The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes.
I beg to move
That this Assembly believes that mental health should be taken as seriously as physical health; urges the Executive to take action to end stigma against mental health; further believes that psychological therapies should be at the heart of the mental health services agenda; and calls for the current underfunding of child and adolescent mental health services to be addressed.
I regard this as a very important motion, which not only touches on a very important aspect of our health service but has wider implications for our economy and society. I am grateful for the Minister's presence in the Chamber this afternoon.
Mental health conditions affect a considerable number of people, with around one in four people facing such issues at some stage of their life and around one in five people being affected at any one time. Not least given the legacy of the Troubles, mental health conditions are more prevalent in Northern Ireland than in any of our neighbouring jurisdictions. Despite this, mental health remains the poor relation in the health system and is sometimes referred to as the Cinderella service. We must do everything in our power to change that. However, it is important to recognise that there has been some rebalancing of mental health expenditure from acute inpatient services towards the delivery of services in the community, including some, but not yet enough, additional funding for key areas such as child and adolescent mental health services (CAMHS) and psychological therapies. That said, funding challenges do not lie only in the rebalancing of a fixed budget. We need to show how the overall funding package can grow. In that regard, although we acknowledge and welcome some recent improvements to mental health service funding, quality and access, mental health services are still underfunded in comparison with services for physical illness and in comparison with the rest of the UK regions. We are still investing a lower share of health spending on mental health in general, compared with other regions. In particular, pressures remain in some areas such as psychological therapies and child and adolescent services.
The Alliance Party recognises the move to community-based mental health services away from the historical inpatient model and we support its implementation, provided that there is consultation with families and carers, which is vital and paramount. Nothing should be forced on people against their will. There must also be a focus on ensuring recovery for those experiencing mental health conditions. However, it is vital that resources are successfully transferred across to the community setting to support the development of the full range of community services. Sufficient access to home treatment teams across the lifespan is required, including for children and adolescents. In addition, rehabilitation services are urgently needed for people recovering from severe mental health problems. It is vital that such services are carefully and transparently planned.
The views of users and carers must be included in the development and planning of all mental health services, including rehabilitation services. There should be seamless access to community mental health services across the statutory, voluntary and community settings with appropriate signposting for individuals, their carers and their professionals. In addition, an appropriate and sufficient level of provision of inpatient acute mental health beds must be retained. It should be remembered that people who live in rural areas and who suffer with mental health difficulties require equity of access to the full range of community mental health services.
Although funding is important, this debate is not simply a narrow one about the level of resources. We must recognise the benefits to better physical health, individual self-esteem, the economy, our communities and society as a whole that come from positive mental health. Through placing a greater priority on assisting those who have mental health conditions or are at risk of deteriorating mental health, we can derive many other benefits. The risk of physical illness is increased with incidence of mental illness and vice versa. An emphasis on mental health as being central to the public health programme will facilitate people to adopt healthy lifestyles and, indeed, reduce health risk behaviours. This shift will allow prevention of physical illness and will promote mental health and well-being across the lifespan.
Helping people to stay in work or to access and sustain employment will improve their mental health and helps our economy. I very much welcome the fact that the Minister for Employment and Learning is devising a disability employment strategy and that he and the Minister of Enterprise, Trade and Investment are devising a strategy on economic inactivity for the Executive. Social deprivation and economic inequalities are known determinants for mental and physical illness; these health inequalities impact on mental health, causing transgenerational mental health and physical illness, which creates a vicious cycle leading to further inequality.
Investments that can be made in social housing, education — including, in particular, early years interventions — and promoting social inclusion more generally are all crucial. A central theme has to be combating the stigma that many people with mental health conditions perceive and, indeed, experience. Having a mental health condition should be regarded as and taken as seriously as having a physical condition, but unfortunately that is not the reality for too many people. Stigma and associated discrimination must and should be tackled throughout our society so that it no longer remains a major barrier to equality nor impacts on the ability to seek help early and the possibility of recovering and well-being. We must be clear in our message that people can continue to lead meaningful lives despite mental health conditions.
The Bamford report on mental health and learning disability provides the overarching framework for addressing mental health issues in our society, though we should note that it is now almost a decade old and, indeed, much work remains to be done. I welcome the Executive-wide Bamford action plan 2012-15 and support its full implementation. That rightly indicates that a number of Departments have critical roles to play in achieving positive mental health outcomes. Every Department should place mental health and well-being and the elimination of stigma and discrimination at the core of policy development. It is also important to acknowledge the crucial role that is played by a number of organisations in the community and voluntary sectors in the provision of advocacy and advice and the delivery of services in a range of different contexts.
Mental health issues can cover a wide range of conditions and require a range of different interventions. Psychological therapies are indeed central to improving the mental health and well-being of all people in Northern Ireland across their lifespan. We support the psychological therapy strategy and call for the appropriate funding stream for the full range of psychological therapies, including psychodynamic psychotherapy. There is also a need for greater awareness of mental health issues, including liaison and follow-up for patients who arrive for treatment in A&E facilities. Self-harm and suicide, including the high rates of suicide in young men, must be tackled through addressing issues such as socio-economic inequalities, the legacy of deprivation from the Troubles and the effects of the recession, and by providing early interventions for families in disadvantaged communities. The Protect Life strategy is therefore a key mental health intervention.
We also support the forthcoming introduction of the Mental Capacity Bill. Rather than two separate Bills dealing with mental capacity and mental health, there are considerable advantages in having a single integrated piece of legislation, and we look forward to its early completion. One major advantage is the elimination of stigma for those with impaired capacity associated with mental health problems. We in Northern Ireland have the opportunity to become a world leader in that respect.
There are also different types of challenges in providing appropriate mental health interventions for different groups of people, such as children and adolescents, older people and those with learning disabilities. Child and adolescent mental health services have historically been underfunded. Young people amount to almost one quarter of our population but have not benefited from an equivalent share of funding. As the number of older people in Northern Ireland continues to grow, there will be an increasing need for appropriate mental health services, including equity of access to high-quality primary care and community-based services. Sufficient services will be required for older people with a range of mental health issues and for people specifically suffering with dementia.
