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I beg to move:
That this Assembly recognises the importance of prioritising mental health and well-being as part of the COVID-19 recovery; notes that the long-term impact of the pandemic on working practices, everyday social interaction and hospital or care home visiting will present new and substantive challenges to individual mental well-being, especially among the most vulnerable; stresses, therefore, the need for refreshed and reformed mental health and well-being service provision that is fit for purpose; further notes, to this end, the transformative role played by community and voluntary providers whose services are subject to increasing demand; and calls on the Minister of Health to outline plans to tackle COVID-19-related mental illness moving forward.
The Business Committee has agreed to allow up to 1 hour and 30 minutes for the debate. Two amendments have been selected and are published on the Marshalled List, therefore an additional 15 minutes has been allocated to the total time. The proposer of the motion will have 10 minutes, and those who make winding-up speeches will also have 10 minutes.
At this stage, I will indicate that we will accept both amendments to the motion. I thank Sinn Féin and the UUP for their thoughtful additions to it.
While much focus in recent months has, rightly, been on the physical well-being of our population as we face the threat of coronavirus, the impact on mental health must not be forgotten. The restrictions placed on personal freedoms and everyday social interaction during lockdown have had a profound effect on the emotional and psychological well-being of people living in Northern Ireland. Worryingly, the cross-cutting nature of the impact of the virus and the subsequent regulations have come into direct conflict with established triggers of mental illness, including social isolation, loss of work and general financial concerns, medical trauma and work-related stress. The steps taken in good faith and on the basis of scientific evidence by the Executive to protect lives were necessary. However, we must ensure that the benefits are not overshadowed by long-term harm from unaddressed mental health issues. As we continue the pathway to normalisation, to reopening our health service, mental health and well-being must be at the forefront of the Department of Health's priorities. That is why we tabled the motion, and I trust that we can unite, as a House, behind it.
Poor mental health is not a new problem faced by our society. It is not one of the many new consequences of COVID-19. Pre-COVID, the issue of mental health and the need for targeted intervention was already clear. One in five of our population identified as having a mental health issue at one time in their life. Over half of the Health and Social Care (HSC) nursing staff reported being injured or unwell as a result of workplace stress in a 2019 survey. On a daily basis, we hear in our news bulletins and through our contacts in the community of lives lost to suicide. Our community was already struggling.
The reality is that COVID-19 has exacerbated the problem. A study by researchers from the Stress, Trauma and Related Conditions (STARC) research lab at Queen's University Belfast surveyed 2,500 people living in the UK during the first month of the COVID-19 lockdown period.
It found that one third of those surveyed met the criteria for anxiety, one third met the criteria for depression and 20% met the criteria for PTSD related to COVID-19. Some 50% of those surveyed reported concerns about the financial impact of the pandemic.
Professor Armour, who led the research, concluded:
"Based on the figures reported in this study related to mental ill health during lockdown ... funding should be provided for an uplift to the mental health workforce to support the potential influx of individuals needing mental health support."
A second study by Ulster University and the University of Sheffield reported that, in total, across the week of the study, 25% of women and 18% of men exhibited clinically meaningful symptoms of anxiety and that 23% of women and 21% of men showed signs of depression. Those aged under 35 living in the city, those living alone or with children, those with lower incomes, those with health conditions and those whose income has been hit by the pandemic had higher rates of anxiety and depression. Those who felt that they belonged to their neighbourhood and trusted their neighbours had lower levels of anxiety and depression.
Members, I am sure that, as it was for me, learning of those survey figures is sobering. It is a microcosm of the problem in our wider society, and something that must be tackled. The depth of the problem is stark, and it could well worsen as, for example, unemployment grows as a result of the economic tsunami that COVID-19 has wrought on our local economy. Financial loss and unemployment have strong links with mental ill health, with the risk doubling if people lose their job. That is why the support given to local businesses has been so vital. I commend my colleague Diane Dodds for all her work and, indeed, Her Majesty's Government for the vast levels of support.
Just as we have risen to the challenge of COVID-19, we must rise to the challenge of its mental health legacy. The onus falls on the Minister of Health in that regard. I hasten to add that the Minister and his officials have acted responsibly under unprecedented pressure during this crisis. The publication of the mental health action plan and its COVID-19 response plan annex provide a constructive platform on which to progress the debate. I welcome the plan brought forward by the Minister and know that it is a matter that he identified as a priority before coronavirus struck.
To take one issue from the plan, we are supportive of the proposal to establish a model for specialist perinatal mental health services by September. Northern Ireland is currently the only region of the UK without a dedicated mother and baby unit, and it is vital that we accommodate more compassionate care for bonding and development at this critical time. One major concern with the plan as it stands, however, is that, to most intents and purposes, it is cost-neutral and therefore cannot hope to make the transformative reforms needed to mental health services without there being additional agreement on comprehensive funding to take forward the 38 actions. The total cost of the mental health action plan in the first year is up to £2·8 million. The recurring cost of the much-needed new specialist perinatal mental health service alone is expected to be up to £3·6 million a year. A strong signal from the Executive, including the Department of Health, and generosity of spirit are therefore required in order to move forward with the agenda to reform and refresh the current provision.
We need to look at solutions, and what is key to that is a cross-cutting approach being taken to mental health and well-being, given health inequalities and longer-term changes to how society operates. Health inequalities researched by the Department of Health have indicated strong links among deprivation, age and gender in COVID-19 infection and admission rates. Similar correlations between the virus and higher rates of anxiety and depression have been found among those aged under 35 living in a city, those living alone or with children, those with medical conditions and those in financial hardship. In that sense, when tabling the motion, we were acutely aware that it is not just an issue relevant to the public health response or health and social care but something that has to be tied to and targeted at the social and economic factors that lead to mental illness.
A one-size-fits-all approach cannot be effective. A cross-cutting, cross-departmental, cross-sectoral approach is required. Indeed, in DUP Departments such as Education, our Ministers are actively working on plans to address the legacy of COVID-19 for children who were already identified as being at risk prior to the pandemic and whose physical, mental and educational well-being may have been acutely disadvantaged by loss of contact and/or closure of schools. Although the Minister takes the lead, we want to work with him across the Executive to tackle the issues in a collaborative and effective way. A particular example would be to look towards our arts sector. I appeal to the Executive to recognise the huge contribution that the arts and culture make to mental health outcomes and to understand that the sector has huge challenges ahead and requires support if it is to survive.
That collaborative approach must go further; a vibrant and well-resourced community and voluntary sector is the key to success. The unprecedented demand on health and social care capacity has meant that mental health well-being charities and faith-based organisations have been a lifeline for providing early and skilled responses to those who are at risk of mental illness during the pandemic. Their contacts with vulnerable groups of people, including the elderly and those who have been shielding, have been an invaluable preventative tool against mental ill health.
That contribution has been made in the midst of increasing demand and fewer resources, which has put many organisations at risk of folding. There needs to be a serious look at what we can do to support the sustainable future of the sector moving forward. I wish to put on record my full appreciation for the mental health provision from the community and voluntary sectors such as that provided by Impact Network NI, which is based in Randalstown and is a great example of an invaluable service to the community. Service providers in the community and voluntary sector must be at the heart of the recovery and reform process. The focus must be on co-design and co-production of the new services and regular dialogue. As Departments seek to wade their way through the financial outworkings of COVID-19 expenditure, any tendency to look for community providers as an easy target for more savings must be opposed.
In conclusion, it would be remiss of me not to make special mention of one group of people for whom we must deliver support, which is our front-line healthcare workers. What they have encountered and seen and have had to do on the wards and in care homes, having sacrificed family life, has had a huge impact on so many nurses, doctors and other healthcare workers. I urge the Minister to ensure that all necessary support is in place for our heroes. I am pleased to propose the motion and I urge Members to unite behind it.
Leave out all after "interaction" and insert: ", individual coping strategies, and hospital or care home visiting will present new and substantive challenges to individual mental well-being, especially among the most vulnerable; stresses, therefore, the need for refreshed and reformed mental health and well-being service provision that recognises the structural barriers to addressing a dual diagnosis of mental illness and an addiction; further notes, to this end, the transformative role played by community and voluntary providers whose services are subject to increasing demand; and calls on the Minister of Health to outline plans to tackle mental health problems, mental illness and addictions related to COVID-19 moving forward."
I thank the proposers of the motion. The challenge before all of us is how to improve mental health and well-being as we gradually emerge from the COVID-19 lockdown. That will not be an easy task but it is an essential one. Mental health and well-being are not just the responsibility of the Health Minister; they are the responsibility of all Ministers and their Departments. I believe that our amendment adds to the motion and, importantly, draws attention to the needs of addiction services and the challenges of a dual diagnosis.
