Mental Health

Private Members' Business – in the Northern Ireland Assembly at 3:30 pm on 2 November 2015.

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Debate resumed on motion:

That this Assembly recognises that mental ill health affects one in four people every year; further recognises the importance of having quality services that are fairly resourced, trained staff to afford early access and support, and a focus on prevention, resilience and mental well-being; recognises the importance of rehabilitation, with clear objectives established for accessing mental health professionals, within 28 days and close to home; further recognises the importance of raising awareness, reducing stigma and discrimination in relation to mental ill health; and calls for the Executive to work in collaboration to make dealing with mental ill health a top Programme for Government priority. — [Mr McKinney.]

Photo of Alex Easton Alex Easton DUP

I beg to move the following amendment:

Insert after third "health;" "urges broad support for the urgent implementation of the world-class mental trauma service announced by the Minister of Health, Social Services and Public Safety in September;".

I thank the proposer of the motion for bringing it to the House for debate.

It is widely recognised that Northern Ireland has higher levels of mental ill health than any other region of the United Kingdom. It is estimated that one in four adults across Northern Ireland suffers from a form of mental ill health at some stage of their life. Mental illness does not discriminate, as it affects many people from all walks of life. Despite better outcomes from treatment for mental illness, there is still a stigma attached to it that prevents people from coming forward for help. More needs to be done to do away with that stigma and to encourage people to come forward, as well as to find and deliver the best services that we can to tackle mental ill health.

The Bamford review set in motion some of the most significant changes ever seen in mental health services. Those changes have transformed how we care for people with a mental illness and have significantly improved outcomes for many. The Bamford vision is to treat people in the community, close to their friends and family, and for inpatient care to be provided only for acute cases in which someone needs to be detained for their own safety and well-being. At the time of the Bamford review, we were spending 60% of the mental health budget on hospital services and 40% on community services; we now spend 44% on hospital services and 56% on community services. That is what Transforming Your Care is all about: care in the community.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

As Bamford has been rolled out, we have seen improvements in how we treat, handle and help those with mental ill health. In 2014, the Department launched the regional mental healthcare pathway, You in Mind, to commit the health service to delivering care that is more personalised and improves the experience of people with mental health problems. The trusts provide a range of services — including psychology, psychotherapy, cognitive behavioural therapy (CBT) and trauma therapy — that promote mental health and well-being. As we deliver services that are recovery-orientated and move away from reliance on drugs towards providing people with access to psychological and cognitive behavioural or talking therapies, we see that the Health and Social Care Board (HSCB) and the Public Health Agency (PHA) are delivering joined-up services on how mental health services, GPs and other primary care providers and hospitals can get better at making earlier interventions and moving people from long-stay hospital wards to community-based arrangements.

The Department published a stepped-care service model for child and adolescent mental health services (CAMHS) that promotes a more consistent, person-centred approach to mental health service delivery for children and young people. To reduce stigma, the Public Health Agency is working in partnership with the Northern Ireland Association for Mental Health (NIAMH) to deliver a future wide-ranging, three-year anti-stigma programme. There is also cooperation at cross-departmental level, with the ministerial coordination group on suicide prevention. The Department is working with DARD and DCAL on a joint initiative on awareness and help-seeking behaviour through rural networks and sporting organisations. That is Departments working together. We also have the Mental Capacity Bill, currently at Committee Stage, which sees the Justice and Health Departments working together in partnership.

That brings me, finally, to my amendment, which urges broad support for the urgent implementation of the world-class mental trauma service announced by the Health Minister in September. What will it do? It started with discussions in the Stormont House Agreement implementation group, which considered proposals to implement the agreement's commitment to establish a comprehensive mental trauma service in the health service. That was discussed by all the political parties that were in the Executive at that time. If agreed fully, it will lead to a better joined-up service that will provide opportunities for Departments, organisations and groups across sectors to share expertise and resources, ultimately benefiting service users.

I urge the House not to divide on the issue. I believe that we want the same things and the same outcomes. Let us show that we can unite on this very important issue. The amendment, I believe, strengthens the motion.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to speak on this important topic, and I welcome the Minister back to his desk. I hope that we will see some direct action coming from today's debate and the many others that are coming in front of it and behind it. It is important that we move mental health further up the political agenda with a clear strategic investment. It goes without saying that that is long overdue. Two recent reports — one from Queen's University and the other from the University of Ulster — have painted that in stark terms. The report from Queen's does not make easy reading in some regards. It highlights key issues of underfunding, a deeply fragmented system and concerns regarding children and young people's services. As a society, we must take note of that and act on it.

In recent years, there has been an increasing recognition of mental ill health, and it is becoming a major public health issue. It is now regarded as one of the four most significant causes of ill health and disability. It is estimated that one in four people in the North has a mental health problem. There is evidence that mental health problems are 25% higher here than in England. Despite that, between 2008 and 2014, the actual spend on mental health services by trusts was around 25% less than was previously proposed, while spending in areas like primary care increased.

There are key messages in both reports about how we treat people as people. There are concerns, particularly in the Queen's report, about how service users are perceived by the system. The report highlights fragmentation across the system and poor communication between parts of the system, and it states that services have become very separate from each other and are very much working in silos. Care respondents frequently mentioned poor communication between different professionals, specialisms and facilities and often:

"had to fight to receive the appropriate level of services".

We must also respond to concerns about young people. I quote the Queen's research:

“When a 14 year old won't open up, or talk, there is nothing for them. They are completely abandoned and left to their own devices, even when parents are begging for help”.

I want to make specific reference to the impact on mental health for those who have suffered sexual abuse. In 2012-13, there were 1,948 sexual offences in the North. If the core problem of psychological trauma is addressed at an earlier age, the victim is less likely to suffer the wider health implications that can arise from sexual trauma — another area of work that it would be wise for us to take note of.

The Children's Law Centre pointed to research that shows that there has been a significant increase in the number of children and young people with mental health needs. It is estimated that 10% of children between five and 15 years old have a significant mental health issue. In the last 25 years, there has been a 70% increase in the number of teenagers with depression and anxiety. As far back as 1999, the Chief Medical Officer recognised that children and young people in the North would suffer significant mental health problems before their eighteenth birthday.

A number of recommendations flow from the reports, one of which calls for the mental health budget to be ring-fenced. Another one calls for a mental health champion. I also acknowledge the recent work by Professor Siobhan O'Neill examining the link —

Photo of John Dallat John Dallat Social Democratic and Labour Party

Will the Member bring her remarks to a close?