As a member of the Health Committee, I am very happy to speak on this issue today. There is no doubt that mental health and well-being is only now beginning to receive the kind of attention that has been badly needed for many years. I welcome the development of that now. I believe that much of that is down to the number of voluntary and community sector organisations that have been involved in campaigning, coupled with the highly effective use of social media to promote mental health well-being.
Over the past few years, I have seen for myself how the trauma of a mental health condition can go undiagnosed for decades and how it can dominate and dictate how an individual can struggle to live their life trying to manage the condition without support of any kind. There are, of course, infinite reasons why an individual can suffer from mental health problems but, for me, the important thing is how to get that condition diagnosed in the first instance and then ensure that sufficient support is in place to help those who are diagnosed to cope with that condition.
I am of the firm view that we must do more to recognise, diagnose and support people who suffer from mental health issues and learn how to effectively promote mental well-being among our children and young people to ensure that they get the best possible start in life. Of course, we also need to tackle the associated stigma that is attached to mental health issues. There are huge benefits to be gained, not just for the individual who is treated, but for society, particularly in places like Northern Ireland where history has delivered to us all a set of circumstances which have led to huge mental health suffering over decades.
I have seen how someone who has been dealing with a depressive illness for decades is only now getting the right diagnosis and treatment, and it has to be said that getting that diagnosis and treatment was not an easy journey. In fact, it took almost a year for the person to get an appointment with a counsellor, such was the demand on local services. Yet, in only a relatively short period, that person is learning new practices that are making a real difference to how they manage their depression. That is why I want to see a much greater emphasis being put on mental health issues; I can see for myself what a difference the right treatment can make to an individual's life. Years of medication is not the answer for many people, as it merely manages the condition without doing anything to resolve the issues or rescue the sufferer. The truth is that, through proper counselling and the use of such techniques as mindfulness, there is a real possibility and evidence that lives can be changed. I am convinced that this is something that we must resource and promote now, because it works. I will of course urge the Minister and the Department to make this an urgent priority.
Go raibh maith agat. I welcome the opportunity to speak on this important debate. Mental health and increasing levels of mental health problems in our communities must be a concern to us all. We must move away from the notion that mental health resourcing and funding is the poor relation in the health service. With that in mind — and there have already been a number of comments on the general issues around mental health — I would like to concentrate my comments on two aspects of mental health: the need for a rehabilitation strategy and the pending Mental Capacity Bill.
The Bamford action plan stated that there were 150 long-stay patients in psychiatric wards who could be resettled. A total budget of £2·8 million had been allocated towards that, but it was viewed that the total cost of resettlement is, and will be, significantly higher. The report also, importantly, identified about 100 people in mental health facilities, with quite challenging behaviour, who would require long-term rehabilitation before they could be considered for community placement. Indeed, the Royal College of Psychiatrists suggests that that group requires a specialist service for rehabilitation. Rehabilitation exists in some form in all trusts, but it has not been included in any current strategy. That must change, and a recovery-based approach will be, and is, required.
It has been suggested that people in receipt of good rehabilitation services are eight times more likely to achieve and sustain successful community living. In the North of Ireland, over 20% of children under 18 years of age suffer significant mental health problems. There has been, and is, a failure to adequately resource appropriate mental health services. In 2012-13, only £19 million was allocated to child and adolescent mental health services. That equated to simply 7·9% of the total planned mental health expenditure for that period.
In 2008, the Committee on the Rights of the Child expressed its concern about the continued treatment of children in adult psychiatric wards. It is well recognised that factors associated with the conflict, and with society emerging from conflict, have impacted severely on child and adolescent mental health. The incidence of mental health problems among vulnerable groups of children and young people is disproportionately high. Currently, there is no forensic inpatient children's psychiatric provision in the North and only limited inpatient adolescent facilities. Almost 200 children in the North were detained in adult psychiatric wards between 2007 and 2009, and, from January 2012 until December 2012, there were 91 admissions of children to adult psychiatric wards in the North. That is despite a commitment that the Department of Health made in 2009 that it would make age-appropriate mental health detention of children a priority.
It is estimated that there will be a shortfall of £800 million in the health budget in the North of Ireland in 2014-15. We are extremely concerned that the provision of services to children and adolescents will deteriorate further rather than being urgently addressed and that children and young people will continue to suffer.
There is also a recognition that the current mental health legislation is not fit for purpose and that it is not compliant with the European Convention on Human Rights in places. Following Bamford, the new combined mental health and mental capacity legislation, which will extend to include the criminal justice system, is being brought forward and is expected to become law in 2017. However, there is a view that it falls far short of what Bamford recommended. The new Mental Capacity Bill will provide a number of important safeguards and protections for people who lack decision-making capacity. However, and this point is critical, all children under 16 years will be excluded from the scope of the new legislation and the non-ECHR-compliant Mental Health Order, which will remain in place for children and young people under 16 who have mental health problems.
I welcome the opportunity to speak in the debate, and I support the motion. The prevalence of mental health problems continues to be an issue here. Indeed, the work of the Northern Ireland Bamford Centre for Mental Health and Wellbeing in the University of Ulster has shown that conflict-related incidents have had a direct correlation with high levels of mental illness. It is for that reason that we should place great and greater emphasis on the need for mental health treatment. So, the SDLP agrees with the motion in that regard.
Much good work has been done, and an example of that is the efforts of organisations such as MindWise, which has recently launched its "You can take control" campaign to aid recovery after mental illness. However, there are also major issues of concern, particularly with children's mental health services.
The key challenges that this Government have faced in the delivery of mental health care have been the role of Transforming Your Care, budgetary cuts and the subsequent cumulative effect that they have had on the Bamford action plan.
Late last year, the SDLP noted its concern about the Department's ability, due to financial cuts, to carry out each of the initiatives in the 2012-15 Bamford action plan. Ms McLaughlin referred to some figures, but let us look at some more. In 2009, when the first action plan was embarked upon, the total amount of additional funding that the Department anticipated over three years, including for mental health, was £44 million. However, due to the comprehensive spending review, the actual amount of additional funding that was allocated was £29·5 million. It is the admission of the Bamford action plan itself that the £14·5 million reductions in additional funding had:
"some effect on the Health and Social Care sector’s ability to deliver on actions".