I want to begin by paying tribute to all of the organisations and staff that are working in the field of mental health and all those who regularly attend the all-party group on suicide prevention, including many Members in the Chamber whom I know care deeply about the issue. I also want to pay a special tribute to all those across our communities who are struggling with their own mental health problems. I want them to know that, even when they feel most alone and isolated, there are people and services who want to help. Our new reality is that COVID-19 will be a part of our lives for the foreseeable future and it will have a lasting impact on communities across the island, even without a second wave. Anxiety is being felt across all communities and across all sectors of our economy and we, as a body, must be well prepared to deal with the challenges that that will pose.
I acknowledge that in the early weeks of the pandemic the Department of Health took on board my recommendation to create a dedicated page for mental health and well-being advice. I also acknowledge that the Health Minister has expressed to me, verbally and in writing, his commitment to progress and develop a new and improved substance misuse strategy, alongside and as part of the wider mental health action plan and the 10-year strategy. The question is now: how will the wider health and social care system respond to the mental health challenges that we face in the time ahead? Will there be a clear and dedicated mental health action plan that has adequate resources attached to it?
I note that the Minister previously announced the appointment of a mental health champion. Again, although that is very welcome, we still need the Minister of Health to be our ultimate champion for improving mental health services, including addiction services. I agree that there needs to be more resources for mental health and well-being. It is also important that we see mental health and well-being in every programme from every Department and not just from the Department of Health. For example, the resilience and well-being framework being developed by the Education Authority for young people in our schools is a step in the right direction. However, it must now also take into account the legacy of COVID-19. How will the Department for the Economy measure the impact of job losses and financial worry, and how will the financial stress being felt across our communities be factored into tangible supports for all our businesses and workers?
Every Department and every arm's-length body must be asked the same pertinent question: how are you promoting the well-being, health and mental health of all your staff and service users? Although there is clearly a need for all Departments to respond and collaborate, I believe that this will be best placed within the Executive working group that was established for mental health.
The Department of Health must also have its own detailed plan to respond to the need for greater mental health and addiction services. A few weeks ago, the Health Committee received an oral briefing from organisations providing these services, and I really urge all Members to go back and listen to some of the stark evidence from those groups, as it is a testimony to the struggle of providing addiction services to those suffering most from those issues, and with mental health challenges on top. It is very clear to see that the sector is deeply concerned about how the lockdown has affected those service users who are already seeking help, and indeed those who will in the future need those services due to COVID-19 and the lockdown.
I want to take a bit of time to explore a bit further the issue of dual diagnosis. A dual diagnosis is when someone has to first choose between addressing their mental health condition or their addiction. It is often the case that they are interlinked, but services are unable to respond or, worse, are not there to respond at all. I recently asked the Minister a question regarding dual diagnosis, and I thank him for his response, which was:
"There are ... no legal barriers within the Mental Health Order ... 1986 prohibiting the establishment of a dual diagnosis service for addictions and mental health."
While that sounds positive, what it actually says is that the barrier to putting the person first is not actually because of the legislation but because they maybe do not fit neatly into a predefined box when they are looking for help and support. As services are rebuilt and commissioned in the future, it is vital that they be person-centred and take individual needs fully into account. We need to consider that the individual needs for many may require treatment for those who are battling with both a mental health problem and an addiction.
I will finish my comments by welcoming some more of the positive news coming from the Department of Health recently in and around the innovative programme towards zero suicide. That programme is going to be resuming in July. Again, that was one of the aspects of mental health and suicide prevention that had been impacted by COVID-19 and the pandemic and now must adapt, along with everything else, to meet people's needs post-COVID and the demand on services. However, I also raised concerns at the last Committee meeting that the Department put in a bid for only just over £2 million in additional moneys for mental health and suicide prevention in the June budgeting allocations.
Just to finish, in my view all of this needs to be considered in the context that our mental health services, as we all know, are already under pressure. The suicide prevention strategy, a big piece of work, still has to be fully implemented. On top of all that, we are now expecting a possible surge in demand for services as we exit the lockdown restrictions. I support the motion and, again, thank the Members for tabling it. I am happy to support it and hope that Members will lend their support to my amendment.
At end insert: "; and further calls on the Executive to support a cross-cutting and outcomes-based approach to providing the funding and resources needed to maximise the health and social care and the community and voluntary sector's capacity to contribute to addressing poor mental health and promoting well-being."
Thank you, Mr Temporary Speaker, if that is the right terminology. I will not use my full 10 minutes.
"Wouldn't it be great if it was like this all the time."
On a subject as important as mental health and, ultimately, suicide prevention, we could not be talking about anything more important here tonight. It is one of the only subjects where I will not have written notes, because I am so passionate about it.
I want to thank the party that tabled the motion, which was moved by Mrs Cameron, and Sinn Féin for tabling the amendment that was moved by Órlaithí. Another amendment was proposed by the SDLP, which very much mirrored our amendment. I will speak in favour of the motion and both amendments and I urge every Member to support them as well.
There is no doubt that mental health is everyone's business. I had written a few things down, in preparation for speaking, but the two Members who have spoken have blown me out of the water because they have got it in spades. They have accepted that mental health is everyone's business. Whilst the purpose and intent of the motion calls on the Health Minister, it recognises that, actually, this is across the full Executive. This is for the Department for Communities, the Department of Justice, the Department for the Economy and the Department of Education. If we are going to catch the tail of this problem and epidemic, which existed long before COVID, we have to act responsibly and in a collegiate manner.
I will get to the COVID-specific issues in a minute but I am particularly pleased with the contributions so far. Mental health is not new and poor mental health is not new. The problems that people are facing, out of COVID, existed before and are the same problems. Perinatal mental health has already been mentioned by Mrs Cameron. That is so important because if we cannot get off to the right start, with mums who are pregnant and babies in those early years, what are we storing up for ourselves in the future? The Minister has already made a commitment to that. I am sure that if he had the support of the Executive, with regard to the finance, we could do much more. I believe that if we work collegiately — to use the word again — we could achieve much more.
I am now a member of the Education Committee. I assure you that, if you were to sit in on the Committee, you would see that — as happened today in the Chamber with the Minister — every opportunity that I get, and other Committee members get, is used to ask, "What are you doing to tackle mental ill health?" The fabric of the building, the support that teachers can get, the support of our teachers, pupils, families and their children.
I became a Member in 2016, and we talked about the correlation between poverty, social deprivation, criminality, addictions and poor mental health. Those are all things that are in the fabric of our society in Northern Ireland that we really need to tackle and get to grips with. It is worth noting that a number of reports point out that, through the COVID pandemic, addictions — alcohol, gambling and drugs — are being targeted to those who are the most vulnerable. In their downtime, they are being exposed to even greater risk, and we need to do something about that.
It is my absolute privilege to chair the new all-party group (APG) on tackling gambling-related harm. I would like it to be noted that that is a real issue through the COVID pandemic: those people, who are gambling addicts, are coming to real harm. I look forward to the Minister for Communities looking at that with regard to new legislation.
I commend Órlaithí Flynn, the chair of the all-party group on suicide, on her work to target the message of the zero suicide figure, which is something that we support.
There are many reports on poor mental health across many communities and sectors. I urge everyone to not allow us to get to the point of paralysis by analysis. We are reported out. We have enough reports. We know what we should be doing and we need to target our resources, support each other and put our collective shoulders to the wheel, not just the Executive but in the Assembly, to see real progress. It was good to note that the first two Members to speak gave the Health Minister credit because he did not just look at COVID and say that he was going to sit here and look at it. He followed through with the pre-New Decade, New Approach commitments and said that we would have a mental health action plan, and that has started, and we are going to look at the mental health champion, a commitment since 2016, and I hope that that is delivered very soon. There is a further commitment for the mental health strategy, starting by December this year, and looking at a 10-year strategy. These are all very welcome, needed and will help us to save lives.
Now that we have the impact of COVID, and all the related matters that, whilst they do not complicate it, perhaps consolidate our focus on the need to do this together. That is what it does; It does not make it any more complicated, guys. What are the COVID implications? One of them, and the most stark, is the bereavement process. People have died, through COVID, and people have not been able to grieve or have the burial or wake in the normal manner that we are accustomed to. That is something that is going to have an outcome, with a cost to bear, and we need to support those people.
On loneliness and isolation, I commend Sinéad Bradley as the chair of the APG on preventing loneliness, and she has been leading the battle on that, but loneliness existed before COVID-19. It has been magnified and exacerbated, but it is about the society that we live in. It is a societal change that we need. We need to provide the leadership for that. There are the visiting restrictions in hospitals and nursing homes, and the inability to see those people who are probably on a palliative path, who are certainly ill, and could do with a cuddle, a handshake or a kiss. Those are things that should resonate with each and every one of us.
We have refugees and asylum seekers who already, at times, find it difficult to integrate into our communities. Have we forgotten about those people during the COVID-19 crisis? I hope not. I was on a call, I think on Friday, with a group and it was interesting. They were talking about the Northern Irish spirit and how much they enjoy being here, but, throughout COVID-19, did we do enough? We certainly need to try harder.