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

— between suicide and mental health. There are clear lessons for all of us in both reports, and I appeal to the Minister, in his response today —

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

— to commit to taking action on a proper mental health strategy with decent and fitting investment.

Photo of Mike Nesbitt Mike Nesbitt UUP

I begin with early apologies: I have a meeting at 4.00 pm elsewhere on the estate that, I think, will cause me to leave the Chamber earlier than I would have wished. I support the motion as amended, and, if time permits, I will return to the amendment.

My interest in mental health and well-being started at home, 21 years ago, when my wife suffered a serious mental health and well-being issue. It has not made me an expert by any stretch of the imagination — I do not claim that — but it has made me very aware of certain issues, not least the stigma that still surrounds mental health and well-being. If one of the 108 MLAs arrived in the Building with a broken arm, the other 107 would approach to ask, "What happened?" and "How can I help?". With mental health, the exact opposite happens: the instinct is not to mention it and to stay clear. There is no logical reason for that sort of stigma in 2015.

I hugely admire my wife for her public contribution to this debate, not least in tackling the stigma and saying to others that it is OK to speak publicly about poor mental health and well-being issues. It encourages me to ask the other parties in the Chamber whether they will support the Ulster Unionists in calling for a mental health champion. Victims and survivors have a champion; older people have a champion; and children and young people have a champion: why not those suffering from poor mental health and well-being? I am not calling for a big commission or £1 million per annum. This can be done with a negligible impact on the public purse, but it would send out a hugely positive message to all those suffering from poor mental health and well-being.

The Chair of the Health Committee has already referred to the huge scale of the problem in Northern Ireland. I believe that globally, on a per capita basis, Northern Ireland may have the worst mental health and well-being on the planet. We are certainly up there with the likes of Israel and Lebanon, and nobody can be in any doubt that it is one of the most toxic legacies of the Troubles. Take a map of the Troubles hotspots measured in shootings, murders, bombings and the rest, as The Cost of the Troubles Study did in 1999, and you have a very clear picture. Then, take a contemporaneous map of poor mental health in Northern Ireland in terms of alcohol abuse, drug addiction and attempted and completed suicides: effectively, you have a match. There is no doubt — the evidence is there that this is a legacy issue for us.

I support the motion, not least because it recognises the need to make help available as close to home as possible. As a victims' commissioner, I spent time with a man from Fermanagh who used to come up to Maryfield for cognitive behavioural therapy. His daughter, who drove him there, said that, as they left to head back to Fermanagh, he was in great form, but, by the time they got off the motorway, she could sense him slipping back. When they hit Augher, Clogher and Fivemiletown, he was nearly as bad as when they had left. This kind of medicalised help — that sort of intervention — needs to be as close to the front room as possible.

I mentioned the amendment, and, because it urges us to offer broad support to the Minister of Health's initiative, I can support it. I cannot give it any further support because as yet we lack the detail. The Minister would acknowledge that all he did was task senior officials to look at what might constitute a world-class mental trauma service. I am glad that he is looking at that. It is, of course, a commitment in the Stormont House Agreement of 23 December last year. I will certainly support him if he puts forward solid proposals for a world-class mental trauma service.

To my mind, if we are to tackle this as we should, the solution is not purely a medicalised one.

We need to look at the societal interventions out there that can be copied so that the tens of thousands of people who woke up this morning feeling no real purpose in their lives can find that purpose —

Photo of John Dallat John Dallat Social Democratic and Labour Party

Will the Member draw his remarks to a close?

Photo of Mike Nesbitt Mike Nesbitt UUP

— can start living fulfilled lives and go to bed with a sense of achievement. That is the prize.

Photo of Kieran McCarthy Kieran McCarthy Alliance 3:45, 2 November 2015

I am happy to support the motion and the amendment on behalf of the Alliance Party. The motion is not dissimilar to one that I brought to the House on 28 April 2014, which we got full support for. I welcome our Health Minister to the Chamber and hope that he can give us a positive response at the end of this debate.

It is recognised that around one in four people have mental health conditions or problems. Unfortunately, that is more prevalent in Northern Ireland, and the legacy of the Troubles is a particular factor. At the same time, Northern Ireland spends less per head of the population on mental health than other jurisdictions. I acknowledge that some positive changes have occurred in the quality of and access to services, and that there has been some rebalancing of mental health expenditure from acute inpatient services towards the delivery of services in the community. Nevertheless, we are still investing a lower share of health spending on mental health in general compared with other regions. Pressure remains on some areas in particular, such as psychological therapies and child and adolescent mental health services.

Mental health services remain the Cinderella of the health service, which is a shame. They remain underfunded in comparison with services for physical illness, and there is considerable underfunding here in comparison with the rest of the UK. This systemic under-resourcing of mental health services is perhaps the clearest example of the reality that we do not have the balance of funding in our health service correct at this time. We urgently need to reassess our priorities and reach out to people like Margaret Gibson, who recently wrote to a morning newspaper to plead with MLAs — that is us; all of us — to listen and to provide her and her family with a proper mental health service.

Addressing mental health issues is more than just an issue for the Department of Health but for the Executive as a whole. The Bamford review of mental health and learning disabilities, as has been mentioned, provides the overarching framework for addressing mental health issues in our society. I welcome the Executive-wide Bamford action plan 2012-15 and support its full implementation. However, I remember that, when the Bamford report was launched, no extra funding was provided. Perhaps that is why we are suffering today.

One key component of Bamford is the Mental Capacity Bill, as has been mentioned. That legislation is now moving through its Committee Stage. It offers the prospect of Northern Ireland becoming a world leader through having a single statutory framework for decision-making and care for physical and mental health conditions. Our Department of Justice is jointly working with the Health Department, and we all wish to see a speedy end and a good result. Time is tight in which to get that legislation through before this Assembly term ends. Unfortunately, the process has been held up due, I maintain, to the absence of a Minister, which prevented the Department from responding to requests from the Committee. Any further delays would result in a real missed opportunity, not least as this legislation has been under development for almost a decade. I would be grateful if the Minister would give the Assembly an assurance that all efforts will be made to ensure that the legislation can pass through all its stages before the Assembly winds up next year.

Concern has been expressed at the potential cost of implementing the mental capacity legislation. It is important that we also understand the implications of not proceeding. Notwithstanding the Executive's financial difficulties, I think that the Minister should also give an assurance that the legislation will proceed and, at the very least, that the Bill or aspects of it will be commenced as circumstances allow.

