Counselling Services: East Belfast
Sammy Douglas (DUP)
: I am pleased to bring the Adjournment debate on counselling services in East Belfast to the Assembly. I thank the Minister and other colleagues for attending this late session, although it is not that late yet.
Yesterday morning, three local parents called to my office on the Newtownards Road. They were very distraught that needles used by illegal drug users had been found near their homes. That find was in addition to the discovery and seizure of needles in a play area close to Connswater shopping centre last Friday night. Before I go on to my main points, I pay tribute to the Police Service of Northern Ireland and Belfast City Council for their rapid and professional response to what was, after all, a very dangerous and frightening situation for residents in the Connswater area.
I am not using that example solely to highlight the growing problem of drug abuse and the whole aspect of drug abuse with needles, because that is not the biggest problem in East Belfast. I certainly do not want to highlight it as a huge problem; it is one of the smaller problems, but a problem nonetheless. It is not about only drug abuse, but alcohol abuse and other addictions. With that growing problem of addiction there is a growing need for preventative work and support for cost-effective counselling services. Let me give an example: statistics given to me recently show that one in four people in Northern Ireland are affected by a mental health problem. The cost of mental ill health in Northern Ireland is approximately £1,680 a head, and investing in preventative psychological therapies, for example, would cost just £250 a head. It is, therefore, very much about preventative care as well.
When we look at what counselling is available currently in East Belfast, it is obvious that excellent work is being carried out by a number of community and voluntary organisations. I am sure my colleague Chris Lyttle would agree with me on that. Some sterling work is being carried out. However, it appears that that sterling work, much of it voluntary, is under-resourced, lacking in cohesion, and, at this time, there is no agreed strategy or plan, to my knowledge.
I want to put things in perspective. The current service provision includes East Belfast Community Counselling, which is based in inner east Belfast. It dedicates 95% of its service delivery to the local community of that area and currently works with 35 to 40 clients weekly. It does an excellent job in the area. In fact, I would go so far as to say that it survives not only on minimal grant funding, but client donations. It is the only voluntary and community organisation in the area working on the suicide prevention helpline, Lifeline. It has also been awarded a small contract with the Belfast Health and Social Care Trust to provide counselling sessions. All counsellors are members of the British Association for Counselling and Psychotherapy and adhere to its code of professional standards and ethics.
Pathways is another organisation. Its base is on the Newtownards Road. It provides counselling for loyalist ex-prisoners. People who have been in prison or have been involved in the conflict may, many years later, struggle with their past and with coming to terms with life outside prison. It is funded through Charter Northern Ireland. To my knowledge, it is the only counselling service in east Belfast funded under the Public Health Agency’s Protect Life strategy.
There are other organisations, such as Anchor Counselling, which is very much a church-based organisation. It provides Christian counselling to anybody who comes to the Christian Fellowship Church on the Newtownards Road. Addiction Northern Ireland is a voluntary organisation operating in the area for those affected by addiction. It has been operating from its base on the Albertbridge Road for something like 24 years. Addiction Northern Ireland has seen a growth in demand for services in all locations, but it is interesting that the biggest growth in demand has been in east Belfast. We should take note of that.
An organisation outside east Belfast is New Life Counselling. It is a charity. Although it is based in north Belfast, it works in east Belfast and offers one-to-one free counselling services for children, young people, adults and families. It is funded through a range or cocktail of funding.
We also have the East Belfast Community Development Agency’s health development and connections programme, which seeks to support local individuals, groups and community workers engaged in improving health and well-being. Finally, we have the East Belfast Partnership. It is involved in regeneration, but part of its remit is about tackling health inequalities.
That is just a snapshot of activity in east Belfast. In my constituency office, I meet people who are affected by stress, anxiety, depression, relationship breakdown, drug and alcohol abuse, bullying, self-harming and suicidal thoughts and actions. We all remember last summer’s rioting and disturbances in east Belfast, which led to trauma. A lot of people in the area fled their homes. Many of the people affected by that have had to receive counselling. Nearly a year later, they are still receiving that treatment. That is a new aspect for us in relation to the recent conflict.