Like me, I am sure that, throughout the pandemic, your inboxes have been busier than before. There has been no respite for us. I am not asking for anybody to have any sympathy, but you will know that there has been an impact on everybody who has been contacting you. Whether it has been a business that has been struggling to work out the furlough and to work out whether they are entitled to grants, and great work has been done. However, all that stress and angst adds up into a toxic mix, and that is, sometimes, where mental health and ill mental health comes from.
As has been pointed out, we have to give thanks to those who have been standing in the gap and those who have been bridging the gap and meeting the need for those people who, for instance, perhaps already had poor mental health. Those nurses, doctors, care workers and those people who are working in the community — who are still working in the community through very difficult circumstances — who are, in many instances, probably not being paid enough to do the job that they do in providing the link between the outside world and the loneliness of living alone or being in hospital for treatment and enduring sicknesses. Therefore, for those nurses and care workers, we say thank you. For those doctors who stand in the gap, we say thank you.
The biggest purpose of the motion is to talk about the community groups and charities that have shown great innovation over the past weeks, and it has been wonderful to see. They have had to adapt their strategies and their way of working to meet the differing needs of the people who have needed them. In Lisburn, there are a few that I will mention — forgive me, if anybody is listening, if I miss you out — the Atlas Women's Centre, Via Wings in Dromore, the Resurgam Trust and the COVID-19 Ballymacash Response. Those guys, when they went out with food, met a different need. They did not even know, sometimes, the benefit of what they were doing by just smiling at somebody and showing kindness. Kindness. Kindness is a big part of this cure; it is better than a tablet, and I think that it is something that we can lead the way on. As Van Morrison said:
"Wouldn't it be great if it was like this all the time."
I told you that I was not going to talk for 10 minutes but I probably am. I am probably going to use the last minute and a half, and that is OK. To pull my contribution together, there is only one way that this will work and it is not just the responsibility of Robin Swann, as Minister, or the Department of Health. It is a collective responsibility. I see this as how the Executive might work in the longer-term, if we can prioritise mental health and protecting and saving life, does it matter whether you are a unionist, nationalist, other or neither? Does it really? Can we show the people out there that we have a priority that we share and that we are going to work collectively to achieve it?
I think that out of the legacy of one of our most regrettable circumstances — the level of poor mental health and the high rates of suicide — if we can look at one of our darkest marks and do something transformative, what a light this place could be. We will support the amendments and the motion.
On behalf of the Alliance Party, I support the motion and both amendments. I thank the Members for bringing these forward for discussion. It is very timely and absolutely crucial that, as we re-establish our health and social care services, time is taken to ensure that we include a firm understanding of the state of our nation's health and well-being as we emerge from the health crisis, and that we make decisions with that information going forward. To do that, we need to look at the needs of those most affected by the COVID-19 pandemic. We should look at the hundreds of families across the country who have lost loved ones to coronavirus, and who have been plunged into immense sadness and have been curtailed in their grieving process due to the health protection regulations. We also have the many others who became infected and ended up in hospital needing urgent treatment. They faced the prospect of death and now have a long road to recovery, physically and mentally.
Our doctors, nurses and the whole health and social care family have been working at the front line and have been dealing with the most critical conditions that have been caused by this new virus, which nobody could have predicted would sweep across our society. Further, we have to recognise that many of those key workers live with underlying health conditions or in households with loved ones who do. Knowing the risk, how incredibly scary and traumatic it must have been for them to just go to work during the pandemic.
We then need to focus on those for whom lockdown has been equally traumatic. We have to recognise that the isolation from mainstream society has had a devastating impact on them. Where, in ordinary circumstances, they could manage or, at least, cope with their pre-existing mental health issues through engagement and activity, suddenly they have been trapped in their homes and their conditions have worsened. That will have been particularly prevalent in homes in which carers look after loved ones with learning or physical disabilities and whose conditions will also have worsened due to a loss of daily routine and external support.
Sadly, we saw a spike in reported cases of domestic and sexual violence during the pandemic. As the motion suggests, the community and voluntary sector had to move quickly and very innovatively to reconfigure its services to respond to that spike, and we should be grateful to it. I am thinking of bodies such as Women's Aid, the Men's Advisory Project, the NSPCC, Barnardo's, Nexus and many more. I do not know whether we will ever know nor be able to estimate the number of unreported cases and the number of men, women and children who had to suffer in silence and live with their abusers during this time and, sadly, will have to continue to do so.
We also have to recognise the other societal and economic issues that will have been exacerbated by the pandemic and that will greatly impact on the nation's well-being. Those include the loss of employment leading to increased poverty and the rise in alcohol use, drug abuse and gambling addictions, all of which will have had a detrimental impact on feelings of self-worth and shame. The motion tabled by Sinn Féin reflects the need for a dual diagnosis and, as Ms Flynn outlined, the need to not compartmentalise issues. One further point that I would make is the need for specialised psychiatric treatment for extreme gambling addictions. That is not available here and the strategy should incorporate that going forward.
It is important that the action plan from the Health Minister, via his Department, for the development of a 10-year strategy reads across all aspects of society and looks at the causes and contributors. To achieve that, the public engagement aspect of developing the plan has to be extensive and creative. We know that, for example, there are high levels of mental health difficulties among young people with learning disabilities, which, as I said, will no doubt have been made worse during the pandemic. How can we ensure that they are properly included in the process and have their voice heard? How can the principles of co-design and co-production be configured to reach the hardest-to-reach sections of our society?
I will end by referencing the amendment that has been tabled by the UUP, which recognises the need for cross-cutting efforts across Departments and all public services and to find ways of measuring through outcomes and not outputs. To seriously tackle mental health issues, we will need serious investment, and I fully support that. However, we need to ensure that the money is spent wisely and effectively. Thought will be required to put in place society-wide mechanisms to measure impact and our collective well-being.
COVID-19 has undoubtedly reshaped how we function as a society. It has shifted our coping mechanisms, our family dynamics, work practices, parenting methods and so much more. We agree fundamentally with Members that the period post-COVID-19 is a moment of opportunity to set priorities and define key action points to improve and enhance our mental health provision and address its gaps and implement improvements where necessary. New challenges require new solutions.
After talking with representatives of the voluntary sector in my constituency, I discovered that many were subject to increasing demand throughout the COVID-19 lockdown, especially groups that work with domestic violence victims. The pressures put on those services throughout the pandemic highlight and prove how crucial it is that voluntary groups and charities are well protected and funded correctly.
The conversation about addiction diagnoses and treatment is important. Recent figures announced by Addiction NI show that the number of men dying from drug-related causes has increased by 98% in the past 10 years. The emphasis in amendment No 1 further highlights how addiction and issues with alcohol dependency can be born of a lack of access to mental health support, leaving many to feel even more vulnerable.
We feel, of course, that there is also a rural dynamic to the conversation. Rural isolation causes barriers to accessing services. In Protect Life 2, the primary health and social care need of rural citizens is identified as availability and provision of timely and high-quality suicide prevention and self-harm services. Before COVID-19, many in rural areas were already experiencing mass changes, especially depopulation and migration in some areas, and such issues are having an impact with the sense of loss of community. Rural barriers to mental health support can also include more conservative approaches to help-seeking and heightened stigma around mental illness, and we must consider that, moving forward. Access and support require a collaborative and coordinated response.
Earlier this year, I wrote to the Minister of Health to ask that bereavement support services are well supported throughout and post COVID-19. Given the traumatic nature of recent deaths and the denial of regular burial ceremonies throughout the pandemic, I am deeply concerned about the mental health of those who have lost a loved one during the pandemic. The usual support of friends, family and community has been denied to those who have recently lost a family member. The past few months of restrictions have caused great distress for those who grieve. With the loss of so many lives, it is paramount that bereavement support organisations and charities across the North are well supported.
Lastly, in striving to achieve the aims of the motion and the amendments, it is imperative that collaboration continues between private and public-sector organisations, academics, professional bodies, service users and community agencies. Many of my constituents have voiced their fear of returning to normal because "normal" was not working: now is our opportunity to change that.
Thank you, Mr Temporary Speaker. I acknowledge your elevation from the Back Benches, even though it may be only temporary. Congratulations.
I support the motion and the positive merits of the amendments. The past few months have created a significant amount of fear, worry and concern among the population at large but particularly among certain groups, such as those with underlying conditions, older folk and care providers. We had already seen a significant psychological impact manifest itself in increasing levels of stress and anxiety pre-pandemic. However, after three months of lockdown, with changes to many people's usual activities, routines and livelihoods, the levels of loneliness, depression, harmful alcohol and drug use and self-harm or suicidal behaviour are also expected to rise.
The restrictions placed on personal freedoms and everyday social interaction during lockdown have had a profound effect on the emotional and psychological well-being of people in our community. We can all experience mental health problems, whatever our background or walk of life, but the risk of experiencing mental ill health is not equally distributed across society. Those who face the greatest disadvantages in life also face the greatest risk to their mental health.