The only additional funding that has been earmarked for mental health and learning disability over the budget period referred to is £9·2 million, with £2·8 million for mental health. That reduction, in line with the change agenda of Transforming Your Care, has affected the number of services that can be delivered. It is a reasonable contention that it will affect the Bamford action plan's ability to improve mental health services here.
In the Transforming Your Care 'Vision to Action' consultation document, the following was proposed: we should be more joined-up in how we provide mental health services; put in place intensive home and community support; remove beds from hospital settings; and develop six inpatient acute mental health units. However, we do not have concrete evidence of the extent to which that has been done to an appropriate degree, as none of it has been properly measured. As pointed out, it has already been hampered by budgetary reductions. What we have seen is a Health and Social Care Board proposal to relocate services for addiction and subsequent rehabilitation away from the west of the region and into Antrim and Downpatrick. There has been no confirmation of how that may affect the proposed specialist phase 2 mental health facility in Omagh, which is a flagship project for mental health treatment in the North. That is particularly worrying given the high levels of mental health problems in the Western Trust.
Rural mental health continues to be a problem, and rehabilitation has proven that to be the case. Asking people to travel long distances to receive treatment is not acceptable, and it may even exacerbate the problem. The mental health group Suicide Talking, Educating, Preventing, Support (STEPS) has investigated the amount of attention given to mental health across the region. It found that not enough focus was placed on rural areas.
I recognise the Choose Well campaign that is trying to communicate information to the public about where to go when you feel unwell. However, in a survey carried out by the Time to Listen; Time to Act mental health campaign published last month, only 9% of patients and carers surveyed believed that there was adequate provision of information about mental distress. The point needs to be addressed if we are to break the current stigma around mental health issues, as the motion suggests. The Health Department published its service model for the delivery of children and adolescent mental healthcare in 2012. That was in response to an RQIA review that found that no strategy was in place. The SDLP agrees with much of what is planned in the 2012 service model. However, the problems with mental health provision for young people here can be seen quite clearly in the commissioning and resources section of that service model. Transforming Your Care is clearly referenced. That model of care for children and adolescent mental health depends on the deliverance of Transforming Your Care-based funding and the strengthening of the community care initiative.
The motion asks us to support mental health as much as physical health. In funding, infrastructure, commissioning and delivery, it is fair to say that there is an enormous distance to travel.
I also support the motion. I declare an interest: I am involved in the Carrickfergus Community Drug and Alcohol Advisory Group, which provides counselling for those who need support. Psychiatric therapy has proven to be very effective, as has been recognised by NICE and others. To that extent, it is important that it is highlighted in the motion, and I thank Mr McCarthy for doing so.
One in four people will suffer from a mental health condition at some point in his or her life. The issue is much wider than any of us might at first think. Each of us is likely to know a family member or a close friend who will have suffered not so long ago. It is something that is very real to everyone in the community. We must appreciate and support the issue to ensure that there are adequate funds to address the need. It affects old and young, irrespective of gender or economic background. However, as was said, socio-economic background can increase the likelihood of mental ill health.
Northern Ireland has about a 25% higher incidence of mental ill health than in England and Scotland. About half of all women and a quarter of men can expect to suffer from depression at some point in their lives. A quarter of people over the age of 65 show symptoms of depression. Some 35% of all GP consultations are thought to have some form of mental issue at their root. It greatly affects our community. We must ensure that sufficient resources are in place to address the matter and to try to take proactive action to lessen the likelihood in the future.
Some 61% of people in Northern Ireland are thought to have experienced a traumatic event in their lives. The Troubles are thought to have increased the number of people with such experiences and may have contributed to the higher level of mental ill health in Northern Ireland. Indeed, many perpetrators may suffer as a result of the horrific actions in which they took part many years ago. It is important that we try to address that very apparent need in our community.
Yet Northern Ireland has lower proportional spend than other parts of the United Kingdom. It is vital that we improve our health and well-being. The Appleby report found that Northern Ireland's spending need was some 44% higher per capita than England's, yet its spending was actually between 10% and 30% lower. As others said, there has been some improvement, but there needs to be considerable additional investment in this area.
Psychological therapy has been proven to be effective. It is recognised by the National Institute for Health and Care Excellence that, when appropriate, psychological therapy is very cost-effective. It is important that there be good access to the service as regards both timeliness and from a geographical point of view. Providing support in this area brings a cost to the health service. However, there is also a huge economic loss and cost of lost productivity and the effect that it has on individual lives.
The motion calls for increased funding for child and adolescent mental health services, and I support that. It has been recognised that there has generally been a lack of investment in children's and young people's services in Northern compared to elsewhere. Yet, it is widely recognised that early investment is very effective and provides better value for money. If you address issues early, you get better outcomes, and issues are not allowed to develop to the same extent.
Mental health appointments have a higher proportion of "did not attends". If you have a physical difficulty, how will you get to a service that is perhaps 30 or 40 miles away and requires you to make several public transport connections? It is important that there be better access and better local services, whether through the new health and care centres or through other partnerships and outreach, so that it is much more localised and so that those who need it can get support. It is also important that we look at health and well-being in our schools and communities —
I, too, welcome the opportunity to speak in this debate. Mental health is an ever-increasing issue. Unfortunately, one in four people will experience some kind of mental health problem; practically every family in Northern Ireland will be affected by mental health issues during their lives; and women are more likely to have been treated for a mental health problem than men. The fact that the World Health Organization predicts that, by 2020, depression will be the second leading cause of disability in the world shows the seriousness of the problem and the extent of mental health issues.
Rising self-harm and suicide statistics are also very worrying, to say the least. Sadly, suicide seems to be becoming an ever more common problem across our constituencies. I am sure that all Members will know someone close to them who, tragically, has taken their own life. The startling fact that 10% of children have a mental health problem, and that depression affects one in five older people, highlights that mental health knows no boundaries of age, race, class, wealth or gender.
It is vital that services be put in place to provide care and support to patients, carers and families affected by mental illness, that services be readily available for patients and carers and that they be consistent across all trust areas. The Minister, Edwin Poots, has taken an active interest in developing mental health services across Northern Ireland. I know that he will continue to pursue what is best for the people whom we represent. At the recent launch of the Mindwise charity's You Can Take Control campaign, the Minister rightly pointed out that:
"The majority of people can and do recover from periods of mental illness and many others learn to live with their symptoms and lead full lives. Fundamental to recovery is social integration, education, training and employment."