For me, there is little doubt that a significant problem exists around the issue of mental health in east Belfast. I acknowledge that considerable efforts and successes have been made in regeneration, particularly through organisations such as the East Belfast Partnership, and we are talking about some of the most disadvantaged wards in east Belfast. However, there is a need to provide support for the emotional well-being of our local residents. It is clear to me that the area is under-resourced in terms of counselling and that there are insufficient services to help people in need of support.
The latest East Belfast constituency profile, which is from last September, shows that East Belfast is a constituency with an estimated 13·8% of people on prescribed drugs for mood and anxiety disorders. The Northern Ireland average is 11·5%. At a recent meeting in east Belfast on the Welfare Reform Bill, there were major concerns that various benefit cuts will exacerbate the problems around mental health and well-being; in particular, for those in the most disadvantaged areas. There is certainly a fear out there that the welfare reforms will have a major, negative impact on many communities, particularly those in disadvantaged areas. There is a feeling in advice agencies and counselling services that their workload will definitely increase, and I certainly agree with them.
We need a defined strategy and clarity of vision to provide a joined-up service. It can be very confusing to work out who has responsibility at different levels. I suggest that we agree an area action plan to include all the current providers and to find out what level and type of counselling services are available in east Belfast.
I understand that a mapping exercise, commissioned by Belfast local commissioning group, for East Belfast counselling and support provision is under way.
Finally, I hope that the debate will be the springboard for a more effective, efficient and proactive counselling service provision. That should lead to improved partnership working between providers, such as the various groups that are involved in counselling, the Public Health Agency and, indeed, the Minister’s Department. Again, I thank the Minister and other Members for attending today.
Michael Copeland (UUP)
: I support the Adjournment topic and congratulate those who brought it forward. I endorse and underscore, insofar as it is in me, what Sammy said. I do not intend to go through the range of organisations that are involved or the statistics for the problem, because that would simply mean that we have both been reading the same briefing notes.
How do you judge a place? Do you judge it by its scenery? Do you judge it by its climate? Do you judge it by its industries, its roads or its infrastructure? Do you judge it by the cleanliness of its streets? Do you judge it by its education system? Or do you judge it by how it looks after those who are least capable of looking after themselves?
I know something of counselling, but I have never been a beneficiary of it myself — although it has been suggested to me on a number of occasions. My wife found counselling necessary shortly after being injured in a shooting incident while serving as a police officer. She eventually trained as a CBT counsellor, paying for that through the Police Rehabilitation Trust. She currently works in a number of institutions that are largely to do with bereavement and that are centred particularly on cancer, which she herself survived. In many ways, she has made herself a receptacle for the unpalatable troubles of others, as have all those who put their head above the parapet and care enough to become involved in this as a profession — if profession is the right word. It is a profession that requires very high standards of training and dedication and a very large begging bowl when you go to get somebody to pay you for doing it. Those people have made themselves receptacles to such a degree that, in pursuance of the exercise of their skill, they have to attend supervision regularly so that, in some way, their own mental health can be protected from their efforts to protect others.
The problem does not exist solely in working-class districts. It is more prevalent there perhaps, but depression, black-dog days and potential thoughts of suicide and self-harm affect everyone in society. Indeed, Winston Churchill, one of the greatest wartime leaders of all time, was perpetually plagued through the darkest of days by deep, deep depression.
This morning at 3.00 am, I received a call from an unknown phone to my mobile. When I answered, a voice that I knew but could not place said, “Michael, I can’t take this anymore. I’m going to kill myself.” I spent from 3.00 am until 7.30 am trying to work out who it might have been, before eventually establishing at 9.30 am that nothing had befallen the 20-year-old female. She is a product of the city and district of her birth, but she cannot yet find either a relevant place or slot in life, an outcome or something that gives her a reason to believe that she is special and can contribute. I know all the organisations that Sammy talked about.