A study by Ulster University and the University of Sheffield reported that those under the age of 35 living in a city, living alone or with children, with lower incomes, with health conditions and whose incomes have been hit by the pandemic have higher rates of anxiety and depression. The distribution of infections and deaths during the COVID-19 pandemic, the lockdown, the associated measures and the longer-term socio-economic impact are likely to replicate and deepen the financial inequalities that contribute towards the increased prevalence and unequal distribution of mental ill health. Academic research has indicated that instances of mental illness in Northern Ireland during COVID-19 have continued to reflect the 25% higher prevalence than other parts of the UK.
The mental health risk from economic hardship starts early in life. Socioeconomically disadvantaged children and adolescents are two or three times more likely to develop mental health problems. The World Health Organization has determined that material disadvantage trumps emotional and intellectual advantages; in other words, people from poorer economic circumstances are more likely to have worse mental health, even if they have been supported to develop good personal coping and intellectual skills. People with an existing psychiatric diagnosis are also at greater risk of financial inequality and are less likely to be in employment, fuelling their experience of multiple disadvantage. Furthermore, debt itself is an issue. People in debt are more likely to have a common mental health problem, and the more debt people have, the greater that likelihood is. One in four people experiencing a mental health issue face a problem with debt, and people with mental health problems are three times more likely to be in financial difficulty.
Studies have found that unemployment has a range of negative effects, including levels of poverty or a drop in standards of living for those who had a job, stresses associated with financial insecurity, the shame, sometimes, of being unemployed and in receipt of social welfare and the loss of vital social networks. The Organisation for Economic Co-operation and Development has described how loss has a traumatic and immediate negative impact on mental health and has noted that there is further damage where unemployment continues into the long term. A meta-analysis has shown that unemployment is associated with varieties of distress, including mixed symptoms of distress, depression, anxiety, psychosomatic symptoms and drops in subjective well-being and self-esteem. The same study found that 34% of unemployed people experienced mental distress, compared with 16% of those in employment. Importantly, the analysis showed that unemployment causes that distress. Research has constantly shown that unemployment has been associated with lower well-being. Furthermore, job insecurity and restructuring have negative impacts on employee well-being.
Unless action is taken to protect the economic security of vulnerable people and support them in dealing with the resulting stress, mental health inequalities are likely to increase as the pandemic and the economic downturn proceed. Thus, it is a necessity that a collaborative, cross-cutting, cross-departmental and cross-sectoral approach is created. No Department can tackle this alone.
Like others who have spoken, I commend the members of the community and voluntary sector who have done so much during the pandemic not just by delivering parcels and things like that but by keeping lines of communication open. One of the organisations in the constituency that I represent — Whiterock Children's Centre — deals all year round with asylum seekers, refugees, immigrants and people like that, who are vulnerable to begin with, and many other families living in dire poverty. It has continued its operation and scaled it up while the pandemic has gone on. In the Ardmonagh Family Centre, there is a project called "Good Morning, West Belfast" that long predates the pandemic, where volunteers and staff phone up elderly and vulnerable people every day, sometimes twice a day, to make sure that they are all right and that they have someone to talk to. It is not just a quick 20-second call; sometimes, it is a yarn. It is a conversation with people who have no one else to speak to. I commend those organisations.
I want to speak about health inequalities. We were all surprised when the Minister said in Committee the other week that affluent areas had been affected disproportionately by COVID-19. Now that there has been more drilling down into the data, it appears that that was not accurate. I am not surprised. Disadvantaged areas are disproportionately affected by conditions like obesity, diabetes, cardiovascular disease, hypertension and dementia, all of which have been flagged up as serious risk factors for COVID-19. Disadvantaged areas also suffer disproportionately from mental ill health, suicide and addiction. There was a serious mental health crisis before the pandemic arrived. I do not think that anyone here would disagree that the mental health crisis will be immeasurably worse as we move through the pandemic and come out the other side.
Whiterock is a ward in the West Belfast constituency. In previous years, it has been at the bottom of all the socio-economic indices. In the past couple of years, it has moved up the table a bit. It has improved, or maybe other wards have "disimproved" — I am not sure how it works. In any event, Whiterock has always remained rooted at the very bottom of the health domain. Mental ill health is a big, big issue, as are suicide and addiction. Often, as Órlaithí Flynn mentioned, the three are interlinked.
I ask every Member who is in the House today to imagine themselves living in grinding poverty. Maybe you are a single parent living in poor housing that is damp and cold. Your kids are getting ill because of the poor conditions in the house. They are missing school frequently and falling behind and will leave school without qualifications. As we know, kids who leave school without qualifications frequently end up in the criminal justice system. Children are taking their own lives. Parents are taking their own lives and leaving their children behind as orphans. That is the grim reality of life for some of our citizens today. That may be the extreme end of it, but that is what happens day and daily in disadvantaged areas.
Members have mentioned the need for a cross-departmental approach to these issues: I accept that. The Health Minister cannot solve the problems on his own. However, he has a responsibility to do his share of the heavy lifting. We need parity of funding between physical and mental health, and the urgency that has been employed in the fight against coronavirus should be employed in tackling the scourge of mental ill health. When Michelle O'Neill was Health Minister, I constantly said that we should work collaboratively on health, because health —.
Thank you, Mr Sheehan. I just want to bring Members up to date. Five Members are left to speak. I think that, if everyone sticks to their time, we can get everybody in. I am conscious that Mr Carroll from People before Profit is a member of the Health Committee, so I will give him priority now. Then, I will call Mr Middleton, Mr McGuigan, Mr Lyttle and, hopefully, the honourable Member for North Down, Miss Woods.
Thank you for calling me early. Sometimes, Members from smaller parties are not called to speak in debates, so I am glad that you did that. I thank the Members who tabled the motion and the amendments.
During a debate a few weeks ago, the Health Minister made the point that Stormont had failed to support the NHS properly for years. It is the view of many, including me, that Stormont has failed to properly invest in and support people with mental health issues. Over many years, it has failed to invest adequately in mental health services.
As has been mentioned already, people in the North suffer from higher levels of depression, anxiety and PTSD compared with people in the South or in Britain. Mental health problems are 25% higher here compared directly with England, but we spend less per head on mental health services than those places. As Action Mental Health stated, there is an actual 26% underspend overall in mental health services generally. So, we had a massive underspend in mental health services before the coronavirus crisis.
The Department's own language is that the mental health impact is likely to be severe, and GPs have warned of a tsunami of mental health illness after coronavirus. Unfortunately, I do not see wide-ranging or enough actions from the Department or the Minister to reflect that severity or the reality of that increase that people will face after lockdown ends. If we are to really support people with mental health problems with more than just nice, well-meaning words, we need serious increased investment in those services.
I thank the Member for giving way. He does not often get a chance to speak, so this will get him an extra minute. Will the Member agree with me that the Minister has, in the very short period that he has been in place, taken exceptional steps to meet the epidemic of mental ill health and suicide, given that we had a three-year hiatus in this place when mental health was not the priority?
Thank you. I thank the Member for his question. I agree that the Minister has taken measures, but I do not think that they are wide-ranging enough, to be frank, and it is not just him; it is previous Ministers and the Executive as a whole. We have to be honest about that.
In our budget briefing in the Health Committee, we were told that there will be £72 million savings across the health service, or cuts as they are most commonly known, despite being told that we must learn the mantra of COVID-19 or learn the lessons from it. I do not believe that that lesson has been learned in terms of protecting public services.
On top of that, we have seen a 50% increase in significant stress for those people working with people who have had COVID-19. The people front and centre of supporting people with COVID-19 have seen an increase in their stress levels as a result of the work that they are doing.
It is important to recognise that the community came out and clapped for our NHS workers and thanked them for the crucial role that they played throughout the crisis. I am sure that most people here did that as well. It is still a disgrace that those workers have not been paid their strike pay — money that they lost out on because they had to go on strike because their work was not appreciated year after year by this House and Westminster. It is urgent that we press the Executive to cough up and pay those workers what they are owed. For my part, you cannot give vague messages of support to healthcare workers whilst not supporting them when push comes to shove.
Last week, the Health Committee heard from the RCN about the fact that we have at least 2,000 nursing vacancies across our health service. Not only does that create extra pressure and potentially exacerbate mental health problems for those nurses who are working harder than ever, but it does not address the fact that we need to increase our support and investment in the health service generally if we are going to seriously tackle the mental health problems in our community. We urgently need to see an increase in counsellors, psychiatric nurses, those working in addiction services and many more workers if we are to support people in need and the increased demand that we are likely to see at the end of this crisis.
Too often, when we talk about mental health, we talk about it in isolated terms and with very little reference to the environment that people live in, which hugely shapes their mental health. All predictions are that, if we continue along the usual economic path, we will be staring into an economic abyss with the worst recession in 300 years.
Historically, we know that suicide rates skyrocket in times of economic instability. In the 1929 stock market crash, suicide rates increased 50% in a year. There is a direct correlation between unemployment, deprivation, recession and, unfortunately, suicide. We want to see mental health not just as an isolated issue, as Members have said, but as something that is multifaceted and, ultimately, connected to economics and politics. How the Executive approach any new economic strategy needs to change rapidly, not only if we want to protect people's jobs, but to protect their mental health. Stormont needs to embark on an emergency jobs protection and creation programme that intervenes in the economy to —.
