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Mental Health Waiting Times

Health – in the Northern Ireland Assembly at 3:45 pm on 15th November 2016.

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Photo of Robin Newton Robin Newton Speaker 3:45 pm, 15th November 2016

Mr Mark Durkan has given notice of a question for urgent oral answer to the Minister of Health. I remind Members that, if they wish to ask a supplementary question, they should rise continually in their place. The Member who tabled the question will be called automatically to ask a supplementary question.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

Mr Durkan asked the Minister of Health what action she will take to address the unfolding crisis in mental health waiting times in every health and social care trust across Northern Ireland.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I am grateful for the opportunity to address this important issue today. Compared with other regions, we have a higher than average prevalence of mental health issues, and it is that, together with an increased awareness of psychological therapies and a legacy of unmet need, that has contributed to increased waiting times. Since I was appointed, I have consistently said that mental health is one of my key priorities. I have been working hard to identify the needs and the gaps in services to be addressed and to formulate a plan for action.

The draft delivery plan for the Programme for Government improving mental health indicator is out to consultation until next month, and it recognises that psychological therapies is an area that needs further investment, together with a wide range of specialist services, such as perinatal mental health. It currently envisages that it will take five years at the very least for us to start to see an appreciable movement in mental health on a population level. A 10-year programme is probably more realistic.

I have adopted six principles to improve mental health, with a first step of committing to a move towards parity of esteem to ensure that mental health receives the time, effort and resources required to meet local needs. Of the £10 million that is invested in psychological therapies, around £2 million is invested in the development of primary-care talking therapy hubs. I acknowledge that a further £3 million is needed to complete the programme. At the moment, nine hubs are operational across the region, providing treatment and care at a community level to over 7,000 people. A further five hubs are in development. Recovery colleges have also been established in each trust area. I also allocated a further £180,000 to continue the development of a comprehensive mental trauma service, which is based on the psychological therapies stepped care mode. When fully established, it will employ over 40 specialist staff.

Clearly, we face a challenging budgetary situation. Although I am actively making the case for more money for mental health, it is incumbent on us all to get the best value for the money that we already spend, and that is why the board is working up proposals for a managed care network to better utilise existing expertise across trusts and to promote uniformity and better continuity of care. That also demonstrates why fundamental reshaping of the health and social care service is so vital. It will enable money to be released across the system so that it can be targeted at those areas that need it most.

I am fully aware of the significant mental health challenges that face us. I am committed to improving services. It will be a long-term effort and, given the current budgetary position, there will be a need to prioritise. It is also important to note that, even if all the money required right across mental health services was immediately available, there would be a delay in utilising it fully, given the need to recruit highly skilled staff.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Minister for her answer. We have heard much from the Minister about how she will prioritise mental health, but, given the health service authorities are saying that they now need about 160 additional staff to deal with mental health pressures, what action has she taken to recruit staff in that area? What action has she taken to support external organisations, many of them unfunded, that provide services and support to people in their darkest hours?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I will pick up on your point about external organisations first. I presume, for example, that you are referring to the community and voluntary sector. Earlier today, I had a meeting with the Niamh Louise Foundation, which I am sure the Member is aware of. It provides excellent services in the community, and its staff will quite often describe themselves as being first-aiders when dealing with mental health issues and people who feel suicidal. We have to continue and enhance the role that we have across government, and also with the community and voluntary sector, in order to tackle successfully mental health issues in our society.

There are a number of issues that I need to tackle, and a number of factors point to the current state of play, particularly the fact that we have a legacy of underinvestment in our mental health services, which is something that we need to address over time. Doing that will be particularly challenging, given the budgetary issues that we have to deal with.

There is an increasing demand for services and a recognition that psychological therapies are an excellent way of supporting people. That means that more people are aware of psychological therapies and that more people are requesting them and being referred for them. That is a good thing.

The board has set out its stall in relation to the challenges that we have in recruiting staff. That is not just symptomatic of issues in mental health but right across health and social care. All those factors have led to a situation where we have a long way to go to improve mental health services. I said that it is a priority for me and that it is an issue that I want to champion and run with.

Just last week, I received the evaluation of the Bamford review, which looks back over the last 10 years at how the Executive and all Departments have worked to improve services for people with mental health problems. It has pointed to a number of gaps in services and where we need to do better. I will use that work, and when we put that together with the recent work commissioned by the Royal College of Psychiatrists in Lord Crisp's review, we have a real body of evidence that points to what we need to do differently.