The key message that we need to get across is that mental ill health can be overcome and defeated.
The Bamford review sets out its theme of improving community-based services for mental health patients. It sets out a clear vision for a shift towards community-based treatment. With this vision, it is essential that the right networks exist to support patients, with carers and families at the core. Its main themes are health promotion; promoting independence; supporting carers and family; and the modernisation and improvement of services. However, as with any issue, funding is, unfortunately, limited, and challenges remain to improve the efficiency and effectiveness of our mental health services.
I welcome the ongoing progress in the South Eastern Trust area. Recently, the trust prepared a business case for the rationalisation of acute mental health inpatient services, and it concluded that the preferred option is that a single mental health inpatient unit be located on the old Tor Bank site adjacent to the Ulster Hospital at Dundonald. It also concluded that a low-security rehabilitation centre should be located at the Downe Hospital. This programme of works will enable the trust to achieve its vision for the rationalisation of inpatient mental health services and to deliver an equitable and sustainable care model for our population.
I also commend the sterling work of many charities such as CAUSE, Action Mental Health, Awareness Defeat Depression, MindWise and Praxis Care, all of which play a vital role in providing support for people affected by mental health issues. One in five adults in Northern Ireland will show signs of a possible mental health problem. This shows the wide-reaching nature of the problem and highlights the fact that it is vital that we all continue to play our part in helping to tackle it. I support the motion.
Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I also support the motion. It is so important that mental health is taken and treated as seriously as physical conditions, as the statistics bear out. Mental health is the single biggest cause of disability in the Western World. Around 450 million people worldwide have a mental health problem, and up to 20% of children and adolescents worldwide experience a disabling mental health problem. Depression is the most common such problem.
Mental health problems adversely impact on many aspects of life, such as work and personal relationships. People suffering mental ill health face considerable stigma and discrimination and, because of this, often delay seeking help. As someone who worked in the voluntary sector for many years, advising people on benefits and representing them at tribunals, I know that the stigma attached to mental health, particularly in rural areas, is so obvious and really needs to be dealt with and overcome. People are often stigmatised, not only by their neighbours and communities but sometimes, unfortunately, by members of their family. It is an area that needs to be taken into the open and addressed very seriously.
Here in the North, we have a higher level of mental health need than other parts, particularly England and Scotland. A health and social well-being survey showed that 24% of women and 17% of men here have a mental health problem, and factors contributing to these rates include persistent levels of deprivation in some communities and the legacy of the conflict. A recent study of the families of the victims of Bloody Sunday, for instance, found persistent effects of these traumatic events on the individuals concerned, with evidence of psychological distress still being found more than 30 years after the event.
The incidence of suicide here has been a particular concern in recent years. The suicide rate increased by 64% between 1999 and 2008, mostly as a result of the rise in suicide among young men. In 2008, 77% of all suicides were males, and 72% were in the 15-to-34 age bracket.
Since I have been a Member of the Assembly, I have heard so much about Bamford that I almost feel that I know the author of the report personally, but it has to be said that little has been done. The Bamford action plan talks about promoting positive health, well-being and early intervention; supporting people to lead independent lives; supporting carers and families; providing better services to meet individual needs and developing structures in a legislative framework. Those are all themes that need to be addressed and recognised, and, as Gordon Dunne mentioned, there are many very good voluntary organisations such as MindWise and CAUSE, which do tremendous work. They seem to be taking Bamford seriously, maybe more seriously than some of the statutory agencies.
I am grateful to the Member for giving way. He referred to the Bamford report. I recall clearly the day that Bamford was launched in the Stormont Hotel by the late Paul Goggins, who was Health Minister. The question at that time was about how much Bamford would cost, and the response was £600,000, but there was not one penny in the budget to implement that, so that is probably why we are finding such a struggle even at this moment.
I thank the Member for his intervention. The Member has been here longer than I have, so he probably has a better memory of that day.
As others stated, as many as one in four people will suffer from a mental health condition at some point. It can also affect particular groups. As was stated, women are more likely to experience anxiety disorders and depression, whereas men are more likely to experience drug and alcohol addictions, personality disorders and suicide. The direct and indirect costs associated with mental illness are immense. Estimates suggest that the cost in the North is around £2·8 billion. Despite that, funding for mental health services and promotion is disproportionately low, so raising awareness of mental health is crucial.
Encouraging positive mental health can take a general population approach or be targeted at risk groups. Individuals can also adopt a range of coping strategies. Positive mental health strategies and policies should involve the cooperation of a wide range of stakeholders. Developing community mental health services and good access to primary care support are also important.
Cognitive behavioural therapy is recognised as one of the most successful ways to deal with depression. In my constituency, for instance, it is not easily or readily accessible. That needs to be addressed because it is recognised as a way of people getting help for their condition.
I have to comment, in a debate like this, on those carers who look after people with mental health problems 24 hours a day, seven days a week. I recently attended a meeting in my constituency that was facilitated by CAUSE. It is heartbreaking to listen to stories of young couples, one or other of them having mental health problems, who have young children and are trying to cope on a daily basis. Financially, they get very little help. They get carer's allowance. It is so important that the work that they do and the money they save the health service is recognised. It also has to be recognised that they need support as much as anybody.
I support the motion and ask the Minister to look favourably and sensibly at the motion.
I, too, welcome the opportunity to speak in favour of the motion. I congratulate Mr McCarthy on bringing it forward. I know that it is an issue that is very close to Mr McCarthy's heart, and I pay tribute to him for seeking to bring some good on the back of a personal tragedy.
Many in the Assembly will know that my upbringing was in a church manse. Growing up, whenever the phone rang in our house, it was seldom a social call. It was not unusual to pick up the phone and for the voice on the other end to be in deep distress, whether it was a mother or father, a son or daughter, or a husband or wife, giving us the news that their relative had been taken into hospital or, perhaps worse still, had left this scene of time.
There was no difference in the distress of those relatives' voices as to whether their relative had taken a heart attack, had a stroke, been diagnosed with cancer or had been taken with a mental illness, whether depression, schizophrenia or some other of the well-known forms of mental illness. Therefore, the sentiment behind the motion is the right one in that it is wrong to differentiate between these illnesses, because the effect that they have on loved ones who have to deal with the illness and the effect it has on their relative or loved one is, in many ways, the same. Therefore, I think that the sentiment behind the motion is correct.