I also welcome some of the initiatives that have been taken in recent years, including the Executive's economic inactivity strategy and the consultation on a disability employment strategy that was recently published by my colleague the Minister for Employment and Learning, Dr Stephen Farry. If we can help people to stay in work or to access and sustain employment, it would improve their self-esteem and help our economy. We must be clear in our message that many people can continue to lead meaningful lives despite mental health conditions. Addressing discrimination and stigma, as already mentioned, is therefore particularly important.

Photo of Kieran McCarthy Kieran McCarthy Alliance

It is also important to acknowledge —

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member's time is up, please.

Photo of Kieran McCarthy Kieran McCarthy Alliance

— the crucial role played by the voluntary organisations. I commend FASA for its recent opening of the Nightingale project on the Newtownards Road.

Photo of George Robinson George Robinson DUP

In speaking in favour of the amendment, I have to commence from the beginning and say that I hope that the proposers of the motion will agree a budget and allow forward planning by the Minister and all Departments.

As someone who had a close family member suffering from mental health problems a few years ago, I fully appreciate the trauma that the patient and family go through. For whatever reasons, there is a high level of mental health issues every year — about 400,000 in Northern Ireland — and it is a challenge to ensure services that are capable of dealing with that level of need.

The Minister has outlined the world-class mental trauma service in September. I believe that that is the way forward. I would like to pay tribute to the first-class staff who maintain our mental health services. While they deal with the problems of others, it is rarely recognised that they need our support.

Photo of Brenda Hale Brenda Hale DUP

I thank the Member for giving way. He will know that I have the full support of the current Health Minister on armed forces issues. We are aware of the devastating impact that PTSD has on sufferers and their families but, sadly, many healthcare professionals do not recognise the symptoms, instead using guidelines for schizophrenia and bipolar, resulting in sufferers being turned away, as a Belfast hospital did recently. Does my colleague agree that we must recognise and acknowledge that PTSD as a mental health issue may stand alone, that it disproportionately affects members of our security and armed forces and that the implementation of a mental trauma service would be welcomed by the families as well as by all service users?

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member has an additional minute.

Photo of George Robinson George Robinson DUP

I fully agree with Mrs Hale and acknowledge that all pathways to mental health services must be available to serving and ex-serving members of our armed forces. I believe that the Minister will address that particular issue later in the debate.

I ask Members to support mental health today. The best way to do that is to vote for the amended motion. That will give staff and patients a world-class service, which will have clear, strategic goals that will benefit those in need of, and those manning, the service. I welcome an emphasis on prevention, as a preventative model is always better than a curative one.

I would like to say a few words about the stigma attached to mental health. As chair of the all-party group on epilepsy, I have learned how damaging stigma can be for individuals and families. I understand that the same applies in cases where mental illness occurs. The best way to address that is to educate our population as to the need to be proactive with mental illness. Bearing a condition only leads to suspicion and stigma. The sooner a problem is identified, the sooner that work can begin to address the situation and put support in place.

I urge all Members to support the amended motion, as I see it as the best way to provide and continually develop the services required for those with mental health issues.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. Today's debate gives clear focus to the issue of mental illness within our society, and I commend the proposers for bringing it forward. It brings home to us the very real truth that probably one in four people are grappling with mental ill health at any given time.

We know that there is a connection between mental ill health and suicide. That can sometimes lead to a person taking the tragic decision to end their own life. Some 280 people per year feel that they have no other choice. Some of those tragic deaths could be avoided if the right services and supports were in place. Early intervention is key to addressing the needs of people who feel isolated, depressed and hopeless.

In that context, it is a matter of grave concern that the services that are offered by Lifeline are under threat, and we have all received lobbying from that organisation to urge us to support its funding being continued. Lifeline is a 24/7 suicide crisis prevention helpline and counselling service. The situation must be addressed to ensure that the lives of people who desperately need that important service are not placed at risk.

On that note, a recent study by Action Mental Health and Queen's University, Belfast has alerted us to the fact that sufferers of mental health conditions are being let down on a ongoing basis due to major reductions in funding to psychiatric support services in the North. Following the research launch a few weeks ago, David Babington, the chief executive of Action Mental Health, flagged up some very salient points. He told us that mental health services here are already underfunded and that further funding cuts mean that people who rely on those services have to wait far longer for the help that they so badly need. While the funding for primary care services has been increased by 136% over the last six years, facilities for mental health provision have suffered a 26% underspend. That is a matter of huge concern.

Officials in the statutory, community and voluntary sectors know only too well that people who use mental health services experience increased social isolation, stigmatisation and total frustration with the lack of provision for their needs. We need to do something about that to ensure that people do not continue to suffer needlessly. The situation is as dire as it could possibly be, and it is clear that there is a real need for the Executive to give a positive reaction to the needs of the sector to address the lack of understanding and investment in resources, education and professional training.

A number of recommendations arose from the study, and it is timely and worthwhile for those to be given genuine consideration. They include: a more secure funding basis for mental health services; the establishment of a regional working group to examine the extent and impact of mental health service fragmentation, including variations in provision between urban and rural settings; the establishment of a mental health champion to renew the Bamford vision; and the need for attention to be given to the role of carers. Other important recommendations include the need for a recovery ethos to be more firmly embedded in the practices of users and carers, for a person-centred approach to be in place and for a relationship-building approach to be central to service delivery. One other very important recommendation is for action to be taken to reduce the stigma that surrounds mental ill health. People have talked at length about that.

The study found that statutory and voluntary sector organisations identified the need for better partnership working between different sectors and service providers. There must be a genuine review of mental health service provision so that a coherent strategy can be produced that will use resources in a way that serves the real needs of sufferers. The role of the community and voluntary sector is crucial in that provision, and the future lies in an effective collaboration between that sector and the statutory agencies so that the widest possible range of providers and approaches are made available for those who need those services.

Several weeks ago, the Health Minister made a very welcome announcement about the setting up of a world-leading mental health service to provide high-quality and effective treatment for people who are experiencing trauma-related mental health problems. He stated that mental ill health is the greatest cause of disability here and much of that relates directly to the conflict. In that regard, a special case has to be made for the North of Ireland so that there is a real recognition of the impact of the conflict and how it has contributed to the high levels —

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member's time is almost up.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

— of mental ill health here.

I urge people to support the motion and that proper strategies are put in place to address mental health issues.

Photo of Thomas Buchanan Thomas Buchanan DUP

I support the motion and the amendment. While mental health issues have always been branded the Cinderella of the health service, through a lot of good work by charities, and since the Bamford review, things are slowly beginning to change. However, that said, much work is yet to be done.