East Belfast is peculiar in some ways. We have a very high proportion of ex-servicemen. There is a condition, post-traumatic stress disorder, which I know that many senior officers in the army do not believe exists. The Minister will recall that I have plagued him — I think that he would agree that that is the right word — with questions on post-traumatic stress disorder. We have a very high proportion of ex-servicemen in our community. That includes not only those who served in the locally raised units during the Troubles but those who currently serve in Iraq or Afghanistan or in any of the other corners of the earth where democracy has to be defended by force of arms. When the comradeship of the mess, the unity of the platoon and the guidance of the officer have gone, some of those people find themselves in a lonely place.
One case in particular sticks in my mind: that of a soldier who was sitting in the back of a Land Rover many years ago preparing to go out on a patrol when his company quartermaster sergeant (CQMS) recognised him as someone with stores experience. He took him out of the vehicle and placed him in the stores, replacing him in the Land Rover with an 18-year-old who I believe was on his first day’s duty. Twenty minutes later, the soldier was taken from the stores, put into a Land Rover and taken to the scene of an improvised explosive device (IED). There was a hole in the ground, at the bottom of which was a red stain. That was pretty much all that was left of the Land Rover and the four people on board.
He broke down in our office recently, and I do not mean that he threw a hissy fit. He shook and sobbed. He could not understand why his source of income — employment and support allowance — had been removed on the basis of a test that was carried out in the absence of any medical records. He just walked out.
A burden falls on us as a society to do what can be done. As Sammy said, the cost of mental illness or depression — call it what you will — left unattended is around £1,680 a year, while spoken therapies cost £250. The difficulty with spoken therapy is that you cannot tell how well it is doing because you cannot tell how many drugs have been given. You cannot have a photograph taken at a nice, shiny building, and there are no instant fixes. However, I will tell you, as my wife tells me, it works. Not in all cases, but in enough cases to make the effort worthwhile.
Therapies have difficulties with the medical profession, which tends to look at non-chemical or non-physical interventions with a sideways gaze. We are building up long-term, massively disabling conditions in all sections of our community.
Mr Douglas rightly referred to welfare reform. I understand and accept the need for a realignment of the economy, as does his colleague the Minister for Social Development, but the difficulty is that it took 30 years to bomb and destroy our industries, communities and the streets that people came from. Now, because of a fiscal requirement in Westminster, we are being given the same treatment as everybody else, disregarding the fact that it will impact here in a way that it will not do on the mainland.
Living with single-room rates and in houses of multiple occupancy are things that we do as students. I do not want to be prescriptive or make bland statements, but generally in Northern Ireland if you are by yourself and you reach 35 years of age, there may in some cases be a reason why. A suitable antidote to that is not to stick you in a house with a bathroom and kitchen that dear knows who is using, a common living room, and then, up the stairs, a bedroom of your own. That will simply reinforce the difficulties that were there to begin with. Sometimes I think that the people who come up with these policies need to go and experience what life is like in certain quarters.
I do not know whether what we are talking about is the solution, but I believe that we need to develop a strategy to establish at least whether it is worthwhile. I heard the Minister a few moments ago pledge financial assistance for kinship care, and that is laudable and supportive, but I ask about his travels through his admittedly empty coffers. Well, the coffers are very full, but there are many demands on them. I am not sure that we have ever adequately come to terms as a society with the long-term emotional effects of living on or near interfaces, spending every single day of your life thinking about your children playing in the back garden, your car parked out the front or every rattle in the roof space. We need a piece of work on the long-term effects of living in those locations for the folk who are living on them. I know many cases of people with absolutely impeccable character who, within six or seven months of moving home, have acquired a criminal record. Generally, the criminal record is rooted in the person taking the law into their own hands, because the law failed to take sufficient steps, in their terms, to protect them, their homes and their families. There are many questions. My view is that spoken therapies, the gentle hand of friendship and an emotional lifebelt will always work more satisfactorily than drugs or other therapies, which, in my view, can be very addictive. I support this. Thank you for your time.