I welcome the work that has been done by many Departments on this issue. Indeed, I was heartened to hear Mr McCarthy refer to the work that the Employment and Learning Minister is doing, because I believe that providing work and opportunities for people with mental illnesses so that they can get into some sort of mainstream employment to perhaps help them focus their minds on being productive in the workplace and so on is an excellent way of dealing with these issues. I welcome that news because, unfortunately, a number of schemes that provided the flexibility that patients with mental illnesses need within the workplace have ceased or been done away with. I welcome the news that new schemes are perhaps going to be put in place.
Another issue that has not been touched on yet is the challenges of mental illness in rural communities. A lot of services are quite urban-centric, and I know that there are good reasons for that — of course you have to follow the population base. However, there are issues, particularly within our farming community, where, over the past number of years, there has been an alarming rise in the rate of depression. Unfortunately, that has manifested itself in a number of farmers taking their own lives. Therefore, we have to ensure that that issue is dealt with.
At the start, I mentioned relatives and loved ones, which moves us to the issue of respite. That issue is brought to me quite regularly. Of course, when it comes to respite, we are dealing with people with very severe mental illnesses — those who are almost completely incapacitated by their illness. Respite services are important and, indeed, I have corresponded with the Minister, who has given me a number of assurances about good work in my constituency that is going to continue.
Whilst I pay tribute to Mr McCarthy and believe that, in proposing the motion, he was very sincere, one or two of the other contributions — one in particular — have risked veering into the realm of, I suppose, playing politics with this issue. I think that we have to be very cautious of that when it comes to an issue as sensitive as this. The Minister has been very supportive of schemes such as Grangewood in Londonderry, a new facility that was opened at the tail end of last year. That constituency and area should perhaps reflect on that. They have been very well facilitated in that regard.
When it comes to Bamford, we have to accept the fact that 83% of the proposals and the progress have been implemented. None of that progress is not going to happen. One or two elements have been slightly delayed. I will end my comments there; I know my time has run out.
Go raibh míle maith agat a Phríomh-LeasCheann Comhairle as an deis cainte a thabhairt dom ar an cheist ríthábhachtach seo faoi shláinte intinne. Éirím ar an ócáid seo le tacaíocht láidir a thabhairt don rún. Thanks very much, Mr Principal Deputy Speaker, for the opportunity to speak on this very important issue. Of course I support the motion, and I pay tribute to Mr McCarthy for bringing it to the House.
It is often said that mental health is one of the Cinderellas of illness. It still suffers the sort of stigma that was associated with cancer until recent times. I believe that, as the motion states, we should do all in our power to reduce and remove that stigma.
I was in the company of Mickey Brady and Willie Irwin when we met CAUSE in Newry. Indeed, that group highlighted to us the issues that carers have, especially in dealing with people who have serious mental illnesses.
We gave the group an undertaking that we would highlight the issues they brought to us, and we asked the Southern Health and Social Care Trust for a meeting with carers to give them the opportunity to highlight their issues.
CAUSE shares a lot of issues with other mental health charities and advocates. It launched its manifesto 'Transforming our care' earlier in the year. That manifesto outlines carers' needs, the need for services to work with carers and to see them as an asset in supporting the recovery of their loved ones from mental illness rather than feeling excluded and sometimes left to cope alone without the actual help they need.
The manifesto was drafted through a number of meetings with carers across Northern Ireland and outlines three mains areas for consideration: greater assistance and support for carers, first, as equal partners in care, secondly, as supporters in recovery and, thirdly, as advocates for change.
During the meeting, we talked about serious issues around, for example, carers assessments, the absence of respite for carers and, as they describe it, a complete lack of funding for mental health services. They relayed very clearly to us the issues caused by confidentiality and the sense that carers are not valued and are not listened to. They asked us to ensure that Transforming Your Care took cognisance of their issues.
We know that health and social care services are changing radically. There is increased emphasis on the home being the hub for treatment under Transforming Your Care. CAUSE expressed to us the growing concern that, under Transforming Your Care, pressures on carers will increase and not decrease. Serious mental illness can result in significant life changes for everyone close to it; obviously, the patient and family members.
The manifesto highlights the strong assertion that carers need to be more involved in care planning as they provide a valuable perspective that can really help to support recovery when working with professionals and with their loved ones.
Mr Principal Deputy Speaker, I thank you for the opportunity to contribute to the debate. I am sure that the Minister will listen carefully to all then points raised here today, and there has been a wide range of them. I do not think that anyone is using this issue as a political football. All Members who spoke have a genuine interest in improving services.
The Assembly has debated mental health before. Last November, the leader of my party proposed a world class mental health facility in Ormiston House. It was a good idea then and, six months later, it remains a good idea. My party leader was right to link mental illness with the after-effects of the Troubles and how we deal with the past. Another colleague, Mr Copeland, drew our attention to the fact that welfare reform was also leading to a lot of mental health problems in deprived households.
We have a great deal of hidden prejudices to overcome in dealing with mental health problems. When this subject was debated in the Welsh Assembly, we received the recent research carried out by Time to Change Wales which showed: first, that one in four people believe that those with mental health problems should not be allowed to hold public office and, secondly, that one in 10 people believe that those with mental health problems should not be allowed to have children.
Those attitudes are very badly informed. In the context of mental health, I often think about our greatest Prime Minister, Sir Winston Churchill, who suffered throughout his life from serious bouts of depression — the "black dog", as he called it. However, where would we be without Winston Churchill? His contribution to our survival as a country was enormous, yet he had mental health problems.
He was not the first Prime Minister to suffer from such illnesses. Over 260 years ago, William Pitt the Elder, another of our greatest Prime Ministers, also suffered from mental illness. He had a complete nervous breakdown and for two years sat in his chair simply staring at the window. The fact that that happened a long time ago makes no difference. His suffering was just as real as people's suffering today. His great contribution to the United Kingdom remains the same. Both those men were great servants of our country, despite having mental health problems. We would do well to remember that when we debate mental health.