It is alarming that we are still in a situation in which one in four of the population in Northern Ireland suffer from mental ill health each year. There is no doubt that that will increase, because, unfortunately, more and more young people require those services. I see this trend through my constituency office, as I help families on a regular basis to access services, perhaps for one of their younger family members. It is always a stressful time for the family. They always relax, if you like, when they get somewhere where they know that their child or an older member can go to be treated and well looked after and where they know that is being provided for them. In rural areas, that can sometimes create further difficulties of travelling times and distances. It is therefore vital that appropriate services are in place to provide proper care and support to patients, carers and families affected by mental illnesses, and that such services are readily available and consistent across all trust areas.

The motion speaks of all the important things that we fully agree with — for instance:

"the importance of having quality services that are fairly resourced, trained staff to afford early access and support, and a focus on prevention, resilience and mental well-being", and it goes right on to raising awareness and reducing stigma and discrimination in relation to mental health issues. However, one thing that it left out was the implementation of the world-class mental trauma service announced by the Minister of Health, Social Services and Public Safety in September. That is the reason why we brought forward the amendment to the motion. The Minister has outlined his vision for Northern Ireland to become a world leader in treating psychological trauma and mental ill health.

As a Member who spoke previously said, there is no doubt that it is a legacy issue. As they grow older, problems and difficulties are created for those who were involved or were victims of the Troubles over the years. They get more and more depressed. Therefore, any service that is provided must be all-inclusive. It must not only be for the citizens of Northern Ireland but include all those who served in the army or other services here.

The key message that we must get out from the House today is that mental illness can be overcome and defeated. There is a stigma out there around mental health and illness which has to be overcome, and that is the clear message that must be sent out from the House. Of course, there are challenges to the mental health sector in rural areas and communities. We can see, and fully understand why, a lot of services are based in urban areas, where the populations tend to be. However, let us look at the more isolated rural communities, such as farming communities, which have suffered over the past years. There has been a lot of pressure on them. We have seen a lot of farmers in despair and at breaking point. Again, it is important that we do not forget those areas but continue to ensure that proper services are provided for them.

Being from west Tyrone, I cannot close my remarks without saying to the Minister that I look forward to him soon making a decision on the second phase for the new acute mental health hospital in Omagh. That acute mental health hospital, to be provided as the second phase of the new building in Omagh, will be a great help to people in the rural west of Northern Ireland.

Photo of Daithí McKay Daithí McKay Sinn Féin 4:00, 2 November 2015

Go raibh maith agat, a LeasCheann Comhairle. I speak in favour of the motion and the amendment. In the North, of course, we have significant mental health problems in comparison to other jurisdictions, as has already been said. We have higher rates of suicide. We have, arguably, a higher rate of stigmatisation in areas as well. Stigma increases isolation and makes it much harder for people to come forward to receive treatment and help. Mental health problems face all of us — ourselves as much as anybody else. Much more needs to be done. People need to speak out about their own experiences to help tackle the stigma that hangs over those with such health problems.

Prevention, of course, is much better than cure, which is why it is important to have services not only in the Department of Health but in other Departments. In DE, for example, there is the independent counselling service for schools. It is also important to make the link between mental health problems and physical health and well-being. Ensuring that people live in a safe and healthy environment in terms of their housing and that they have choice in active travel and sports are important health factors. Mental health does not just go into a box but is connected to all those issues, which all have an impact.

I am a rural MLA, and it is concerning that people living in rural areas have significantly less access to vital mental health services than those living in urban areas, so it is important that funding to key groups in rural areas continues. I can think of many such groups in my North Antrim constituency. The Hope Centre in Ballymena helps people recovering from drug addiction and their families, and Solas in Ballycastle was set up in reaction to the rising suicide rate in the Moyle area. It is a community-led mental health and well-being group. Such groups are located in very isolated areas, and any reduction in funding often results in their going to the wall. That always needs to be taken into consideration.

Earlier today, we had a debate about marriage equality and the LGB and T community. That community faces huge mental health and well-being problems because of bullying and intimidation. The rates of self-harm and suicide attempts are absolutely shocking. We can do something about that. It is important to comment on that, because the more that we can change attitudes and views that are based on people's sexual orientation, the greater impact there will be on that community. The earlier debate about marriage equality is very much connected to mental health when it comes to the LGB and T community, and it is worth bearing that in mind.

As others said, strategies need to be put in place to deal with this huge issue. As the Member who has just spoken said, there has been an increase in the number of people accessing these services. That could be for a number of reasons, but I hope that people who previously did not want to be seen accessing these services are doing so now. Stigma is a big issue when it comes to mental health. The more that people such as us — people in leadership positions — talk about their mental health difficulties — we all have issues — the more chance there is of helping to de-stigmatise what is essentially a massive health issue. Somebody in the sector once asked me, "Why do you always talk about having a mental health problem? If you break your leg, you don't go about saying you have a physical health problem". It is a health issue and problem, regardless of whether it is to do with the state of your mind or something physical. All those things are interconnected.

Photo of Oliver McMullan Oliver McMullan Sinn Féin

I thank the Member for giving way. Does he agree that services need to be rural proofed now more than ever to ensure that the right facilities go into rural areas?

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member has an additional minute.

Photo of Daithí McKay Daithí McKay Sinn Féin

I absolutely agree with the Member. As a Member for North Antrim, I know how isolated communities can feel. In rural areas, you find that the community steps up to the plate. It happens in urban areas as well, but, when you are a considerable distance from certain health services, you find that the community steps up to the plate. It is vital that those community groups and organisations in places such as Ballycastle, the glens and Ballymena continue to have our full support, because they carry out an important role in preventing greater mental health problems. Often, I do not think that their role in prevention is recognised by a number of Departments.

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member's time is almost up.

Photo of Daithí McKay Daithí McKay Sinn Féin

I urge Members to support the motion and the amendment.

Photo of Dolores Kelly Dolores Kelly Social Democratic and Labour Party

I begin by paying tribute to the men and women who have forged careers in caring for people with mental ill health and also the carers and families of sufferers. It is no easy task at all and one that largely goes unacknowledged.

Recently, I met some of my former colleagues in the Southern Health and Social Care Trust to discuss mental health services in my constituency, and I was very impressed by the ways of working smarter. Many people are thinking of new and innovative partnerships to try to better meet the needs of sufferers and their families and also, in a very financially constrained climate, to try to do things differently. I understand that there is now a new group of nurses called "nurse prescribers", which is a wonderful initiative. I understand, too, that the Justice Minister is about to sign off on the elements of the domestic and sexual violence strategy for which he is responsible. I urge you also to make that a priority amongst your commitments and priorities over the next few days. I do not think that any of us could not acknowledge the impact that domestic violence has on the lives of children and families with regard to mental ill health. That should be a key priority amongst many, I am sure, that face the Minister.

