Mental health strategy implementation ‘deeply disappointing’
Despite a 10-year blueprint for mental health service improvement, “derisory” funding means that it will be impossible for this strategy to achieve its objectives, writes Deirdre Heenan, Professor of Social Policy at Ulster University.
Prior to the restoration of the devolved government, our politicians rarely missed an opportunity to reassure the public that addressing poor mental health was one of their key priorities. Notwithstanding these worthy pronouncements mental health services in Northern Ireland are being left to fail.
Patients and service users struggle to access both routine and urgent care. Their inability to access the help that is required is having a severe knock-on effect on other parts of the health service. Frequently, people in crisis are forced to go to emergency departments in search of assistance. These busy, noisy, and challenging environments are completely inappropriate for those presenting with mental health issues.
In a recent report, the Northern Ireland Audit Office (NIAO) warned that Northern Ireland’s mental health crisis is costing the region more than £3 billion per year. Escalating waiting lists, underfunding, a depleted workforce, fragmented services, and lack of access to services are just some of the challenges.
Current waiting times have led to an increased level of stress for those living with chronic conditions, or acute conditions leading to a spiral of worsening physical and psychological health. The inability of the system to cope with demand in an appropriate way, means tragic stories of anguish to individuals, families, and communities are all too commonplace.
Recommendations from seriously critical reviews have not been implemented and the same errors are repeated. A lack of independent oversight means follow-ups do not happen and change is not followed through.
The voluntary and community sector which provides essential services, is under unsustainable pressure. A number of organisations are at a risk of closure as budget constraints mean that they are stretched beyond their limits. Their frustration is palpable. Despite their best efforts they are unable to secure appropriate care and support for those who had reached out for help. They describe a system that is profoundly broken.
Figures for December 2023 record a total of just over 17,500 people awaiting a first appointment to access mental health services. Within this, psychological therapies represent a disproportionate share, with around 6,500 people waiting to access services.
“Mental health services in Northern Ireland are being left to fail.”
Deirdre Heenan, Professor of Social Policy at Ulster University
Alongside this, performance against waiting time targets has also continued to deteriorate. Worryingly, around three-quarters of those on psychological therapies waiting lists, as of December 2023, had been waiting longer than the 13-week target time. As a result, service users and their families feel that they cannot get the help that they need.
Without timely treatment, however, peoples’ conditions will deteriorate, becoming more difficult and costly to treat.
Many mental health challenges are preventable and therefore the costs to society could be reduced or avoided. Research has shown that early intervention works and is cost effective. Yet, in March 2023 the only funded primary school counselling programme Healthy Happy Minds was axed due to budget cuts.
Waiting until someone is in crisis and asking them to navigate a system not designed for their needs is bound to end in failure. People are not getting the help that they need, they are not assessed quickly enough, and often are unable to contact crisis teams directly. Being turned away because you are not ‘suicidal enough’ or waiting for hours in a hospital to be told to contact your GP in the morning, is not unusual. There should be no wrong door for people seeking help and assistance.
Northern Ireland is reported to have the highest prevalence of mental illness in the UK. Yet, at 7 per cent, the proportion of the health budget allocated to mental health remains significantly lower than that of the other regions. The most recent figures indicate that the proportion in England is 11.39 per cent, in Wales it is 13.32 per cent and in Scotland it is 9.41 per cent.
In June 2021, the Department of Health published a 10-year mental health strategy; a blueprint to modernise and transform services. In a welcome development, this strategy was accompanied by a funding plan which set out the money required to execute the actions.
To date, progress in implementation has been deeply disappointing. Given the lack of momentum, it defies belief that the Programme for Government states that “we will redouble our efforts to improve the physical and mental health outcomes of Northern Ireland’s population and reduce inequalities, through continued implementation of, for example, the Mental Health Strategy 2021-2031”.
This year the Department of Health have committed just one-eighth of the necessary investment to implement the plan. This derisory level of funding means it will be impossible for this strategy to achieve its objectives. Worse, if timescales and objectives must be revisited, money that has already been spent has essentially been wasted.
Vulnerable people and their families are being repeatedly failed, causing avoidable suffering and distress. We have a blueprint for change but without drive and funding, the devastating consequences of mental illness will continue to blight this society.
