Mental Health Strategy 2021-2031

Ministerial Statement – in the Northern Ireland Assembly at 10:30 am on 29th June 2021.

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Photo of Christopher Stalford Christopher Stalford DUP 10:30 am, 29th June 2021

I have received notice from the Minister of Health that he wishes to make a statement. Before I call the Minister, I remind Members in the Chamber that, in the light of the social distancing being observed by parties, the Speaker's ruling that Members must be in the Chamber to hear a statement if they wish to ask a question has been relaxed. Members participating remotely must make sure that their name is on the speaking list if they wish to be called. Members present in the Chamber can do that by rising in their place, as well as by notifying the Business Office or the Speaker's Table directly.

I remind Members to be concise in asking their question. This is a ministerial statement and not a debate, and long introductions will not be allowed. I also remind Members that, in accordance with long-established procedure, points of order are not normally taken during a statement or the period for questions thereafter.

Photo of Robin Swann Robin Swann UUP

Thank you, Mr Principal Deputy Speaker, for the opportunity to speak today on the important topic of the new 10-year mental health strategy.

As we are all aware, mental ill health is one of the greatest challenges facing us today. The COVID-19 pandemic and the restrictions on everyday life have had and will continue to have a significant impact on our population’s mental health.

It is currently estimated that the long-term effects of the pandemic may create up to 32% more referrals over the next three years. That means more than 19,000 referrals in adult mental health, over 5,000 more referrals to psychological services and over 24,000 more unscheduled care contacts.

That is at a time when our mental health services are already under significant pressure. Inpatient mental health services are under extreme demand, with health and social care trusts consistently operating above 100% bed occupancy levels in acute adult mental health services. We hear stories of patients who have to wait for very long periods in emergency departments under PSNI supervision, as there are no beds available in mental health, and of patients on mattresses on floors.

Equally, our community mental health services are experiencing increased referral rates and heightened levels of acuity. I have heard stories of patients desperately seeking help without being able to receive the help that they need. There are patients as young as eight needing specialist help for eating disorders and older people starved of human contact without the ability to get help for the mental illness caused by loneliness.

Since becoming Health Minister, I have made mental health one of my top priorities. I want to make sure that those who need help with their mental health can receive the help and support that they need when they need it. I have shown that it is not just about words and platitudes but about action. In the last 18 months, I have published the mental health action plan, including a COVID-19 mental health response plan, and I have appointed Northern Ireland's first ever mental health champion. I have approved the creation of a specialist perinatal mental health service and managed care networks for both child and adolescent mental health services (CAMHS) and forensic mental health. I have also established a £10 million mental health charities support fund and initiated change across mental health services.

Across mental health services in Northern Ireland, we have a dedicated workforce who give their all to help and support those in need. I am extremely thankful for their hard work, in particular during the difficult circumstances of the last year. Going forward, we must equip those working in mental health services with the right tools and systems to ensure that they can help those who need help. We also need to work closely with our partners in the community and voluntary sector to reform our mental health services.

I am therefore pleased to announce the publication of the new 10-year mental health strategy 2021-2031. The strategy sets out 35 actions to initiate reform of our mental health services. It sets a clear direction of travel to support and promote good mental health, to provide the right early intervention to prevent serious mental illness, to provide the right care and treatment when people need specialist help and to provide new ways of working across mental health services. The strategy is built on a vision of a society that promotes emotional well-being and positive mental health for everyone, supports recovery and seeks to reduce stigma and mental health inequalities. Our vision sets out the aim for a regionally consistent system that provides equality and equity of service for everyone. We also want to break down barriers so that people are put in the centre.

The strategy is divided into three themes. The first theme — promoting mental well-being, resilience and good mental health across society — is key to removing and reducing the stigma associated with mental ill health. It provides actions for early interventions and prevention across the lifespan and considers those who care for people with mental ill health. The second theme — providing the right support at the right time — provides service improvements, including improvements across the whole lifespan. It also outlines actions to integrate primary care and secondary care and the community and voluntary sector into service delivery. The theme puts the vision of truly person-centred care at the core of the reform work. The third theme — new ways of working — provides actions to create system change to allow effective and efficient delivery of mental health services and to promote innovation and research in order to improve mental health outcomes across our population.

While all the actions in the strategy are important, I would like to highlight a number of them today. Action 2 is to create an action plan for promoting mental health through early intervention and prevention, with year-on-year actions covering a whole-life approach, from infancy to older age. The action plan will consider groups disproportionately affected by mental ill health, who often struggle to access early intervention services, and seek to reduce the stigma associated with mental ill health.