I thank my colleagues for tabling this very important motion and to those who brought amendments, because they add to the motion and put a greater emphasis on it as well.
I also thank the Minister for his attendance. In his short time in office he has already shown a genuine commitment to addressing mental health challenges and has committed to doing his share, as others have put it. It is important that all Ministers take their responsibilities for mental health seriously, along with us as MLAs because, as Mr Butler said, we can show real leadership through our actions in this Chamber by making mental health very much a priority.
COVID-19 has brought many challenges that impact on mental health, such as illness, the loss of life and bereaved families unable to attend funerals and be with their loved ones. Many of us took for granted being able to visit our families, our grandparents and our parents or to attend life-changing moments such as being able to be with our loved ones at baby scans, or visiting loved ones in hospitals and care homes. Those all impact on mental health.
The economic impacts, the job losses, the income reductions and the uncertainty will all go on long beyond the COVID-19 restrictions as and when they are lifted. The health impacts will also go beyond coronavirus itself and its physical health implications.
The mental ill health situation in Northern Ireland prior to the pandemic was already at a higher level than in other parts of the UK, with one in five adults here having a mental health problem at any one time. That is approximately 185,000 people. That is very worrying and something that we should all take very seriously.
Mental health issues can affect any one of us, irrespective of our backgrounds, our age, our religion our race or sexuality None of those things make us immune from poor mental health, however there is a need for a cross-cutting approach to mental well-being, given the health inequalities and the longer-term changes to how society operates.
In terms of coronavirus, health inequalities research by the Department of Health has indicated strong links between deprivation, age and gender on infection and admission rates. Similar correlations between the virus and higher risks of anxiety and depression have been found amongst those aged under 35, living in the city, living alone or with children, health conditions, and those whose incomes have been hit.
The motion highlights that this issue is not only relevant to the public health response and health and social care, but is something that has to be tied to and targeted toward the social and economic factors that lead to mental illness. A one-size-fits-all approach cannot be effective. A cross-cutting departmental and cross-sectoral approach is very much required.
I recently met the chief executive and senior management of the Western Trust in my constituency regarding the trust's reset plan as we come out of COVID-19. The plan is about getting our services working again and allowing people to get back into our hospitals for all routine procedures. It is, however, deeply concerning that they have seen a 52% reduction in mental health referrals. That should absolutely concern us, given the evidence that has been produced that suggests that COVID-19 has had a severe impact on people's mental health.
The restrictions placed on personal freedoms and everyday social interaction during lockdown have had a profound impact on the emotional and psychological well-being of people living in our community. Some of the figures in the Queen's University study that Members have already touched on showed that a third of people have met the clinical criteria for depression. That is a very stark statistic. One in five meet the criteria for COVID-19-related PTSD due to the pandemic. The research also indicated that incidences of mental ill health in Northern Ireland during COVID-19 have continued to reflect the 25% higher prevalence than in other parts of the UK. My colleague Pam Cameron highlighted the conclusion of that report and stated that funding should be provided to ensure that support is available.
Finally, I will mention the crisis intervention service in my constituency. It is a service for which we need to ensure funding is available.
All of these plans are welcome. I appreciate that the onus does not fall on just the Health Minister. I urge all Ministers to come together and, once and for all, to tackle the issue of mental health in such a way that we can try to get a resolution to it.
There is no doubt that the measures that were put in place by the Executive during the pandemic would be considered intolerable by everyone in normal circumstances. That those measures had to be put in place to save lives, stop the spread of coronavirus and protect our health service is also not in doubt and, to that end, they have been successful.
One of the positive aspects of the recent period is that communities have rallied round and people have tried their best to support their friends, families and neighbours. However, the reality is that some have struggled during lockdown, some more than others. Nowhere is that more evident than in the cases of people who suffer from poor mental health. Lockdown measures have placed additional challenges on people who were struggling already, so I welcome today's motion and thank those who tabled it and those who tabled the amendment. It gives us an opportunity to talk about those with poor mental health and about how we can improve their situation as we move out of lockdown.
Mental health covers a wide range of issues. Members have dealt with many aspects of mental health issues and solutions, eloquently and with great knowledge and empathy. I agree with their contributions.
I support fully the call for a detailed plan, including on how to rebuild and provide enhanced mental health and addiction services. It is on the subject of addiction and its services, or, unfortunately, lack of services in some cases, that I want to talk. I will always congratulate the Minister, and my constituency colleague, on his good work, when needs be, but I have to say that I am disappointed to see little or no mention of addiction in his strategic framework for rebuilding services in his mental health action plan or in his post-COVID plans.
Lockdown has had a detrimental impact on the mental health well-being of many individuals who are recovering from addiction. I know that because I have spoken to them. There have, obviously, been difficulties in some sectors engaging with service users, due to restrictions. For many, access to support groups formed a key part of their coping strategy and, for some, it was the ability to see friends regularly or to receive routine encouragement and support from family. Others saw their structured groups and services having to close, or experienced staff being redeployed to COVID-19 duties. What concerns me most about the legacy of lockdown is the fact that it is a lot easier to close a service than it is to reopen it.
Having to stay in the house, boredom, and the added stress or worry, perhaps, in situations where more disposable income is available, or in cases where less disposable income is available, have all contributed to the daily struggles of those who suffer from addiction, particularly those in early recovery. For the same reasons, lockdown will have exacerbated the problems for others who are not in recovery — practising alcoholics, prescription or illegal drug users, compulsive gamblers — and brought more despair to them and their families.
Addiction is an illness. It is, unfortunately, an illness that I have some expertise in, as a recovering alcoholic and compulsive gambler, but I am far from unique — far from it. Few families on this island are untouched by the illness of addiction. Statistics suggest that one in 10 people are dealing with alcoholism. Alcohol has become the third most common reason for why people are admitted to psychiatric wards. It is estimated that, every seven hours, somebody in Ireland — on this island — dies because of alcohol abuse. The statistics for illegal and prescription drug use are no better. It is similar for problem gambling, but problem gambling is not even recognised as a public health issue. That needs to be addressed urgently. Most health trusts do not keep records of those presenting with that illness. Despite that, we know that a problem gambler is 15 times more likely to take his or her own life as a result of their illness. We do not have any dedicated Health Department treatment centres here in the North to help problem gamblers. Some will have to pay for treatment in the South. That is not good enough.
Addiction not only ruins lives but costs lives by overuse or suicide.
The outworkings of addiction on society costs our health service vast sums. It costs the police, judicial and prison services vast sums, never mind the societal damage. We are engaged in a false economy. If we are talking about doing things better, why not try better to treat the illness and not the symptoms? Why not treat the illness in the way that we treat any other illness in the health service, with proper funds and resources?
Most people, thankfully, can take a drink, bet in the bookies or online, take prescription drugs or even illegal drugs without fear or hinder. Good luck to them, but for those who cannot —
I will be extremely brief.
I welcome the opportunity to speak in support of the need for the Northern Ireland Executive to prioritise and deliver improved mental health and well-being provision. I will speak briefly on the statutory duty on the Minister of Health to cooperate with Executive colleagues to deliver a joined-up, cross-departmental approach to improved mental health and well-being. I ask the Minister of Health to address the apparent failure to reference the Department of Education and Public Health Agency emotional health and well-being framework for children and young people in the Department of Health mental health action plan and to work closely with the Minister of Education to ensure that the framework is adequately resourced.
I also ask the Health Minister to meet the Northern Ireland Youth Forum and other young people involved in the "Elephant in the Room" campaign and to allocate officials and resources at his disposal to support the delivery of the substantive proposals made by that youth-led campaign. They include the creation of a youth mental health and well-being website to serve as a safe online space that would host relevant signposting information and provide an online support platform that would allow young people to ask questions and receive real-time support to meet their need at an early stage of intervention. "Elephant in the Room" proposals include the explicit inclusion of mental health in addition to physical health in the curriculum. I propose, therefore, that the Minister allocates a Department of Health official and coordinates the allocation of an appropriate official from all other relevant Departments to support the implementation of the youth-led "Elephant in the Room" proposals.
I hope that the Health Minister will take those proposals seriously and act on them. It is vital — indeed, it is a legal duty — that Ministers cooperate to improve mental health and well-being in our community. They will have the support of the Alliance Party to achieve that.
Thank you. I was almost saying I was glad to see you up there giving us a wee bit more say, but not.
Despite the need, we do not talk about mental health enough, so I welcome the opportunity to do so in the context of the COVID pandemic, but a word of warning: we must not just talk about this; we need to deliver something.
There is strong evidence that Northern Ireland has very high levels of mental illness, and suicide rates are the highest in the UK, regardless of COVID. Despite that, Northern Ireland is the only region that does not have an overarching mental health strategy, and the delivery of mental health treatments and care is fragmented and not properly resourced. That must change.