Chris Lyttle (Alliance)
: I, too, support this and thank Mr Sammy Douglas for securing the debate. Mental ill health is no respecter of party political background, and I have welcomed the opportunity to work with Mr Douglas at constituency level. Indeed, I think that it is incumbent on all the MLAs for East Belfast to come together to work on the issue. Mr Douglas mentioned an area action plan and referred to some of the mapping exercises that are ongoing at the moment. It is my understanding that the East Belfast Partnership’s health strategy manager, Linda Armitage, is overseeing some of that work. It has been my pleasure to redirect some groups to the Belfast Health and Social Care Trust’s south and east Belfast mental health community of interest group; it is a bit of a long-winded title, which the group will maybe reconsider at some point in time. It is the working group that is bringing together groups from south and east Belfast to focus on the issue. Hopefully, the MLAs for the area can work together to support that work.
I am grateful for the opportunity to contribute to the debate on what is a serious issue not just in east Belfast but across Northern Ireland. As we have heard, it is increasingly the case that many of us will have direct experience of mental ill health. I have close friends who are dealing with the issue at the moment. Indeed, I lost a close friend to suicide a while ago. He had exceptional abilities and a wide and diverse background, as has been mentioned, and I pay respect to him. It is true that, for many years, the issue of mental health has carried a stigma that has prevented people from accessing the help they need. I hope that the Assembly will play a leading role in defeating that unnecessary shame and in providing the resources to which people are fully entitled.
I think that it is important to base an examination of provision on evidence, and I would like to thank Assembly researcher Dr Lesley-Ann Black for her work in examining the extent of mental ill health in east Belfast compared with other constituencies in Northern Ireland. The facts about mental illness among people in Northern Ireland speak for themselves. As has been said, it is estimated that one in four people in the region will be affected by mental health problems at some point in their life. As Mr Copeland said, there is a difference in terms of mental health problems between Northern Ireland and England, Scotland or Wales, and consequently, incidence of such problems is 25% higher in Northern Ireland. That, of course, comes from having a legacy of violence and a divided, rather than a shared, society. I agree that there is a lot of work to be done in relation to dealing with unique interface challenges.
There are a range of indicators that allow us to examine the extent of the problem in east Belfast, and those have been mentioned throughout the debate today. Indicators such as self-harm admissions, anti-depression drug prescriptions and suicide rates show that east Belfast is in need of assistance in that area of provision. Statistics show that the east Belfast constituency has the third highest hospital admissions for self-harm, is the fourth highest dispenser of antidepressant drugs and has the joint second highest suicide rate of any constituency in Northern Ireland. I know that the increase in suicides is of serious concern to the Members present today and to the Assembly and that Minister Poots is committed to responding to that painful and difficult issue. It is clear that there can be no more painful consequence of mental ill health for any family than suicide. In mentioning that, I pay tribute to the work of the Survivors of Suicide organisation, under Bobby Cosgrove and Bobby Duffin, for the work that it does to highlight the need for assistance.
There are approximately 1,000 patients with a mental illness on the GP register in East Belfast. Unfortunately, however, there appears to be a lack of available resources to cope with the situation at present. Mr Douglas mentioned the contact that we have had with New Life Counselling in the run-up to this debate. It is a charity that supports the emotional health and well-being needs of people through the provision of counselling and therapeutic services across Northern Ireland. It is quite worrying that, between April 2011 and March 2012, despite that organisation being based in North Belfast, it received a total of 120 referrals from East Belfast from 16 separate East Belfast GPs, along with self-referrals from people in the constituency. It is also worrying that people who availed themselves of New Life Counselling’s services did so without there having been any proactive promotion of the charity’s work in the constituency. I know that there are many other organisations that can bear testimony to the increasing demand.