I think that we need to seek a broad political consensus on dealing effectively and compassionately with mental health problems. I support the motion and hope that our Minister takes swift action to facilitate the people here in Northern Ireland especially.
First of all, I apologise to the proposer of the motion, Mr McCarthy, for not being here for all his contribution. He has always been a great stalwart and supporter of mental health initiatives on the Health Committee. You can guarantee that if he spots an opportunity to raise that important issue he will always take it. However, I wish to correct him on one figure that he quoted. He suggested that the implementation of Bamford could be done for £600,000. I understand that the Minister is a bit of a wizard with the economics of health and has been able to strip out £500 million worth of savings, but not even Mr Poots on his best day could implement Bamford for £600,000. I suspect that the figure was £600 million. I just want to correct that, because I do not want people to believe that it is just as simple as that.
We should look not only at solving the problems that are raised by the increasing mental health issues in Northern Ireland but at the causes. If we as a society are determined to undermine every bedrock and building block of our society, is it any wonder that mental health problems are increasing? We make alcohol available to our young people at ridiculously low prices. There is a very clear link, unfortunately, between alcohol dependency and mental health issues. We make it cheaper than water. We sell it at 35p a tin, and we allow young people to develop that addiction. We allow them ready access, unfortunately, to soft drugs and then on to harder drugs. We undermine the principles of marriage. We do nothing whatsoever to bolster and support marriage and to nurture children within loving, faithful, married relationships. Then we wonder why so many of our young people are either feral or are completely disorientated about where they are coming from and where they are going to. We put the most enormous pressures on people in their workplace, and then we wonder why there are so many difficulties with mental health issues. We need to address those causes, as well as to address the outcomes of those causes.
I accept, as everyone said, that mental health spending in Northern Ireland has been the Cinderella, as quoted by Mr Bradley. It has not been Cinderella; it has been Cinderella's mouse. There has been even less spending than in other jurisdictions where it is also the Cinderella of health service spending. The reality is that, for every Minister, both direct rule and, more recently, devolved, faced with a clamour from the Nolans of this world demanding more expenditure on the big-ticket items in health and social services, which, of course, are A&E and acute care, there is always a temptation to pump money into those big, high-profile aspects of the Department to the detriment of mental health provision.
Unfortunately, although this should not be the case, the Minister will never be hauled across the coals for reducing mental health provision and spending, but he will always be criticised when it comes to our A&E hospitals. That is the difficulty that we face in Northern Ireland. As a result of decades of direct rule, we are in a position where everyone agrees that expenditure on mental health is grossly underfunded in Northern Ireland.
An opportunity to address those fundamental issues is now coming before us: it is, of course, legislation. It is no exaggeration to say that the Mental Capacity Bill will be the biggest single piece of legislation faced by the Assembly and will require the most enormous efforts by those on the Health Committee and the Justice Committee, and by me, who is on both. Once introduced, the Bill will dominate the work of those two Committees. It would be very helpful if the Minister, in his response, could give us a cast-iron guarantee that the legislation will be introduced in time and processed before the next Assembly election. I have been given, at the last count, seven different dates for its introduction, long before the present Minister came to power. We really need certainty on the issue. It is absolutely essential that the Bill is brought through and expedited. Unfortunately, I was in the Chamber in 1983 when the previous Bill went through. Little did I think then that — what, 29 years later? — I would be back, sitting through the second Bill. I can assure you that I have no intention whatsoever of being around in 25 years' time for the third Bill.
Thank you very much for the extra minute, Mr McCarthy. You are absolutely right to correct that.
To all those who have been very quick to ask the Minister to spend more money on mental health, which is the right thing to do, I say this: the Minister will find it very difficult to deliver the budget within the present constraints, but, if we go down the route that we may do on welfare reform and start to strip out large amounts of money to fund someone's fad or support the barriers that have been put up to welfare reform, the money simply will not be there — full stop — to implement any form of healthcare never mind welfare reform. Before you call for extra money for various services in health, remember that you cannot do that and then demand that we block welfare reform changes, which none of us wants, but, unfortunately, we have to do. Just remember that.
Finally, the Minister should be very careful about the small number of people — about 100 — who are still left in institutions such as Muckamore. The resettlement of those individuals —
I am grateful to the honourable Members for raising such important issues and welcome the contributions made.
It is widely recognised that Northern Ireland has higher levels of mental ill health than any other region in the United Kingdom. It is estimated that one in four adults in Northern Ireland will suffer from a mental health problem at some stage in their life. Many in the Chamber today will have a friend, family member or colleague who has experienced a mental illness. Mental ill health does not discriminate. It affects people from all walks of life. Despite recent advances in the treatment of mental illness and the better outcomes that people with a mental illness can now experience, stigma is still attached to mental illness and prevents many from coming forward to seek help. The majority of people who experience mental illness consistently identify stigma as one of the main obstacles to seeking help and making a recovery. Hopefully, many of you have seen the Public Health Agency's mental health campaign featuring a boxer, which urges people to "talk about it". The campaign has been very well received, and it encourages people to talk about their feelings, seek help and promote recovery.
The motion is timely, as the Cycle Against Suicide initiative commences today in Dublin. The cycle will go around the Republic of Ireland and Northern Ireland raising awareness of suicide prevention, decreasing stigma and promoting help-seeking. The cycle will spread the message that it is OK not to feel OK. Next week, it will bring that message to Northern Ireland.
My Department will continue to work closely with the Public Health Agency to tackle stigma and to encourage people with a mental illness to talk about how they feel and seek help. We in government will continue to tackle stigma by ensuring that policies and services enable people with a mental illness to live full and purposeful lives in their communities. We will also support our local mental health charities that work tirelessly to educate the public about mental health issues. My Department provides almost £700,000 to those organisations.
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 the outcomes that are achievable for those people today. The Bamford vision is that people with a mental illness should be treated in the community close to their friends and family unless there is a clinical reason for not doing so. Inpatient care should be provided only for acute cases or where someone needs to be detained for their own safety and well-being. In line with the Bamford recommendations, the focus in the last number of years for mental health service development has been on early intervention, home treatment services and the development of psychological therapy services. Since Bamford reported in 2008, an additional £40 million has been invested recurrently in mental health services, bringing current expenditure to £240 million a year.