As I said, I intend to set out, in line with the Programme for Government indicator, how we transform mental health services in the years ahead. We will have to do it incrementally, and I think that we can do that. I always say that a lot of good things are happening in the health service, but we have a long way to go in terms of challenging where we need to do things better. We have the information and the evidence that allows us to support a case to transform mental health services in future.

Photo of Paula Bradley Paula Bradley DUP 4:00 pm, 15th November 2016

I thank the Minister for her answers thus far and Mr Durkan for tabling the urgent oral question. I want to follow up on his question about the community and voluntary sector. I attended the greater Shankill suicide and self-harm reference group meeting in the Hammer community centre in the greater Shankill area. The people there talked about their local community response plan, which works very well when someone presents at an emergency department (ED) who has attempted suicide. The response plan goes in, looks after the community and the family concerned, and builds up a rapport. However, they suggested that maybe our EDs need to look at this slightly differently, given the fact that today's report states that nearly 16,500 people presented at EDs, some of whom had been admitted more than once. Maybe we need to look at our EDs as well to see whether referrals can be made to local community response teams, which are doing invaluable work in their communities. They are not there just to pick up the pieces after a suicide; they are there to assist in stopping people committing suicide.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

That is exactly the approach that we need to adopt. Often, a lot of people will not even present to an ED but will go to people they know in the local community group that is involved in supporting people with mental health problems. I had a very similar experience in relation to understanding the work that they do. There is certainly a role for the community and voluntary sector.

In terms of shaping our services, we have just finished the consultation on the Protect Life strategy — the suicide strategy. One of the things that is very strong in that is the need to work with the community and voluntary sector. I am very open to strengthening how things happen and how the statutory agencies interact with the community and voluntary sector, because they have a role to play. I always say now that no one has the option of working in silos; we all have to work together. If we are all serious about delivering better outcomes for people with mental health problems, I know that the community and voluntary sector is up for that.

In relation to EDs, we should always keep that under review. A number of years ago, after a campaign by families that had been bereaved, the "card before you leave" system was brought into play. There are simple things that can make a real difference, and it was a lifeline for some families. We need to do more such things, but the only way to learn about them is by talking to service users — the people with lived experience who have needed the support of the health service. We have a lot of lessons to learn, but the evaluation of the Bamford review points to all the gaps that are there, and I want to work with the Health Committee and all Members to put plans in place to improve things across the piece. Clearly, whilst the Programme for Government indicator talks about a five-year plan, the feedback that I am getting from health professionals and others who work in the field is that we need to chart a way forward — similar to Delivering Together — for the next 10 years so that we can start to improve things.

Photo of Robbie Butler Robbie Butler UUP

I thank the Minister for attending today. The largest share in breaches of psychological therapy services over recent months was recorded in my own trust, the South Eastern Trust. In August, for instance, the South Eastern Trust accounted for 773 of the 1,798 patients forced to wait longer than 13 weeks. Will she detail specifically what steps she is taking to close the widening gap of unmet need and funding for psychological therapies in my constituency?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

No, I will not get into specifics in relation to the South Eastern Trust in this debate but I am very happy for the trust to pick that up directly with the Member in relation to what it is doing operationally.

The same things that I have just said actually stand for every trust. We have to get to the point where you get the same access to services no matter where you live in the North. It is unfortunate that at this moment in time, depending on where you live, you may have better access to psychological therapies, and that is what we are talking about today. That is not acceptable to me. We need to have a regional standard. We need to make sure that you have full access no matter where you live.

We have a psychological strategy in place. Clearly, there is a recognition that psychological therapies work. They actually take pressure off the acute end of mental health services. They are giving people first-aid. They are talking to people from very early on, and maybe preventing them from having to move through further areas of the health service.

I recognise that we need to do more of this, and I am actively engaged in conversations with the Finance Minister on how we can fund psychological therapies in the future. I believe in them. I believe they are the right thing to do. I believe they work and in terms of doing more — we have to do more — we have a certain level of investment, which has been very positive, but we certainly have a long way to go to improve the picture for absolutely everybody who may need psychological therapies.

Photo of Catherine Seeley Catherine Seeley Sinn Féin

I thank the Minister for being here to discuss this important issue. What consideration has she given to the principles that will inform her plans for tackling mental ill health?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

As I said, we are at an opportune time as we have the Bamford evaluation but, first and foremost, the commitment has to be about moving towards parity of esteem. I have said that I am firmly committed to moving towards parity of esteem.