There is, therefore, a serious need for high-quality psychological therapy services — Mr Copeland mentioned spoken therapies in counselling services — to be well organised, resourced and co-ordinated across East Belfast. The Bamford review identified the need for improved access to services and for a more co-ordinated framework for provision to be developed. A good strategy was launched in 2010, but the budgetary reductions to its implementation have caused a lot of problems.
Early intervention, prevention and treatment across all ages have been referred to today, and it is important that we help everyone: mothers; children; young people; workers; older people; carers; and, indeed, people in the criminal justice system who have experienced unique challenges in life. Provision must be multi-agency, and the health service and the voluntary and community sector must have an opportunity to work together, as has been mentioned.
I definitely want to pay tribute to the many voluntary and community-based counselling organisations in East Belfast that are working in the most difficult of circumstances, with limited resources to improve the health and well-being of members of our community. Adequate support for that work would not only alleviate the pain and distress of mental ill health for individuals, families and communities but would prevent more major crises from occurring further down the line.
My party and I support the provision of community-based services that the Compton review has proposed, but those services have to be adequately resourced and organised. Support should be given to enable the health service and community and voluntary groups to work together, for example, to provide good communication so that people are aware of the range of services that is available — there is some doubt about the co-ordination of that communication at the moment — and to provide appropriate referral mechanisms and supervision pathways.
As Mr Copeland and Mr Douglas said, we know at first hand through the work in our offices that the economic downturn, welfare reform and other unique challenges in our constituency are having a negative impact on the health and well-being of our constituents. It is incumbent on us to lobby for those additional resources that we need. That, combined with the recent history of the Troubles and deep division, means that there is a clear need to increase the availability of high-quality counselling and psychotherapy services in East Belfast and across Northern Ireland. I sincerely hope that the Minister can respond positively to the work that is being done.
Edwin Poots (DUP)
: Mental health services should be of significant importance to us. Historically, investment in community mental health services in Northern Ireland has not kept pace with the rest of the UK, in spite of the fact that we have greater problems with mental health. It is estimated that one in four people will suffer from a medically identified mental illness during his or her lifetime. Mental ill health costs an estimated 3% to 4% of our gross domestic product, mainly through loss of productivity but also through the cost of healthcare and social security benefits. In 2010-11 in Northern Ireland, we spent £228 million on mental health services. That represents around 8% of the total budget spend on health and social care.
We had a number of key messages from Bamford on the prevention of mental ill health: the requirement for new mental incapacity legislation; a shift from hospitals to community-based services; the development of specialist services for children and young people, older people, those with addiction problems and those in the criminal justice system; and the need for an adequately trained workforce. Bamford envisaged that doing all of those things would require a 10- to 15-year programme of reform and a doubling of the healthcare budget to approximately £400 million per annum.
A ministerial group was set up to drive that forward and to monitor the broad strategic changes. That group is chaired by the Minister of Health, Social Services and Public Safety. The Bamford task force in the health and social care sector was set up in late 2009, and it is jointly chaired by the HSC board and the PHA. The Bamford monitoring group was established in September 2009 and is led by the Patient and Client Council (PCC).
I thank Mr Douglas for bringing this Adjournment debate to the House. There have been three very valuable contributions, and I hope to respond to the points that Members raised. First, I confirm that I recognise the need for and the value of counselling to overcome a number of difficulties that people face here, such as support with family relationships, dealing with bereavement and helping individuals cope with mental health problems, trauma or overcoming addictions. Part of the Bamford vision was to improve access to talking therapies, and a strategy for the development of psychological therapies in Northern Ireland was published in June 2010 and is underpinned by an additional £4·4 million a year. The Health and Social Care Board chairs a multidisciplinary group that is taking forward the implementation of the strategy.