At the time of the Bamford review, we were spending 60% of the mental health budget on hospital services and 40% on community services. The balance of that expenditure has shifted, and currently we spend 44% of the mental health budget on hospital and 56% on community services, with the aim that a shift to 60% spend on community services will be achieved by March 2015. Significant reform and modernisation of mental health services has taken place, but much more needs to be done. Transforming Your Care endorses the Bamford approach to service development and will take this agenda forward into the future.
The HSCB, PHA and trusts are rolling out the Implementing Recovery through Organisational Change (ImROC) programme. ImROC is all about embedding recovery-focused practice throughout all mental health services in line with the Bamford vision. The concept of recovery is also central to the mental health service framework, published by the Department in 2011 and endorsed by Transforming Your Care. Recovery-focused practice will allow individuals to take control and to build socially inclusive, connected lives that are satisfying, fulfilling and enjoyable, even if they continue to experience symptoms related to mental ill health. The challenge for professionals and service providers is how we can better support the people whom we serve in their recovery journey.
One of the key developments in mental health services in recent years has been in the provision of psychological therapies, or talking therapies as they are commonly called. In 2010, my Department published a strategy for the development of psychological therapy services. The HSCB and PHA have led on the implementation of that strategy and the key actions flowing from the strategy have largely been implemented. The strategy was underpinned with recurrent funding of £4·4 million. Today, some £6·5 million is spent on those services. That funding provides a range of services, including psychology, psychotherapy, cognitive behavioral therapy (CBT) and trauma therapy. The HSCB estimates that between 75,000 and 80,000 face-to-face therapy sessions are provided each year. Recent investment has been focused on the training of existing staff in psychological therapies and the establishment of primary care talking therapies. Primary care talking therapy hubs bring together GPs, mental health clinicians and third-sector providers into a single service consortium. Those hubs will improve access to care for people with common mental health problems. The HSCB is investing £1·4 million into that initiative and is committed to incrementally building those hubs as a new way of working over the next three years. Psychological therapies do not just help those with mental health problems; they can also help those with physical health needs, such as those with pain management needs, cancer patients, patients with HIV and older people. The HSCB recently invested around £300,000 to enhance psychological therapy services for those with physical health needs.
The Bamford review also set out the strategic direction for children’s mental health services and supports cross-sectoral collaborative working among key agencies and Departments. Child and adolescent mental health services are delivered through four community based teams. The Belfast team also provides services for the South Eastern Trust population.
For children and young people who cannot be treated effectively in the community, there is a 33-bed children and adolescent mental health inpatient unit at Beechcroft.
In July 2012, my Department published a stepped-care service model for CAMHS, which promotes a more consistent, person-centred approach to mental health service delivery for our children and young people. Improvements to CAMHS will include an increased focus on early intervention, better multidisciplinary working and better collaboration with the community and voluntary, education and youth justice sectors. That will ensure that our children and young people have access to the full range of support that they need, no matter where they live in Northern Ireland.
The HSCB recently invested an additional and recurrent £2·27 million in CAMHS, which will greatly assist in the implementation of the service model. That recent investment brings the total figure currently invested in CAMHS to some £19 million, which is double what was being spent in 2006. That figure does not include investments made by the Public Health Agency in a wide range of children's services, such as family support services, safeguarding and primary care services.
It is vital that people with a mental illness are supported to take control of their life and live a purposeful life in their community. However, support for people with a mental illness is much wider than health. It is a societal issue and, therefore, a government-wide issue. It is about education and training. It is about housing. It is about employment. It is about the day-to-day issues that are important to us all.
Although our mental health services have come a long way since Bamford, we still have much more to do. Further reform will require further funding. Some of that can be found by moving resources from hospital services to community services. However, new money will also be needed, and that is difficult to find in the current economic climate and given the range of pressures across the entire Health and Social Care system, particularly when we are losing money from the health service to pay for welfare reform.
I want to respond to a number of Members. Pam Cameron raised the issue of promoting good mental health and well-being for children and young people. The Public Health Agency is taking forward a range of programmes to promote mental health and emotional well-being in our young people, including the roots of empathy courses in school and the iMatter pupils' emotional health and well-being programme. The next suicide prevention strategy will also include an early intervention section, which will include promoting good mental health and well-being in our young people.
Maeve McLaughlin raised the issue of resettlement: 44 long-stay patients are to be resettled from long-stay wards in psychiatric hospitals; and 46 delayed discharge patients are to be discharged to the community. The HSCB has advised that it has the funding to discharge the long-stay and the delayed discharge patients by March 2015.
Ms McLaughlin mentioned the new mental capacity Bill, as did Mr Wells. That will be publicised for consultation over the next few months. Mr Wells asked for a cast-iron guarantee on that, to which I heard Mr McCarthy say, "Hear, hear". I cannot give a cast-iron guarantee because, up to now, this has been held back by the Department of Justice. So Mr McCarthy's "Hear, hear" might assist in getting the Department of Justice up to full speed with the Department of Health, and then perhaps we can give the guarantee that Mr Wells was looking for.
Mr McKinney raised the issue of the Bamford action plan. We are looking at how we can ensure that Bamford is fully implemented, and we have made considerable progress. To assist us in doing that, there will be a meeting of the Bamford ministerial group this Thursday. The action plan is largely on track for achievement. We will update the group at that time and identify any other work that needs to be carried out.
David McIlveen and Mickey Brady raised the issue of mental health in rural communities. It is recognised that there can be particular mental health issues in such communities. The farm families health checks scheme has been very beneficial and assists in ensuring that farming families can receive free health checks, sources of support and information at a local level. It has been widely used at farmers' markets. Lifeline has also been working recently to raise the profile of its helpline services for anyone in distress in rural areas, and the community-based approach of the Protect Life suicide prevention strategy ensures that services are available at a local level in rural communities.
I thank Members who raised these important issues. I assure Members that service development will be informed by such issues, and I am always happy to listen to proposals and ideas that will help improve the lives of vulnerable members of our society.
I thank Members for their contribution to the debate on the motion tabled by my party colleague Kieran McCarthy. The Alliance Party has sought to put the issue of mental health firmly on the Assembly agenda, and, indeed, to put forward a simple motion that states clearly that we, as an Assembly, will take mental health as seriously as physical health; that we will work tirelessly to end the stigma against mental health; and, indeed, that we will seek to address underfunding for child and adolescent mental health services.