Secondly, it is really important that we develop and sustain a recovery culture. Whenever I talked, in the last number of weeks, about how we are going to transform health and social care, one of the things I talked about was co-designing services and planning services along with patients, carers and families. This is an area where mental health is already ahead of the field. Recovery colleges have been established and they are really practical examples of how people with lived experience — those who have had mental health problems — have actually helped to design and improve services and work with others who find themselves in the same scenario. They have then been employed by trusts to provide those services. I want to do a lot more of that in pursuing and enhancing the recovery culture which we have.

Thirdly, involvement by people, as I said, with lived experience is key.

The fourth principle is around service development where our resources allow us to do so. We are going to have to prioritise. We do not have an unlimited pot of money. We are going to have to prioritise services and what we take forward. So, let us make sure that every service that we invest in is about delivering better health outcomes and making a meaningful difference. Over the time ahead, we are going to have decisions to make to plug the gaps between needs and service provision, but the Bamford review is really key in pointing out some of the areas where we need to do more.

I am particularly interested in making sure we do more to support young people, particularly those with a dual diagnosis. I want to do more to establish a regional perinatal service for people with mental illness. I want to do more around eating disorder services, psychological therapies, mental trauma and personality disorders. There are so many things that are key and really important which we need to do, but we need to come at it from a planned system change point of view and that is going to take a bit of time to do. What is most important is that we work collectively — community and voluntary sector and government — to make sure that we provide first-class services for those people when they need them.

I said that waiting lists are always unacceptable. The length of time that some people are waiting for services across health and social care is totally unacceptable to me. That continues to be the case, and when I publish the plan for how I am going to bring elective care under control, in January, I will look forward to discussing with Members of the House how we can improve that picture.

Photo of Sinéad Bradley Sinéad Bradley Social Democratic and Labour Party

While the question today rightly looks at the out-and-out failure to meet the 13-week target, I express to the Minister my shock at finding out that anybody living with a mental health issue would have to wait 13 weeks, let alone that the target has not been met. Is the Minister satisfied that this is an acceptable target?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I was not shocked, and I do not think that the Member should be shocked. We all know that there is a legacy of underinvestment in mental health services. I do not know how aware you are of mental health services and how they are delivered but, certainly, it is no shock to me that there is a waiting list. It is no shock to me that we need to invest more in mental health services. It is no shock to me that we need to invest in all those areas which I have just highlighted, areas where we need to do more.

We have a very challenging situation and, as I said in the first answer I gave, there is a legacy of underinvestment and increased demand for services. Psychological therapies are working, so people want them, and rightly so. We have a big demand on our service and we need to deliver for the people who need our service.

Do not be shocked, but be assured that I am doing everything I can to make sure that we change the services that we provide. I am doing everything I can, along with Executive colleagues and the Finance Minister, to make sure that we deliver the funding that we need to invest in psychological therapies.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Minister, for your answers so far. I welcome your praise for the community and voluntary sector in dealing with the issue and your commitment to review mental health psychological and therapeutic support services. As part of that review, you will find that there is no counselling or support for people under 16 who are the victims of sexual crime. If you could look at that in your review, I would really welcome it.

The organisations that plug the gaps where there is no provision are very reliant on core revenue funding from your Department. As you know, they have a year-on-year increase, so I ask you to look at bringing forward the innovation fund as quickly as possible so that we do not lose the community and voluntary sector services that are so vital to addressing the mental health issue.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for her question. I do not have a full understanding of the services for victims of sexual crime, but I will certainly look into it and make sure that that is included in taking things forward.

You are absolutely right about core funding: the community and voluntary sector does excellent work. The health service has given some core funding for that in the past, but it is probably nowhere near what it takes for them to run the services. If the health service tried to do that itself, it would find itself stretched to the limit. We have to recognise the excellent work that is out there in the community and voluntary sector. The previous Minister obviously decided to end core funding and develop an innovation scheme. I am still looking at that because I wanted to take a fresh look at the organisations that we fund, some of which may disappear. I am fearful, particularly in relation to advocacy, about how those groups will be supported in the future, and I am considering that. I want to get the innovation fund out the door because I know that people are very anxious, given the decrease in their funding over the last number of weeks. I intend at least to initiate the applications for the innovation fund before the end of the financial year to allow people to bid in. Alongside that, I am looking at whether there is any potential or scope to support the community and voluntary sector and the particular groups that we need, because we know the value that they bring to all the people who use their services.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

Given that, according to the Health and Social Care Board, an additional £17 million will be needed to keep up with the demand in mental health services, will the Minister give a guarantee that the money will be found and, if so, say from where?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I think that I have answered that. I am doing absolutely everything I can to work with the Finance Minister and Executive colleagues to make sure that we have proper funding for our mental health services. It is not without its challenges. There is Tory austerity; I could list all the issues that we have to deal with. We do not have an unlimited pot of funding, but we have a commitment to parity of esteem. We have a legacy of underfunding in mental health; I want to change that picture and am committed to doing that. I will work with Executive colleagues throughout the Budget process and will not be found wanting when it comes to shouting and fighting hard to make sure that we have an adequate budget for health and social care in general and, in particular, as in this case today, to address the issues that we have with psychological therapy itself.