I also want to touch on workforce planning because I understand that, under mental health terms and conditions, many staff, particularly in the nursing professions, can leave at age 55. Therefore, there needs to be some element of planning to fill those gaps. Having spoken to many of my former colleagues, some of whom have recently retired and some who are planning to do so, I know that we are losing the huge experience and dedication of those staff. They will be difficult to replace. There is also the opportunity to work alongside the Open University with regard to the employment-based route for some support workers and nursing auxiliary-type staff. I urge the Minister to give that consideration as a Programme for Government initiative by himself and the Minister for Employment and Learning.

I want to focus my remarks on looking at dementia services, which are also part of the Minister's very broad portfolio. In 2014-15, in Upper Bann, which is in the Southern Trust area, there were 2,995 referrals. The demand for dementia services rose by 36% in the Southern Trust area alone. I am aware of the Public Health Agency's work to develop a framework strategy for dementia services for Northern Ireland, which is partly funded, I understand, by Atlantic Philanthropies. I hope that, in looking at all those holistic needs, we also look at the need for short breaks and respite services for carers and that particular attention is also paid to the needs of dementia sufferers who are under 65 years of age because, currently, there is no specific specialist provision for that type of service. As we all acknowledge, many people with learning disabilities are living longer. We also see many of them suffering from dementia, maybe from their late forties onwards, so very niche services are needed in the dementia strategy.

As regards young people, adolescents and CAMHS provision, Bamford made specific recommendations on their needs. I do not believe that those have yet been fulfilled. I worked for 22 years in mental health services, and I still have sisters working in the specialties. They tell me about the younger age of chronic alcoholics who are presenting in long-stay hospitals; people in their twenties displaying symptoms that you would have expected to see in someone who had been a chronic alcoholic for 40 or 50 years. That is mind-blowing with regard to needs. We face a number of time bombs across mental ill health.

I acknowledge the post-traumatic stress needs of the security and armed forces, but I think that, tonight, we will learn more about some of the nurses who were at the front line during the years of the conflict. I met an old colleague who broke down after 30 years. She was a nurse who had attended the scene of the Abercorn bomb; another horrific example of our troubled past.

In looking at the issue of post-traumatic stress disorder, I urge the party on the opposite Benches to look not just at the needs of the armed services —

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member's time is almost up.

Photo of Dolores Kelly Dolores Kelly Social Democratic and Labour Party

— but at those of all our emergency services.

Photo of John Dallat John Dallat Social Democratic and Labour Party 4:15, 2 November 2015

I call the Minister of Health, Social Services and Public Safety

My apologies: I call Mrs Jo-Anne Dobson.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

Thank you, Mr Deputy Speaker. You are forgiven.

I welcome the opportunity to speak to the motion. In recent weeks, the Assembly has debated major issues such as patient waiting times, autism and delays in key cancer services. Another issue, however, arguably just as pressing, is our endemic rates of poor mental health and how we, as an Assembly and a society, respond to that.

One in four people in Northern Ireland will experience a form of mental ill health in their life. Let us think about that for a moment: if we think of our family and our friends, one in four is a perturbing figure. Although the issue affects all regions and communities across the UK, we know that there is a 25% higher incidence of mental health problems in Northern Ireland compared with England and Scotland. The total financial cost of mental illness in Northern Ireland is estimated to be in the region of £3 billion annually, with the majority of costs not healthcare-related. Instead, the costs are to reduced economic output, owing to factors such as sickness absence and non-employment. Human costs, however, entail by far the biggest financial loss, in the form of premature death and institutional problems.

Anyone, no matter what age, gender, socio-economic status, life experience or profession can develop mental health problems, and it is often an invisible condition. As constituency MLAs, I am sure that we all know of people who are facing serious mental health issues but who mask their condition, often bottling it up until it becomes just too much to handle. Quite simply, far too many people are being lost to suicide, particularly young people in relatively confined geographic areas.

I pay tribute to the local charities, including MindWise, that do fantastic work, often with very limited resources, with the most vulnerable in our society. Given that suicide remains one of the largest killers in Northern Ireland after cancer and heart disease, it is clear that there is so much more that we need to do. Northern Ireland's suicide rate has almost doubled since 1998, putting us in the top quarter of the global league table of suicide rates. Worryingly, there is a growing body of evidence that suggests that the trend is associated with the Troubles. For instance, the young people who experienced the worst of the violence in the 1970s are the cohort with the highest and most rapidly increasing suicide rates in the decade after 1998.

The Ulster Unionist Party has serious concerns about the Public Health Agency consultation on the future of the Lifeline crisis intervention service. The most well-known feature is, of course, the crisis response helpline, and I am in no doubt whatsoever that it has been a salvation for people experiencing great distress or despair. I ask the Minister directly today to throw that service an urgent lifeline. As the figures for service users prove, it is simply not true to say that the current service is Belfastcentric. In fact, from April 2012 until September this year, there were 1,184 referrals in my constituency of Upper Bann alone. The facts speak for themselves on that important and life-saving issue.

The Appleby report found that Northern Ireland required almost 44% higher per capita funding than England, yet actual spending at the time was between 10% and 30% lower than per capita spending on mental health in England. Michael McGimpsey identified mental health as an area that required additional funding and used the remainder of his time in office to begin delivering just that.

Later, the Bamford review clearly identified the need for improved access to services and for a more coordinated framework for provision to be developed. Frustratingly, however, few of the recommendations have been followed through to completion. It is about time that the Executive and the Department step up to the mark and start giving our local mental health provision the support that it deserves.

Photo of Simon Hamilton Simon Hamilton DUP

I welcome the debate and the opportunity to participate in it. I welcome the opportunity to focus on mental health, which, as many Members have acknowledged during the debate, has historically been a poor relation in health and social care. As Mr Buchanan mentioned in his contribution, thankfully, things are starting to change. A lot of high-quality, essential work is carried out in our communities and in our hospitals by talented and dedicated people. They very much deserve our respect and our thanks.

We face significant challenges in the arena of mental health: the legacy of the Troubles; an ageing population; areas of deprivation; unemployment; and stress at work. There is barely an element of modern life that does not have the potential to adversely impact upon someone's mental health. As an Executive, we face the challenge of prioritising how we spend finite amounts of public money. One in four adults in Northern Ireland will suffer from a mental health problem at some stage in their life. Northern Ireland has higher levels of mental ill health than any other region in the United Kingdom. The Public Health Agency's 'Making Life Better' strategy, published in 2014, established that Northern Ireland has a 25% higher overall prevalence of mental illness than England.