There is not one of us in the Chamber who has not been directly affected or impacted by mental health issues personally or through family, friends or constituents during and before COVID. Many aspects of mental health can be discussed. Some have been, and there were issues before 2 March on what we need to do about perinatal mental health, tackling suicide, addiction, the absolute need for harm reduction, gambling, domestic abuse, living conditions, workplace stress, those feeling lonely and anxious, not to mention the fear that is very real at the moment because of the potential mass redundancies being talked about in certain sectors. The COVID crisis will have psychosocial impacts on people for years to come. As we emerge from lockdown, the changes will pose more difficulties for mental health. That is as true for everyone here as it is for children and young people. Like my colleague Mr Lyttle, I wish to use my brief time to focus on them and how they are still waiting.
According to the 'Elephant in the Room' report:
"In July 2016 the United Nations Committee on the Rights of the Child recommended that the NI Government: 'Rigorously invest in child and adolescent mental health services and develop strategies at national and devolved levels, with clear time frames, targets ... indicators, effective monitoring mechanisms and sufficient human, technical and financial resources'".
At a follow-up event in October 2016, over 100 young people expressed their frustrations at the lack of mental health education and support services available here and called for the UN's recommendation to be fully implemented. I reiterate that call in the Chamber today.
A number of months ago, some Members took part in a political panel organised by the Northern Ireland Youth Forum to try to answer young people's questions and concerns about COVID. It covered issues such as the economic impact, homelessness, housing, exams and schoolwork. Continually raised in the young people's survey and in the discussion was mental health and well-being, how young people are coping with COVID and what will happen after. Sixty-two per cent of respondents to the COVID survey said that mental health was the main issue that they faced as a young person right now. Some 332 responses said that it was loneliness and isolation, and 361 said fear and uncertainty, all of which we know have impacts on mental health.
This not the first time that we, as Youth Champions, have engaged on young people's mental health. In January, we attended a meeting at its head office on the crisis that was being felt among young people. We heard horror stories about what people were going through and how important support was for them. We heard loud and clear that youth mental health services were unable to meet the demand. The Children's Commissioner has also been clear about the need for a children's rights-compliant mental health system that is responsive to children and young people as their needs arise.
The challenges of the aftermath of COVID-19 are very real in all aspects of our lives, but our health and well-being should be at the forefront of any recovery. As the Minister has said, we have a massive task in front of us. There are competing demands for additional spending across many key areas. The Government need to live up to the commitments that they made, but the Executive need to deliver and refocus the goals to where they need to be and properly resource services for people who need them.
There must be no more cuts to the very organisations that exist to help others and support must be available for people of all ages, especially children and young people. We must not continue to prioritise gross value added (GVA) or GDP as the marker of societal progress but see health and well-being as key to the just and green recovery for our generation and the generations to come.
I was hoping that you were going to cut me to 10, to be honest. I congratulate you on the way that you have handled the debate. I thank the Members who tabled the motion and the amendments and all the contributors. It shows the commitment of all in the House, no matter where we sit, in what party or at what level, should it be the Executive, the Committee Chair, the Health Committee or non-Executive party representatives. The conversation in the House this evening reflects a dedication and commitment to truly tackle mental health issues in a way that the Executive and Assembly never have before. I thank the Members for tabling the motion and the amendments, which have provided us with the opportunity to consider the impact of the COVID-19 pandemic on our population's mental health and emotional well-being and to discuss the need to prioritise mental health as a key element of our society's wider recovery.
Since taking up post as Minister of Health, I have been clear that mental health is a priority for me. I am thankful that that has been reciprocated by all my Executive colleagues, as demonstrated by the establishment of the subcommittee on mental health, well-being and suicide prevention. Mr Lyttle asked if I could assign a departmental official to work with other departmental officials to take forward recommendations from "Elephant in the Room". I will go a step further. I will bring "Elephant in the Room" and its recommendations to the attention of the subcommittee the next time that it meets and make sure that that is on the agenda. There are pressures on our young people as we come out of COVID lockdown but also given the changes in society. The mental health pressures and stresses today are something that we never experienced when we were that age. I give you a commitment that we will take that forward at that point. For far too long, people have struggled to access appropriate mental health services when they need them. For far too long, suicide has cast a shadow over our communities and robbed us of too many young lives.
Ms Flynn, I think, made a comment about the legal barriers to dual diagnosis and quoted a response to a written question that she asked me. There are no legal barriers to dual diagnosis services. However, it is accepted that people with dual diagnosis sometimes experience difficulties accessing services. Work has commenced to plan service recovery for addiction services across Northern Ireland as part of the recovery planning process. Mr McGuigan referred to that. HSC trusts will now look at how they can improve the care offered to patients with ongoing and co-occurring mental health and alcohol and drug issues across the full range of existing treatment settings, and the issue of dual diagnosis will be considered in the development of a new substance misuse strategy and in the new mental health strategy. I want to make it clear to the Members who raised that issue today that we are aware of that and are working on it.
I note that Mrs Cameron's contribution at the start of the debate contained an acknowledgement of the officials who, throughout COVID and our responses to it, kept working on mental health and kept working on the action plan and the strategy. They kept it live and kept it in the central place in my Department, and I thank them for the support that they have given me in doing that.
The advent of the COVID-19 pandemic has brought into stark reality how much we value our relationships, our freedom and our health. The pandemic has changed lives around the globe to an extent that we could never have imagined. In Northern Ireland, the situation is no different. It has had a profound effect on our lives, and, for many people, the knock-on effects will be felt for many months, if not years, to come.
The starkest difficulty, as I said at the beginning — other Members referred to it — is for those who have lost loved ones due to the virus or during the pandemic. It changed how we looked at death and how we were able to respect death and support those who needed help at the most trying times. That challenge has affected many families across Northern Ireland. It will take a long time to recover, and they will have to catch up on that grieving process. People have missed wakes and missed visiting somebody's house. Those are big things that we do across these islands, especially on this island, in how we respect families who are mourning and the people who have been lost.
In particular, the impact of the pandemic on our emotional well-being and mental health has the potential to be significant. I know that many of my Assembly colleagues are hugely concerned about that, and I and my Executive colleagues share that concern. I reassure you that I and my Department have already taken steps to mitigate and address the impact on mental health and well-being. This issue will remain high on my agenda, going forward.
Members will be aware that, on 19 May 2020, I published my Department's mental health action plan, which included a dedicated COVID-19 mental health response plan. The response plan provides immediate actions across seven themes to support mental health and emotional well-being in the face of the pandemic. There is the formation of a mental health and resilience working group that is to coordinate the response to the mental health and resilience strategic working group that was established to drive this work at Department level. To support that work, a cell was established by the Health and Social Care Board to join partners across sectors, including the voluntary and community organisations, to take the work forward on the ground. I thank the Members who took the time to mention so many community and voluntary organisations in their communities and in their constituencies. There are so many more that were not mentioned tonight, and they are worth thanking as well.
In regard to the immediate COVID mental health response, much work has been taken forward already and is having a significant impact. I have published a workforce well-being framework that recognises the huge contribution that the Health and Social Care workforce, across sectors, has made to the pandemic response, often at the expense of their own emotional well-being. Ms Bradshaw, I think, referenced the strain and stress on our health workers going to work every day.
What is also apparent, and we must also be cognisant of, is the stress and strains on those who were left in the house when they went out to work. That fear and trepidation about what or who might come home was always in their minds. It is about looking at the entire health family.
The framework that we have produced includes a range of measures to enhance the psychological well-being of staff. Those include access to psychological support helplines that are manned by psychologists. That is also accessible to care home and GP staff. It also includes a broad range of online resources and drop-in services in critical facilities. A staff well-being working group has been established to oversee service delivery and review implementation of the framework. My officials receive regular reports from the group.
We have also provided material to support students who have joined the workforce early in order to ensure consistent public health messaging on mental health. The Public Health Agency continues to provide the 'Take 5' messaging to help people to stay emotionally well during this time of social distancing.
The Minding Your Head website has been revamped to provide a wealth of information, support and advice to the public at this time, all centralised in one simple-to-access website. A range of online and printed resources have also been developed to support children and young people at this immensely difficult time. Psychological first-aid training has been approved and rolled out across Northern Ireland to ensure that help and support can be provided early. Stress Control classes have been provided free of charge online. The six sessions are delivered across three weeks on YouTube. The classes have proven to be very popular, with the uptake for the second class between 6,000 and 8,000 people across the United Kingdom and the Republic of Ireland. That is considered to be a very good uptake. Initial indications of outcomes indicate an improvement in the stress resilience of those who attend. The third iteration of Stress Control started on 8 June. Further classes will be available for the whole population across Northern Ireland, and will start every month from July through to December.
As I said earlier, it is recognised that a large number of people have suffered from bereavement during the pandemic. To support those who have lost a loved one and those who provide help and care to the bereaved, we have published new support material and are developing a bereavement care pathway.