Photo of Gary Middleton Gary Middleton DUP

I thank the Minister for her answers so far. She will be aware that there has been an increase in the number of children and young people presenting with mental health issues; it is as many as one in nine. Will she look at what specialist services — she touched on eating disorders and addressing that issue — are being provided to help to address that worrying trend?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Child and adolescent mental health services (CAMHS) are delivered under a stepped care model. The board leads on a reform process under the auspices of the stepped care model implementation review. A lot of progress has been made, but you are right: more young people have been referred to our services. We always have to adapt to the needs of society. If more younger people are coming in, we need more emphasis on CAMHS. I am committed to making sure that we do that. We invest over £20 million annually in CAMHS. That shows that there is a recognition that we need to put the funding there to support those young people. I am also considering reforming investment options across a range of other services, including CAMHS. As I said, it is important that we look at children and young people with a dual diagnosis, for example. We do not have a service to support those families, and perhaps we need to look at that. If we cannot do it here, let us look at it on an all-island basis. Is it something we can provide on the island? It is so important that young people know there are services to support them so that they do not feel they have nowhere to go. I am keen to make sure we do that.

The regional acute inpatient services at Beechcroft are frequently under pressure, and I think Members are aware of that. An independent review in 2014 concluded that the current 33-bed model was appropriate but that, crucially, it was dependent on the further strengthening of the crisis resolution and home treatment services. What else can we put into the community that stops people having to go into acute inpatient settings? That is an area we need to focus on.

I should also say that a managed care network for acute child and adolescent mental health services is being established as we speak. That will bring acute services into one managed system and, again, will ensure greater consistency across the region and streamline access to Beechcroft.

It is an area we have to do an awful lot more in, but the Bamford evaluation points to those issues, the service gaps we have and where we need to do a lot more. This is certainly one of those key areas.

Photo of Ian Milne Ian Milne Sinn Féin 4:15 pm, 15th November 2016

Will the Minister give an update on the suicide prevention strategy?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The consultation has closed; however, I have said that I want to go out and engage personally. I have met a number of organisations and individuals about the strategy. I intend to go out next week, and I am doing consultation events in Belfast and the Dungannon area. It is important that I listen to the people who have been bereaved by suicide and make sure that I develop a strategy that very much has their views, ideas and initiatives embedded when going forward. We will work on that over the next number of months and collate the responses we have received. As I said, it is really important that we listen to those with lived experience.

Photo of David Ford David Ford Alliance

As I remember questioning the Minister's predecessor Bairbre de Brún on funding for mental health services about 14 or 15 years ago, it is rather sad that Mr Durkan had to ask a question today to illustrate the problem. Given that the Minister has referred a few times to the Bamford review, can she give us any information on the commencement of the Mental Capacity Act?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Surely the Member is not blaming Bairbre de Brún for all the issues we have in mental health in our society. We are a society coming out of conflict, which is an issue in itself, but we obviously have a prevalence issue that continues to rise with young people and mental health issues and more people being referred to the service. We have a societal problem. I do not think we can pinpoint it on one area; we have a societal problem that we need to address. We need to address it across every Department, council or community and voluntary sector organisation that wants to get involved. Do people have access to a job? Do they have a home? All those things contribute to people's mental well-being. We have a collective responsibility as an Executive and a society to help people who find themselves with mental health issues.

The Member will be very aware that the Act is a very complex piece of legislation. We are working our way through all the issues as we speak. Officials in my Department and in DOJ are working through all the initiatives, because, when we commence the Act, we need to make sure we can deliver on it. From his previous role as a Minister, the Member will be very aware of the challenges we have with the Mental Capacity Act. It was significant legislation, so it is important that we have everything lined up and can deliver everything when we commence the legislation.

Photo of Robin Newton Robin Newton Speaker

That concludes this item of business. I ask Members to take their ease while we change the top Table.

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