I congratulate my colleague Mr McCarthy on having this issue put on the agenda today, and I pay tribute to his tireless work on this issue. He highlighted the underfunding of mental health compared with physical health issues, and with other regions in this jurisdiction regarding child and adolescent mental health services. He also highlighted the need for improved funding for psychological therapies.
Consistent issues were raised by all contributors to the debate, one of which was for community mental health services to be signposted as much as physically possible. In that regard, I commend the work of the East Belfast Partnership in my constituency. It has created an east Belfast health framework, which the Minister has supported, that aims to deliver healthy hearts, bodies and minds in order to build good health and well-being in our neighbourhoods.
We also want to see the preventative power of good mental health being utilised to achieve positive outcomes in other areas, including to access and sustain employment, and to tackle social deprivation and unemployment in many areas, which Mr McCarthy referred to as a vicious cycle that must be broken. Members also referred to other policy areas, such as good housing, education and social inclusion that must be levered to address this issue. I have been raising, in particular with the Minister of Education, the need for improved counselling services at primary school level for our children and young people. It is a statutory provision at secondary level, but many educationalists think that we need to address that at primary school level to have early intervention around many of these particular issues.
Mr McCarthy also identified the critical challenge that we face to combat the stigma in our society, which many other Members referred to. Pam Cameron mentioned the excellent work that is done by voluntary and community sector organisations in campaigning to tackle stigma in our society and, indeed, to encourage people to talk about mental health issues. She stressed also the importance of early diagnosis and support for people with mental health issues. Indeed, she has seen, first hand, the difference that good early diagnosis and treatment has made to putting people on the road to recovering good mental health. She urged the Minister to prioritise mental health provision. To her credit, despite the Minister being her party colleague, she frequently advocates and fights for many of those issues, which are close to her heart. We welcome the call that she made today.
Maeve McLaughlin, the Chair of the Health Committee, identified two key areas that need improved: rehabilitation and the forthcoming legislation. Maeve McLaughlin said that we need to have a recovery-based approach, and I am glad that the Minister endorsed that as well. Indeed, she highlighted the fact that, although £19 million was spent on child and adolescent mental health services in 2012-13, it equated to around only 8% of mental health expenditure.
Fearghal McKinney also focused on the need for adequate and well-coordinated information about mental health service provision. He noted that, while we have seen improvements in child and adolescent mental health services as recently as 2012, it is somewhat concerning that it has taken us until then to start better coordinating that provision. He identified funding, commissioning and infrastructure as three key areas for improvement in mental health services provision.
Roy Beggs MLA also acknowledged the role of psychotherapy and talking therapies in addressing the issue and put forward the useful statistics provided in the Appleby report: whilst there is a 44% higher per capita need here, we have 10% lower spend than in other, neighbouring regions.
Gordon Dunne put forward the startling information that the World Health Organization has indicated that depression would be the second leading cause of disability by 2020. That highlights the link between mental and physical ill health, as if we needed it even more. He referenced the good practice of the South Eastern Health and Social Care Trust in identifying areas for single mental health units and indeed for focused rehabilitation centres in his area.
David McIlveen rightly said that the Assembly must send a clear message that it is fundamentally wrong for us to differentiate between mental and physical ill health. Sam Gardiner backed that up with some startling statistics that show the full extent of the problem of hidden prejudice in our society, where studies have shown that one in four people believe that the mentally ill should not be allowed to hold public office and that one in ten people believes that people with mental health issues should not be allowed to have children. Those are startling statistics that show that, as Dominic Bradley also said, we must reduce and remove this stigma. Dominic Bradley also usefully emphasised the need for us to do better in our support for carers for people with serious mental health issues. There is strong agreement in the Assembly on that.
Jim Wells identified some realism for the debate in terms of the difficult choices that the Assembly has to make in order to fund these resources. A lot of the time, that does not come into the debates around these issues. However, we have some difficult policy issues ahead of us with the Welfare Reform Bill, and I would add to that the fact that, of a childcare budget of £12 million, to my understanding £9 million has gone unspent in the Budget period 2011-15. We know of the high cost of division to our society here in Northern Ireland and, if we needed any issue to focus our minds on dealing with and tackling many of those issues that cost us huge amounts of money every year, hopefully this one will lead people to realise that we need to get agreement around some of those vital issues so that we can invest as much funding as possible in key issues such as mental health provision.
I welcome the Minister's contribution today and the commitment that he has given to tackling the stigma around mental health issues. He rightfully referenced the good work of the Public Health Agency's mental health campaign. In my constituency, YouthAction has a Young Men Talking project. Young men in particular, and men in general, are a key constituency for us to interact with in making people feel comfortable in discussing these issues. The Public Health Agency's campaign, which uses images of boxing and good sporting issues, will hopefully make people feel more comfortable about discussing this type of issue.
The Minister endorsed a recovery-based approach to mental health provision and the need for more collaborative working in relation to CAMHS. He referenced the £19 million a year invested in that area. However, as I said, that has been raised as a relatively low percentage of the mental health budget, and I think that all Members of the Assembly will receive frequent inquiries from their constituencies about children and adolescent mental health services, which is an area that we need to see improved provision in.
I also want to reference the good work of Action Mental Health, the Assembly's charity of the year last year. I found interaction with this organisation extremely helpful, particularly around the workplace and good mental health in employment scenarios. I would like to credit them for the good work that they do.
MindWise's 'You Can Take Control' campaign has been mentioned and I encourage anyone in our community who has experience of living with and recovering from mental health issues to visit the MindWise website and post their stories to encourage others to come forward.
The Children's Law Centre also offers free legal advice and representation for children with mental ill-health and plays a crucial role in policy development in these areas.
I welcome the focused and unanimous support for the motion and I look forward to seeing the Minister deliver on many of the calls that have been made from the Assembly for improved mental health service provision.
Question put and agreed to.
That this Assembly believes that mental health should be taken as seriously as physical health; urges the Executive to take action to end stigma against mental health; further believes that psychological therapies should be at the heart of the mental health services agenda; and calls for the current underfunding of child and adolescent mental health services to be addressed.
Adjourned at 5.01 pm.