Recently, the Department of Health and the Department for Communities jointly launched a well-being hub, developed by Inspire in collaboration with the Public Health Agency and a consortium of community organisations. That will ensure the consistency of messaging and support across sectors and will help to ensure the right information and advice is received by those who need it, especially those hard-to-reach individuals. Again, I commend those who work in the voluntary and community sector for the huge efforts that they have made and continue to make to support their clients and wider society.
I hope that that reassures Members that much help and support has been provided for mental health and emotional well-being during the pandemic. Mental health services during COVID-19 and service recovery have been mentioned. Mental health services have largely continued throughout the pandemic. GPs have continued to see mental health patients. Referrals to special mental health services have continued. There have, however, been changes in how services are delivered. Many face-to-face meetings have been changed in order to accommodate remote working, including phone calls and video communication for those with the most severe mental illness. Mental health inpatient services have continued. All trusts have put in place stringent plans to ensure that patients and staff are safe. That includes monitoring of service usage at local levels.
The health and social care trusts' mental health services — as, I think, Mr Middleton mentioned — are reporting a reduction in mental health referrals, with one trust reporting a drop of over 60% in referrals to mental health services from GPs between the beginning and middle of March. However, since then, the same trust has seen a steady increase in referrals, with levels, now, higher than before COVID-19. Community mental health services have seen a change in usage. Services have been continued where it has been determined clinically suitable. At no point has there been a blanket stopping of mental health community services.
As we move towards the reset and recovery phase, all trusts have developed recovery plans to bring services back to normal. In doing so, they are incorporating the learning from the pandemic to make the services better as we go forward. I am only too aware that we are at the stage of a surge in mental health needs. Early intervention evidence indicates an increase in need, especially for low-level depression and anxiety. Our health and social care trusts are reporting increases in referrals, heightened acuity of patients and, in general, trends towards new and increased pressures across the secondary mental health services. Much is required to ensure that the mental health response to COVID-19 can meet and adapt to the new challenges and to ensure that all who need mental health care will receive it.
I recently announced the creation of a mental health champion who will support and inform our work on the mental health recovery from COVID-19. The champion will be a public advocate for mental health, communicating the collective voices of people with lived experience, their families and carers, and communities impacted by mental health inequalities. My expectation for the mental health champion is that they will work across public, voluntary and independent sectors and wider society to help better integrate mental health into policies and to provide advice to the stakeholders. To ensure that a champion is in post to help with the post COVID-19 mental health response, I hope to be in a position to announce an interim appointment within a matter of days.
As I have said many times, mental health is one of my top priorities. I am honoured and privileged to be in a position where I can drive strategic change and improvement to mental health services and to improve the psychological well-being and mental resilience of the population. I fully recognise the importance of a mental health response, and it is important that it is not forgotten in our recovery planning. The creation of a mental health champion, the implementation of the action plan and Protect Life 2, and the creation of a new mental health strategy will ensure that we have better services for the future.
When we do this, it is impossible not to recognise the immense work done by our dedicated mental health workers, in the health and social care system and in the community and voluntary sector. Without their dedication, we would be in a much worse place.
In the ongoing transformation of our mental health services, I am fully committed to co-production and recognise the importance of listening and including all who can help in transforming our services. That includes people with lived experience who know what works for them and have valuable lessons that we can learn from and the community and voluntary sector that can truly help us to transform services.
I am, therefore, happy to support the motion and the amendments, and I am thankful to the Members who brought them to the House and to all the Members who contributed.
Thank you, Minister, and thank you for your acknowledgement that I am, indeed, the Father of the House, as the longest server not the oldest Member of the Assembly. There are people in the Chamber who are older than I am. Thank you very much for that acknowledgement. I will identify them later.
Mr Temporary Speaker, at the risk of sounding patronising, may I start by commending you on such a polished performance in the Chair? It makes me wonder whether you have ever considered a career in politics.
As ever, I look forward to the day when we debate and sign off the Programme for Government, which is still in draft form. I remind colleagues that the purpose is to improve the well-being of all by tackling disadvantage and driving economic growth. I can think of nothing more disadvantageous than poor mental health and well-being. In driving economic growth, what better could we do than to ensure that the tens of thousands who are economically inactive, not because they want to be but because they do not have the capacity to be otherwise, become active? If we could fix that, what a magnificent achievement that would be.
I thank Pam Cameron for bringing the motion because it is absolutely on message. As she made clear, one in five of us, at some time in our life, can expect to have a mental health issue. She gave us some shocking statistics to back that and made it clear that that is the current situation, before we get through this public health crisis. The impact of COVID-19 is certain to get worse when we exit furlough and enter what could be a recession or even a depression. I also thank Pam for making it clear, from the get-go, that she supports both amendments. It is hateful when the House divides on an issue of mental health, particularly when it is a non-binding motion, as this one is. <BR/>I thank Órlaithí Flynn for bringing her amendment and for making clear, as many Members have, that this is not just the responsibility of the Minister of Health. This is a cross-cutting issue. In the same way as the Minister of Education is not solely responsible for educational underachievement, healthier children do better in school, well-fed children do better, children in good housing do better. As Mr Carroll said: environment is an important factor in influencing poor mental health and well-being.
We need to look at this not just as a medicalised model. It is not all about pills and tablets. As Mr Butler said when moving the second amendment:
"kindness ... is better than a tablet".
This is the same Mr Butler who said he would not speak for long as Pam Cameron and Órlaithí Flynn had covered it all, and then he spoke for 9 minutes and 41 seconds. However, it was good stuff.
It is not all about pills and tablets; it is about being sociable. These days, we are becoming used to social prescribing. What about the carers? Mrs Bradshaw mentioned the carers. There is a shocking number of young carers and, perhaps, because they are caring and missing out on a normal childhood, the development of mental issues is a slow burn. Cara Hunter mentioned the need for coordination, and we all agree with that. I thank her for, this time, not mentioning her age at the time of the signing of the Belfast Agreement in 1998.
Talking of contributions from youthful Members: Mr Hilditch — the youngest member of the class of 1998 — talked about debt. Debt is not tackled with a pill or a tablet. Often the best people to tackle that sort of thing are members of the community and voluntary sector. We need to look at them. As Ms Flynn will know from chairing the all-party group on suicide prevention, Protect Life 2 is the new strategy on suicide prevention. However, the big concern in the community is that small voluntary and community sector groups that have been dealing with mental health in the community, not for years but for decades, are fearful that the tendering process will knock them out, with big organisations, possibly from across the water, coming in because they are good at tendering but not necessarily so good at delivering the services.
Mr Sheehan talked about the Whiterock Children's Centre and Good Morning West Belfast. As a victims' commissioner, I discovered befriending is a simple and cost-effective way of engaging with people and making sure that they feel loved and are not alone. These things are important for their mental health and well-being.
Finally, I have known Robin Swann since we were both elected in 2011. We have a Minister who is serious and deeply committed to tackling mental health. I thank him for that and for being here this evening.
Go raibh maith agat, a Leas-Cheann Comhairle Sealadach, agus comhghairdeas leat. Congratulations on your promotion to Temporary Speaker. I also welcome the motion today. It is a fantastic motion. I acknowledge the work of the proposer and the Members who put down amendments, and their work, individually and together, to bring the motion to the House.
A lot of ground has been covered, and I do not propose to go over it again at this time of the evening. There are a couple of issues that I will pick up on. First, the issue of carers and the additional burden that they have had placed on them throughout this very difficult time. It is an area that is often considered last, and support for that hard-pressed group is often not mobilised quickly enough, which can have a huge impact on their mental health. We should give carers some consideration in the time ahead.
I also acknowledge the Minister's commitment to mental health in his statements and actions to date. He is committed to working with everyone. I acknowledge the importance given by the House to making mental health a cross-cutting measure and something that we need to get right if we want to improve our poor mental health statistics. As has been mentioned, our well-being, prosperity and economic growth all depend on us getting this part of the equation right. It is good that we have a collective will on mental health issues.
One of the issues for one of the all-party groups that I attend is loneliness. It was touched on today, and it is appropriate that it was. Loneliness is recognised more and more as potentially being as damaging for physical health as it is for mental health, and it therefore ends up putting a strain on not only mental health services but physical health services. It is important that we start to look at strategies across a range of sectors for dealing with loneliness in not only older people but younger people, who we have significant concerns about in regard to mental health and loneliness. We also need to look at how we can reach into rural communities to provide ways to support them on an ongoing basis.
I welcome the Minister's mention of early intervention. From my experience of working as a social worker on a crisis response team, I can confirm that early intervention is just as important for mental health as it is for physical health. That is the case not only for the outcomes for the individual concerned but for the complexity of treatment that is required and in how chronic the condition can be. If we could start to move resources into earlier intervention, we will, over a period of time, see significant improvements.