The main funding streams for counselling services are: the HSC Board for those organisations that provide the services regionally; the Public Health Agency for those organisations that provide services in relation to public health, such as suicide prevention, trauma, drug or alcohol abuse and teenage pregnancy; and the trusts for organisations that provide local services in areas such as bereavement, pregnancy, self-esteem, sexuality, relationships, suicide and other mental health issues. It is for the Health and Social Care Board and the Belfast Health and Social Care Trust to —
Michael Copeland (UUP)
: Thank you, Minister. I appreciate your graciousness in this matter. Will you agree, sir, that post-traumatic stress disorder is particularly prevalent in certain sections of the Northern Irish community, given the Troubles and the continued service in the military? Do you share the slight concern that appropriate treatment for soldiers tends to be given at Hollybush on the mainland? As yet, we have not developed a suitable resource in Northern Ireland to tackle that problem satisfactorily.
Edwin Poots (DUP)
: I thank the Member for raising that point. I agree that there has been a strong association with the military in Northern Ireland. The problems that we have currently are not yet, to a great extent, directly related to Afghanistan. A lot of the problems relate to Iraq, and a lot of the problems relate to the Troubles. Post-traumatic stress does not normally materialise within months or a few short years. Generally, it is considerably further down the line, and we have a considerable problem in that respect. I acknowledge that that is an issue that we need to communicate about to identify the best solutions.
Just yesterday, we had a fairly lengthy discussion about the use of drugs in dealing with mental health. That meeting included the Chief Medical Officer, and the general conclusion was that drugs help but do not cure. It is the talking therapies that make the difference. Do we simply want to shelve the problem, or do we wish to deal with the problem? If we wish to deal with the problem, there is a requirement to invest further in talking therapies. How we do that is a very significant challenge, but I recognise from the conversations that I have been having that that is where the best opportunities lie. You need to stack that up against what I referred to: the loss to our gross domestic product through lack of productivity, people not working, people receiving income support and all of that. That also happens in a range of other areas across the health sector.
It is for the Health and Social Care Board and trusts to consider the needs of local populations when commissioning counselling services. Counselling can have many benefits and can help to minimise the negative impact that the issues that I described earlier have on individuals, families and children. Practitioners in counselling organisations should be qualified in the therapies that they provide. Many people take on the mantle of being counsellors without having had training to support that, and we believe that they should be registered with a recognised body such as the British Association for Counselling and Psychotherapy and be appropriately supervised. Those key indicators offer commissioners the confidence that the services that they acquire are safe and are delivered by qualified practitioners to recognised standards.
I will mention adult mental health services. The Northern Ireland Community Addiction Service, the Forum Against Substance Abuse and New Life Counselling all provide counselling services in east Belfast, and the trust currently expends around £198,000 on adult counselling in east Belfast. The Victims’ Commission also funds counselling services for those affected by the Troubles and for those who suffer from post-traumatic stress disorder, and I encourage Members to send people in that direction at this point. My Department also provides funding for a number of regional organisations such as Relate NI, Accord NI and Lighthouse Ltd, which provide counselling services across Northern Ireland.
I will turn to Members’ contributions. Sammy Douglas talked about prevention. We recognise the value of counselling services and acknowledge the benefits of locally based counselling services. It is for the Belfast Trust to assess the value of the services provided and to fund those services accordingly. In our opinion, psychological therapy services are a cost-effective alternative to prescription medicines for some mental health problems, and a strategy of development of counselling services is being implemented by the Health and Social Care Board. That encompasses the statutory and voluntary services.
Mr Copeland spoke of the strategy for the development of psychological therapy services and recognised the benefits of counselling for people with psychological conditions or mental health problems as well as for carers and people who are socially isolated, including older people. He also raised the issue of ex-service personnel, members of the forces and veterans, and there is much more evidence around today, including NICE guidance, on the benefits of talking therapies.
Mr Lyttle raised a number of issues, including that of the voluntary sector. Once again, we want to say that it is very active in removing the stigma that is associated with mental illness. That is important.
Edwin Poots (DUP)
: Certainly. The aim of psychological therapy services is to provide a range of services on a multi-agency and multi-sectoral basis. Once again, I thank Mr Douglas for bringing the debate today. We will take the matter seriously.
Adjourned at 4.59 pm.