In the past decade, significant reform and modernisation of mental health services has taken place, although I acknowledge that more needs to be done. The Bamford review, which was referenced by many contributors, set in motion some of the most significant changes ever seen in mental health services here. Those changes have transformed how we care for people with a mental illness and have significantly improved the achievable outcomes. The Bamford vision is that people with a mental illness should be treated in the community, close to their families and friends, unless there is a clinical reason for not doing so. The focus in the last number of years in service development has been on early intervention, home treatment services and the development of psychological therapy services. Transforming Your Care endorses this approach. Since Bamford reported in 2008, investment in mental health services has increased to £247 million a year. That is an increase from £200 million a year. More importantly, the balance of funding has shifted. At the time of the Bamford review, we were spending 60% of the mental health budget on hospital services and only 40% on community services. Now we spend 44% on hospital services and 56% on community services. We are working towards closing old, inappropriate institutions that are no longer fit for purpose, and we are steadily opening new, more appropriate community-based accommodation around Northern Ireland.

In October 2014, the Department launched a regional mental healthcare pathway called You in Mind. The focus of the pathway is to commit Health and Social Care to delivering care that is more personalised and improves the experience of people with mental health problems by adopting a more evidence-based and recovery-orientated approach. One of the key elements was the publication in 2010 of 'A Strategy for the Development of Psychological Therapy Services', which has largely been implemented. A range of services are provided, including psychology, psychotherapy, cognitive behavioural therapy and trauma therapy. The HSC Board estimates that between 75,000 and 80,000 sessions are provided annually. Recent investment has focused on the training of existing staff in psychological therapies and the establishment of primary care talking therapy hubs. The HSC Board is into the second year of a five-year plan to establish these hubs across each trust area. The hubs focus on providing a range of psychological therapies for people who are experiencing common mental health problems. They are developed around general practice and will improve access to earlier support and care.

There is even an economic argument to support excellence in the provision of psychological therapies and mental health services generally. DSD has since 2008 provided funding to my Department to support the welfare-to-work agenda. A Queen's University/Health and Social Care Board report in 2014, published to support the continuation of this funding, found that 44% to 46% of people claiming illness-related out-of-work benefits do so because of mental ill health. However, for every £1 invested in psychological therapy services, there is a saving of £1·75 to the public sector. The report estimates that, within two years of recovery following successful treatment, the employment rate for those with moderate to severe mental health problems is increased by 11·4% and by 4·3% for those with mild mental health problems. I argue that we need to continue investment in this area.

I turn to the issue of CAMHS, which Dolores Kelly mentioned in her contribution. The Bamford review set out the strategic direction for children's mental health services, which are mainly delivered through community-based teams. There is also a 33-bed children and adolescent mental health inpatient unit at Beechcroft. In July 2012, the Department published a stepped-care service model for CAMHS, and this promotes a more consistent, person-centred approach to mental health service delivery for children and young people. Improvements include an increased focus on early intervention, better multidisciplinary working and collaboration with the community and voluntary, education and youth justice sectors.

I want to turn to an issue that was not raised but which is an important mental health issue nonetheless, and that is eating disorder services. Those are currently provided through a stepped-care approach that ranges from early detection and intervention, to community-based treatment, to specialist inpatient provision. However, I am aware that there is considerable support for a local specialist eating disorders unit. We need to be sure that any such service would be sustainable in the long term. I therefore asked my officials in October to start considering all the various options available to us.

Members will recall my announcement in September that I want Northern Ireland to become a world leader in treating people with psychological trauma and that I have tasked officials to create an innovative service that will meet the needs of those suffering from mental trauma. I welcome the amendment before us today. My announcement followed on from exploratory discussions in the Stormont House Agreement implementation group, which considered proposals to implement the agreement's commitment to establish a comprehensive mental trauma service in the health service. The full details continue to be developed, but the intention is that the final model will support the voluntary and community sector to create an integrated approach with the Health and Social Care system to address mental health need.

The service would allow for a range of interventions, meeting the spectrum of need across our community, irrespective of where that is. It would involve leading-edge, evidence-based treatments in line with NICE guidelines and be based on the authoritative and internationally recognised stepped-care model that focuses on the recovery of the individual from psychological trauma. The model recognises that, for people to recover, they may often need a combination of evidence-based social, family, psychological and psychiatric interventions; in short, a collaborative partnership across community, voluntary and statutory services.

In establishing the service, I intend to achieve four main aims: to address comprehensively the legacy of the Troubles and unmet mental health needs; to improve individual, family and community experience of mental health trauma care; to improve the psychological and social outcomes for individuals, their families and communities who have been traumatised as a result of the Troubles in Northern Ireland; and to improve governance and accountability.

The last of those is very often overlooked, but I believe that it is important that we provide care either in the statutory sector or in the voluntary and community sector and that services are joined up, involve less duplication and enable more timely responses to psychological problems that are effective from the outset. A joined-up service will provide opportunities for organisations and groups across sectors to share expertise and resources, ultimately benefiting service users.

My Department, together with the Health and Social Care Board, has been concentrating on designing the medium- to high-impact, high-intensity support that, in the model, would be provided within Health and Social Care and involve treatment for people with diagnosable and complex mental health problems. Care at that level must be provided by registered mental health professionals. The current model estimates that we would need to recruit over 40 additional whole-time equivalent specialists to accommodate the volume of patients and levels of need. That gives a further indication of the scale of the challenge that we face. Finalising the design of the model and financing such a service are significant challenges that we need to overcome. I urge all Members, including Executive colleagues, to work together to agree those arrangements as soon as possible. Just as the Royal Victoria Hospital is world class in dealing with physical trauma, I hope that we can agree that a mental trauma service would be a fitting legacy to those who continue to suffer as a result of the Troubles.

In respect of the point raised by my colleague Brenda Hale about post-traumatic stress disorder and unrecognised symptoms among armed forces personnel, I am happy to contact her about the issues that she raised and, hopefully, provide her with an adequate response. She will be aware that the Department is involved in working with the armed forces across a range of health issues and chairs a forum that meets regularly and which involves representatives from the charity Combat Stress. For serving members of the armed forces, mental health services are provided by the Ministry of Defence, and services for veterans and dependants are provided within Health and Social Care. She raises a very important issue, and I am very happy to contact her about any specific concerns that she may have.