There has, rightly, been a huge acknowledgement in the Chamber for the community groups that have helped in this emergency crisis and that have stepped up and filled some of the statutory service roles or roles that, in the new reality that we face, were absent for a period of time. In my area, the Niamh Louise Foundation and a lot of the GAA and other sporting bodies formed pop-up COVID groups overnight and provided food and support to their local area. That was all very welcome.
I welcome the contribution on the community and voluntary sector, but I must say that I am slightly disappointed that we do not see more of those community and voluntary voices on the management board. I am hopeful that a way will be found to include a wider range of voices in that conversation. In rebuilding or, indeed, building new services, it is vital that we get as broad a range of perspectives as possible.
The other matter that I think we heard about — this is a theme that we have dealt with on the Health Committee — was addictions. I acknowledge the very personal experiences of addiction that were shared in the House today. Dual addictions and dual diagnoses are well recognised as some of the most difficult areas to get help and support into, and, again, that is where we need to put our resources.
I commend the motion and the amendments, and I once again thank everyone for tabling them today.
I just want to say a few words before I get onto Members' comments. I thank all the Members who are in the Chamber this evening for supporting the motion and the amendments. That means an awful lot to me, as you will maybe see we as go on. I think that the people of Northern Ireland will be delighted to see that we can all actually agree on a motion. That is the way to go, and I hope that it is something that we all remember.
How many times has the Assembly had debates on mental health over the years? Probably dozens, yet, despite all the debates and all the initiatives by successive Ministers, we never seem to be able to really get to where we want to and to get on top of mental health, but it is such a huge issue. That is why I am so pleased at the response from Members this evening.
This is not an easy thing for me to say, but I suffer from anxiety and depression, and at times it is difficult. At times every day, it can be a battle for me. Some will think that it is a weakness on my part to admit that. You can be the loneliest person in the world yet be the busiest, especially me, being a politician, yet you live your life helping others but are scared to admit your own vulnerabilities because of what others may think.
As we start to come out of lockdown and the world around us starts to crank up, the impact that COVID-19 will have on our mental health and well-being will be staggering. We in the Assembly must all come together to tackle what will be a huge task before us. The impact of COVID-19 on mental health is expected to be severe. International evidence indicates short- and long-term direct effects on mental health and psychological well-being and, in some cases, increased risk of suicide and post-traumatic stress. The causes that have had a direct effect on psychological well-being are clearly identified. These are social distancing, isolation, bereavement, unemployment, financial hardship, the inability to access health and social care services and increased work pressures. People who have had to shield for months may feel anxious and unsure about going outdoors. We need to help them.
Early indications in Northern Ireland showed that, for those with the most severe mental health, there was a drop in demand between February and March. However, since then, demand has increased significantly and the daily bed-occupancy level is around 95%, which is quite staggering. There is also an increase in new presentations of those seeking mental health services.
These are the problems we are experiencing because of COVID-19, but in Northern Ireland before the COVID-19 pandemic, mental illness was the largest cause of ill health and disability in Northern Ireland. Prior to the pandemic, Northern Ireland is estimated to have had higher levels of mental illness than other regions in the UK, with one in five adults affected, or 185,000 people — that is an absolutely immense number — having a mental health problem, all at the same time. Some 21% of women and 16% of men had mental health issues, and across Northern Ireland, 45,000 children had mental health issues and problems. In 2015, there were 318 suicides. Despite the Northern Ireland Suicide Prevention and Protect Life strategies, we continued to have a huge issue.
There are so many processes and initiatives out there that are good and positive, but at times it may be simplicity that will best help our mental health and well-being. In the Assembly, we must support the Health Minister on this issue to do all he can to help our population. Minister, you have my support.
Challenges of how we work, are able to interact and even visit our loved ones, will all change, and have changed due to COVID-19. That is why the Minister's launch of the strategic framework for rebuilding services will be so important. It is vital that mental health and well-being are at the centre of it.
The Minister for Health has announced some good things and good strategies, such as the process for a mental health champion. That role will be vital over this period, and will be needed to support the community and staff in the health and social care sector, who must not be forgotten.
The new Executive working group on mental health and well-being has been established. It is going to be vital, also, and it must prioritise mental health as we work through the outcomes of the COVID-19 pandemic. I warn people that the COVID-19 virus is far from over. We have a long way to go and we cannot forget that.
It is vital that we provide advice through the mental health response plan. Support is important, such as online classes for stress control, apps to access libraries for reading, support for health staff, especially nurses and social care workers, and dealing with our past, which we, as an Assembly, have failed to do.
We must remember the independent sector, and those offering counselling services, to help us address mental health waiting lists. Their input and help is going to be crucial. Funding must be made a priority for them. We need them to be able to open, as a matter of urgency.
We do not have a happy population, and we have to ask ourselves why that is. Have we been part of the reason? What are we going to do to address it? Hopefully, this motion will go a long way to help. That is why I am delighted at the response of Members.
I will now address some of the Members' comments. I hope that I keep to time, as I work my way through them. I thank Pam Cameron for tabling the motion. She mentioned that mental health needs to be at the forefront of health, wanted to work with the Minister, and praised front-line health staff.
Gerry Carroll said that Stormont had failed to protect people's mental health and that there was a 26% underspend in mental health spending. That needs to be addressed.
Paula Bradshaw said that we should focus on those in lockdown and what they had been through. She mentioned the spike in sexual offences and praised the many organisations which had helped deal with it. She mentioned the mental health action plan and said that there needs to be serious investment. I hope that is accurate.
I will deal with the contribution by Colm Gildernew, the Chair of the Health Committee, last. Sorry.
Órlaithí Flynn said that there was a challenge to improve mental health and well-being. She mentioned the substance abuse strategy, and thanked the Minister for supporting her on that. She wants the Minister to be the champion for mental health and is worried about the lack of funding for the mental health action plan.
Pat Sheehan commended the community and voluntary sector. He mentioned how affected disadvantaged areas have been throughout the COVID-19 pandemic. He said that he wanted to highlight the fact that there was a serious mental health crisis before COVID. He also wants to see parity of funding between mental health services and physical health services.
Rachel Woods said that we do not speak about mental health enough — I hope that I did today — and that words are no longer enough. I agree: words are not enough any more. We have been here too many times before, so we need to do something about it.
Robbie Butler, I have to say that I was impressed with you the most tonight. I was impressed with everyone, but you were outstanding. I am never saying that to you again, but you were.
Yes. It is a one-off. You mentioned how important perinatal health is. You said that we need to tackle addictions and poverty. You spoke about tackling gambling. You said that you want us to target a zero suicide rate. That is very commendable, if we could do that.
The Member said that he wants real progress to be made on mental health and the action plan. He mentioned loneliness and isolation and said that we need to try harder. He thanked the health staff and those in the community and stated that we cannot do this without them.
Miss Hunter said that we need to plug the gaps in mental health and mentioned the support that voluntary groups need. She spoke about the rural community, which not many Members did, so well done on mentioning its need for support. She also talked about the help that bereavement support services need.
David Hilditch mentioned the impact of the lockdown on the community's mental health. He mentioned debt and said that one in four people with debt has mental health issues. He also spoke about the stress of financial insecurity and unemployment.
Gary Middleton said, and I agree, that the Minister has shown a commitment to tackling mental ill health. He said that mental ill health was already a serious issue before COVID-19 and that it affects so many different people, right across society.
Philip McGuigan said that the community has rallied round as a result of COVID-19. He said that he is disappointed at the lack of addiction services and by the fact that the issue was not really mentioned. Well done on that.
Finally, I say thank you to everybody for supporting the motion. It has really made me very happy tonight to see that. Let us move forward together and improve the lives of our people.
We overran by 38 seconds, which is not too bad. It is the debate that overran, not Mr Easton.
I thank everyone who has made this such an easy debate to chair as Temporary Speaker. I pay tribute to Mr Easton and Mr McGuigan for the honesty and courage that they showed, which added to the debate. I also thank Mr Chambers and Mr O'Dowd, who sat through the debate but did not get a chance to speak. That serves as an example to other MLAs to show an interest in a debate even though they may not get the chance to stand up and contribute.
Question, That amendment No 2 be made, put and agreed to.
Main Question, as amended, put and agreed to. Resolved:
That this Assembly recognises the importance of prioritising mental health and well-being as part of the COVID-19 recovery; notes that the long-term impact of the pandemic on working practices, everyday social interaction, individual coping strategies, and hospital or care home visiting will present new and substantive challenges to individual mental well-being, especially among the most vulnerable; stresses, therefore, the need for refreshed and reformed mental health and well-being service provision that recognises the structural barriers to addressing a dual diagnosis of mental illness and an addiction; further notes, to this end, the transformative role played by community and voluntary providers whose services are subject to increasing demand; and calls on the Minister of Health to outline plans to tackle mental health problems, mental illness and addictions related to COVID-19 moving forward; and further calls on the Executive to support a cross-cutting and outcomes-based approach to providing the funding and resources needed to maximise the health and social care and the community and voluntary sector's capacity to contribute to addressing poor mental health and promoting well-being.