggling mentally because of over a year of social isolation and face to face connectivity; studies have shown that loneliness and isolation have a profoundly damaging impact on mental equilibrium and the probability of morbidity outcomes.

According to minister Swann 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 unable to meet this.

“The economic impact of the pandemic also is something we are going to see in the coming months and years. People who have lost their livelihoods plunged into anxiety and depression and while we have made some progress in service provision it is of course not yet anywhere near enough to deal with demand for services occasioned by the pandemic. Telling people to just go and get a job will not cut it.”

Professor O’Neill emphasises that things like welfare provision and doing what is necessary to eradicate economic inequality will also make a dramatic difference in attempting to drive down rates of mental illness on a societal level.

She also emphasises the ‘five steps to wellbeing’ she helped formulate in defence of mental health. First is ‘connect’ because our mental wellbeing is so profoundly shaped by the relationships that define our lives. Then it’s ‘stay active’ - if we don’t move our bodies our mental health is liable to deteriorate - and number three is ‘keep learning’ because engaging our brains is something that brings immense satisfaction. Also ‘take notice’ - try to be in the moment and live in the here and now. The last one, O’Neill concludes, is ‘give back’ because when we do good for others it boosts our own self-esteem and mood, making us feel we are leading meaningful lives.