Action 10 seeks to increase the funding for CAMHS to 10% of the funding for adult mental health services. That will allow for real service improvement, and will continue to ensure that there is increased funding for CAMHS every time adult mental health services receive additional funding. Action 15 will change how mental health services are structured, with a greater focus on the community. That will bring mental health services closer to the person who needs them, where they have support from family, carers, friends and others. Action 17 seeks to fully integrate the community and voluntary sector in the development and delivery of mental health services. That will recognise the good work that is carried out outside the statutory sector and will bring those valuable partners into the work to improve mental health outcomes. Action 31 will create a single mental health service. That will be done not by removing HSC trusts, but rather by supporting them in their work through regional cooperation and consistency.

Unfortunately, mental health services in Northern Ireland have historically been underfunded when compared with those of other jurisdictions. For example, it is estimated that funding in Northern Ireland is 27% less than in England and 20% less than in the Republic of Ireland. That is despite mental health need being assessed as up to 25% higher here than in England. The strategy is therefore ambitious and provides the much-needed reform of our mental health services. However, delivery will be dependent on the provision of additional and sustained funding.

To outline the investment that is needed for the reform, I have published a funding plan together with the strategy. The funding plan identifies significant investment need, with an estimated need of £112 million to £158 million revenue funding per annum and a £285 million one-off capital investment. The funding plan outlines an investment need of £1·2 billion over the next 10 years to fully implement the strategy. At that level, it is therefore clear that my Department does not currently have sufficient funds available to implement the strategy unless significant levels of existing activity are ceased. Additional investment from outside the Department will therefore be required to make the strategy a reality. It will require a collective effort across the entire Executive to bring about the much-needed reform of mental health services. I am therefore working closely with my Executive colleagues to ensure that provision of the necessary funding is prioritised in the next Budget process.

Four actions in the strategy have been identified as key enablers. That includes staffing resources in the mental health system for implementation, the regional mental health service, the workforce review and the outcomes framework. My Department has identified funds in 2021-22 to initiate those four key areas of work, which will set the foundation for the strategy going forward.

In conclusion, it is accepted that the pandemic is having a significant impact on the mental health of the population. It is also accepted that our mental health services are in need of reform. The new mental health strategy that I am publishing today is the blueprint for that reform. Before concluding, it is worth noting all the people who have supported the development of this strategy. The strategy is the result of genuine co-production. Over the past year, hundreds of people have been involved in meetings, workshops, online events and direct communication with my officials on how we can ensure that we have mental health services that are fit for the future. That includes service users, carers, professionals, community and voluntary sector groups, and many others. In addition, I want to pay particular tribute to officials in my Department. From the moment that I entered the Department of Health, I have been hugely impressed by the commitment, professionalism and unwavering dedication of the staff in the mental health team. In particular, I want to commend Tomas Adell, head of the adult mental health unit, who has been the real driving force behind the strategy, along with Peter Toogood, the new mental health director in my Department. Without their efforts, along with the support of everyone else, the work to develop the strategy would not have been possible. I want to extend a huge thank-you to everyone who has been involved in that work.

Together, we can continue to reduce stigma around mental ill health. Together, we can improve services and the mental health system. Together, we can improve mental health outcomes in Northern Ireland. I commend the statement to the Assembly.

Photo of Christopher Stalford Christopher Stalford DUP 10:45 am, 29th June 2021

Thank you, Minister. We now proceed to an hour of questions on the statement. An hour is the maximum time, and I have lots of Members listed, so please focus questions so that I can get as many people in as possible. One person who will get a bit of leeway is the Chair of the Health Committee, Mr Colm Gildernew.

Photo of Colm Gildernew Colm Gildernew Sinn Féin

Go raibh maith agat, a Phríomh-LeasCheann Comhairle, and go raibh maith agat, Minister, for this very important statement on important and central work. I acknowledge the work of your officials and of the many organisations and activists involved in developing the strategy. In the Committee, we have engaged very effectively with Tomas and Peter on a regular basis. That is welcome. I also welcome the indication in the statement that the stakeholders in the charity and voluntary sector will be more centrally involved on an ongoing basis. That is to be welcomed and is the right approach, so go raibh maith agat mar sin.

Minister, access to GP services is increasingly under pressure, and, given their workload, GPs are also under pressure. However, access to local, accessible and effective counselling services is also difficult and can be a postcode lottery. Depending on where you live, GPs, in many cases, do not even provide counselling services. Can you outline how this strategy will ensure that there are accessible counselling services locally so that patients do not have to travel large distances to access services?