It is vital that we speak openly about mental health and encourage people who are experiencing emotional difficulties to seek help. Health and Social Care is working across a number of levels to reduce the stigma associated with mental ill health. The PHA and the Northern Ireland Association for Mental Health are working in partnership to deliver a future wide-ranging three-year anti-stigma programme entitled Change Your Mind. The cross-departmental ministerial coordination group on suicide prevention has expanded its remit to cover a broader range of activities to promote positive mental health. My Department is working with DARD and DCAL on a joint initiative to promote mental health awareness and help-seeking behaviour through rural networks and sporting organisations.

Another progressive development is the Mental Capacity Bill, which is currently at Committee Stage. If passed, it will be an international first in establishing a fused approach for mental health and mental capacity law. I am very grateful to Members from all sides who are considering the Bill so assiduously, and I urge colleagues to continue to work together to ensure that we pass Final Stage before the end of this mandate.

In her remarks, Jo-Anne Dobson mentioned the Lifeline service, and I want to use this opportunity to provide an update to the House. The current Lifeline contract ends on 31 December this year, with the possibility of extension until 30 September next year. I understand that an extension has twice been offered to the current provider of Lifeline services but has been refused on both occasions. The Lifeline crisis response service is a key component of the Protect Life suicide prevention strategy. The PHA is keen to engage with the relevant stakeholders to ensure that the future service specification is appropriately informed, and the agency has already undertaken a Lifeline pre-engagement public consultation, the findings of which have assisted in identifying the most effective and efficient model to obtain the best outcomes for taking the service beyond 2015.

The proposals for the future delivery of the Lifeline service retain four essential core components of the current service. Those are a free-to-call crisis telephone helpline that will be accessible 24 hours a day; skilled helpline staff trained in crisis de-escalation and in assessing suicide risk; signposting callers to the most appropriate service for their needs; and referral to follow-on support where necessary. By splitting the provision of immediate helpline support from follow-up support, the proposals avoid a potential perverse incentive whereby the helpline provider would gain financially from referring a client to follow-up support that it also delivers. By ensuring that follow-up support is locally based, access to that service should be improved, particularly for rural dwellers.

The point is that the plans that are out for consultation at this time are looking at better integration with elsewhere in the service, particularly with the Ambulance Service, and better coverage across Northern Ireland. That recognises a criticism that the service has not been up to standard outside Belfast. There should also be improved governance. The important point for Members to remember is that, at the end of this consultation and at the end of this work, the Lifeline service will be retained, and we are seeking to improve the service that people receive.

In conclusion, improving people's mental health is vital for their well-being and that of their families. It is as important as their physical health. People with a mental illness must be supported to take control of their lives and live purposefully in their communities. While our mental health services have come a long way since Bamford, we have much more to do. I am committed to further reform and innovation. That will require funding. Some of that can be found by reprioritising existing resources, but new money will also be needed. That will be difficult to find, but we all have a responsibility to ensure that we have sufficient means to meet the mental health challenges that we face as a community.

Photo of Pam Cameron Pam Cameron DUP 4:30, 2 November 2015

I rise as a DUP member of the Health Committee and as a member of the Ad Hoc Committee on the Mental Capacity Bill, which is currently going through. I welcome the opportunity to contribute on this important matter. As we are all aware and as many Members have highlighted, during our lifetime, one in four of us will be affected by some degree of mental health difficulty. Many of us in the Chamber, including me, will be well aware of what it is like to suffer from poor mental health at some stage in our lives. In my case, after childbirth, I did not recognise that I was suffering from postnatal depression. Unfortunately for me, I was not diagnosed. In fact, I was not even aware that I should be seeking help at that time of my life. Twenty-three years on, I trust that mothers today are more aware and that the stigma that has always been there has lessened over time.

In the eight years since the publication of the Bamford report, we have made significant improvements in how we deal with patients presenting with mental health issues. That is a trend that we must continue and build on, in keeping with Transforming Your Care.

At the core of any strategy, we must focus on ensuring that stigma surrounding mental ill health is removed. Sadly, many misconceptions, inaccuracies and misnomers surround the issue, meaning that many people, particularly men, are reluctant to ask for help.

With the Bamford vision to be able to treat as many people as possible within a community setting, our efforts must centre on normalising the reality of mental ill health and ensuring that we work towards community-based support systems, such as within the family, friendship circles or local help networks. Coupled with recognising the parity between mental and physical health, that would provide a strong foundation on which to provide early intervention and improve outcomes for those suffering from poor mental health.

In September, the Health Minister announced plans for a world-leading mental trauma service. At the time of the announcement, he recognised that mental ill health was the biggest cause of disability in Northern Ireland. He also acknowledged that over 213,000 people were suffering from mental health difficulties that could be attributed directly to the Troubles. That figure is likely to be much higher due to the ripple effects on families, causing a worrying precedent for future generations.

It is clear that this service is much-needed and will be possible only with inter-departmental working. I cannot think of one Department that does not have a part to play in shaping the service, whether it be the Department of Education looking at early coping mechanisms such as one I witnessed on a recent visit to Ballycraigy Primary School in my constituency, which provides a fantastic nurture facility to help children to cope with emotional and social difficulties; the Department of Agriculture in reaching out to the increasing number of members of the farming community who are experiencing depression; or the Department for Social Development in tackling drug and alcohol abuse through funding charities such as FASA, to name but a few.

There is no silver bullet and these are not changes that will happen overnight. However, working with the community and voluntary sector, we can make a real societal change.

I want to turn to some comments from the Floor in relation to our party's amendment. I welcome the support given to the amendment. Fearghal McKinney, the proposer of the motion, said that it neither added to nor took away from the motion. He welcomed the intention to develop a mental trauma service.

Alex Easton, the proposer of the amendment, said that a mental trauma service has been discussed by all political parties and that it would lead to a better, joined-up service, allowing opportunity to share expertise and resources to the benefit of service users. Maeve McLaughlin spoke of the huge scale of the mental health problem in Northern Ireland.

Mike Nesbitt, supporting the motion as amended, spoke of his awareness, in particular, of the stigma in relation to mental health, given his own wife's experiences. He talked about a mental health champion and the commitment in the Stormont House Agreement to have that trauma service.

Kieran McCarthy spoke to the motion and amendment. He said that Northern Ireland spent less per head than the rest of the UK on mental health. He also spoke of how the Mental Capacity Bill was moving through Committee Stage.

George Robinson said that he believed that a world-class mental health trauma centre —

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member's time is almost up —

Photo of Pam Cameron Pam Cameron DUP

— was the way forward. There were other contributions as well.

Whilst the motion transcends politics, it is obvious that none of this will be possible without agreement to welfare reform. We all understand the severe cost that is being imposed. I thank the Members across the Floor for supporting the amendment.

Photo of Dominic Bradley Dominic Bradley Social Democratic and Labour Party

Go raibh míle maith agat, a LeasCheann Comhairle. Go raibh míle maith agat, a LeasCheann Comhairle, as deis cainte a thabhairt domh ar cheist ríthábhachtach seo na sláinte intinne. Éirím ar an ócáid seo le hachoimriú a dhéanamh ar an rún, ach caithfidh mé a rá go bhfuil muidinne ar an taobh seo an-sásta tacaíocht a thabhairt don leasú fosta. Tá súil agam go mbeidh mé in inmhe cothrom na Féinne a thabhairt do oiread Comhaltaí a ghlac páirt sa díospóireacht agus is féidir liom.

I welcome the opportunity to wind up what has been a very positive debate on the motion. While Members may disagree slightly on the nuances of the implementation of mental health services, they all agree on the scale of mental health issues and that it cannot be ignored. The provision of mental health services is one of our society's greatest challenges. In Northern Ireland, this has only been amplified by the conflict, which has left many people with lasting mental scars.

Mrs Dobson and Mr McKinney mentioned the figures. One in four people in Northern Ireland has a mental health problem, with the region having a 25% higher risk of problems than England, for example. A significant portion is directly related to trauma experienced during the conflict, with over 213,000 people dealing with mental health issues. As Ms McLaughlin mentioned, further figures note that, between 2008 and 2014, actual spending on mental health services was 25% less than it was in the previous period. Certain figures quoted in today's debate continue to paint a grim picture of our current position regarding mental health aid.

As Mr McKinney and others said, the 2007 Bamford review heralded a new understanding that mental ill health was not only widespread across the region but, further, that it needed serious planning and funding obligations to meet the demand and create new positivity. Bamford held that:

"people with a mental illness should be treated in the community, close to their families and friends, unless there is a clinical reason for not doing so."

This goal was later reflected in Transforming Your Care. The Minister outlined the move towards treatment in the community when he mentioned the hubs. He said that these were based around general practice and involved cognitive behavioural therapy (CBT) and trauma therapy and evidence-based, recovery-orientated approaches.

Mr McCarthy mentioned Transforming Your Care and said that we need to reassess our priorities. Ms McLaughlin mentioned the fact that funding for mental health is now 25% less in real terms, a point that I have already covered. It is frustrating for those involved in the mental health sector and those who rely on it to find that a lack of funding and continued cutbacks continue to stall progress on the Bamford principles. The scale of need recognised in the Bamford report and Northern Ireland's own unfortunate position was further recognised by the Heenan-Anderson Commission, which rightly identified that the legacy of trauma from the conflict could only be dealt with through a world-class, universal mental health system.

Dolores Kelly praised the professional staff involved in mental healthcare and the work of family carers and friends. She mentioned the need for smarter ways of working and referred to nurse prescribers, who she said are making an excellent contribution. Mrs Kelly also outlined the close connection between domestic violence and the mental health of women and children and emphasised the need to bring forward the sexual violence strategy. She also mentioned the experience of CAMHS in dealing with chronic alcoholism in people who are much younger than the past norm.

She said that that was a problem that needed to be addressed urgently. She also mentioned that the dementia services in her constituency last year had almost 3,000 referrals, which was a 36% increase on the previous year. That is obviously a problem that needs to be tackled.

The proper provision of a quality mental health service is not simply to address the needs of those affected by the conflict; it is for the common good of everyone in Northern Ireland, young and old. Access to properly funded services delivering the best care possible is critical to helping people to identify their own struggle and grants them the tools to manage their mental health. It is critical that the Assembly recognises the scale of mental health issues in Northern Ireland and that we do everything in our power to raise awareness and banish all the stigma that has been erroneously attached to mental illness in our society.

Mr Buchanan referred to stigma. He said that mental health services were often the Cinderella services of the health system, so it would be good if the Minister were to prove to be their Prince Charming. The truth is that we can talk easily of physical illnesses, even cancer, but there is still unwillingness to speak openly about mental health and well-being. As Mr Nesbitt said, it is time to take it out into the open and champion it in public to remove the stigma and make it OK to talk. Talking is often the first step towards mental well-being. I praise the work of the race against suicide, an island-wide voluntary strategy that seeks to emphasise that it is OK to talk. Recently, in my constituency, starting in Crossmaglen, we had the Slieve Gullion spin-off cycle, which made a tremendous contribution locally to highlighting mental health issues and suicide and urging people experiencing mental health difficulties to talk about them.

Mr McCarthy urged that the Mental Capacity Bill be expedited and resourced to the greatest extent possible. The Minister referred to it also and urged Members to bring the Bill forward and make it the best it can be. George Robinson emphasised the need for prevention and, where there is mental ill health, the need for early intervention. That was reflected by other Members. Jo-Anne Dobson and Rosie McCorley mentioned the importance of retaining the Lifeline service intact. We in the SDLP support them in that regard. The Minister responded to that and outlined his plans. Many Members referred to the world-leading mental health trauma service. The Minister responded to that: he said that he would take a collaborative approach based on those who suffer because of the Troubles, including individual victims. He also said that there would be emphasis on governance and accountability and that the approach would be cross-sectoral in nature. Daithí McKay mentioned the high rates of suicide. He referred to the LGBT community and the trauma that members of that community suffer through bullying, self-harm and suicide. He referred to today's debate on equal marriage. The vote on that —

Photo of Dominic Bradley Dominic Bradley Social Democratic and Labour Party

— is a positive outcome, even though there was a petition of concern. It will give the LGBT community an uplift.

Thank you, Mr Deputy Speaker, for allowing me to contribute. I support the motion and the amendment.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to. Resolved:

That this Assembly recognises that mental ill health affects one in four people every year; further recognises the importance of having quality services that are fairly resourced, trained staff to afford early access and support, and a focus on prevention, resilience and mental well-being; recognises the importance of rehabilitation, with clear objectives established for accessing mental health professionals, within 28 days and close to home; further recognises the importance of raising awareness, reducing stigma and discrimination in relation to mental ill health; urges broad support for the urgent implementation of the world-class mental trauma service announced by the Minister of Health, Social Services and Public Safety in September; and calls for the Executive to work in collaboration to make dealing with mental ill health a top Programme for Government priority.

Adjourned at 4.50 pm.