Can I ask you for some details on the review on the mental health workforce that you identified? In particular, when will that be complete? Will it have clear recommendations on the staff numbers and roles that are needed going forward?

Photo of Robin Swann Robin Swann UUP

I thank the Chair, including for his acknowledgement of the engagement that my officials have had with the Committee and the engagement that the Committee has had with the voluntary and community sector in bringing forward the publication of this strategy, which was done while we were dealing with the pandemic as well.

There is a specific section in the mental health strategy on the workforce review. The outcomes are to present a well-supported workforce that is fit for the future and meets the needs of all those who are mentally ill. It is also about increasing the number of training places for mental health professionals and increasing the number of staff employed. Over 20% of mental health nursing posts in HSC trusts are currently vacant, and while the number of psychiatry posts is not higher than in the rest of the UK, the use of locums to fill those vacant posts is very high. We have a combined locum and vacant post rate of 22%. Whilst locums can fill those duties, it is not the same as having a permanent post. The work is in there on how we fill those posts on a long-term basis and in a sustainable system. The funding plan mentions the investment that is needed to sustain those posts over the next 10 years, which is the duration of this strategy.

On the issue of local engagement, there is a desire and an indication in the mental health strategy to produce mental health hubs to ensure that provision and support is closer to the people who need it and in the communities where they need it. We engage in both primary and secondary care delivery to do that. It is about that engagement and that multidisciplinary-team-approach that we have seen work elsewhere, and that will also be delivered through those local mental health hubs.

Photo of Gordon Lyons Gordon Lyons DUP

I welcome the statement, and I hope that it makes a real difference in the lives of the people whom we represent. There are, however, a couple of very stark figures in the document, the first of which is the fact that COVID restrictions and the impacts of the pandemic have led to a 32% increase in referrals. That is shocking, and we need to be wary of that in the House when we are bringing in regulations. The other figure is the huge financial gap that exists and the fact that our funding is 27% lower than that in England, even though our need is 25% higher. We need to deal with that funding issue, and we need to deal with treatment. Does the Minister agree that we need to look not only at treatment but at building resilience and early intervention, because that is key to helping people and saving money in the long term? Finally, I say to the Minister that the facilities that we have are incredibly important. We need 21st-century facilities, not 19th-century facilities. To that end, can he give an update on the acute mental health facility that is to replace Holywell?

Photo of Christopher Stalford Christopher Stalford DUP

Wait just one second: I counted three questions. To ensure that people further down the list get their chance, it is only fair — I am glad to see the Member for North Down nodding in agreement — right and proper that they get that chance.

Photo of Robin Swann Robin Swann UUP

I thank the Deputy Chair for his questions. You counted three questions, Mr Principal Deputy Speaker, but I counted five.


I will take them in order but at a high level so that other Members have a chance to ask questions.

With regard to the capital programme, there is a sustained item in the mental health strategy relating to the required capital investment: we need £285 million. That is also covered in the funding plan, which addresses the three mental health facilities that have already been earmarked to be updated and upgraded from their current state. The Member is right about the investment that is needed in physical build and capital structure. The strategy sits alongside the funding plan because of the need for that collaborative approach.

The impact of COVID on mental health has always been at the front and centre of the Department of Health's decisions and its recommendations to the Executive. As a former Minister, the Member knows that that discussion on mental health, as well as commentary and input from the Chief Medical Officer about how to take those recommendations forward, have always been taken into consideration. The funding gap is historic. In the House, we know that that issue has been there for some time, but it is about how the strategy and the associated funding plan sits alongside that to address the gap. The strategy also sets out to address some of the inequalities and internal funding issues in mental health. That is why there is a specific commitment to support CAMHS financially. The additional moneys that come in for mental health will also be invested in CAMHS so that it gets the 10% uplift and support that it needs.

Photo of Cara Hunter Cara Hunter Social Democratic and Labour Party

I thank the Minister for his statement and for his ongoing commitment to mental health and suicide prevention, which is most welcome.

In action point 15 of the statement, Minister, you mention restructuring mental health services to bring them closer to the individual who needs them. My constituency is very rural, and there is limited access to crisis support services, specifically from midnight to morning. What will action point 15 mean for rural constituents?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her point about accessibility to mental health support, which she has often raised. Point 50 of the strategy highlights certain sectors and individuals and explicitly refers to the rural and farming community, in which mental health is a particular concern. As the Member knows, that is due to physical isolation from communities, worries about livelihood and anxiety around personal and family safety. Research conducted by the Farm Safety Foundation revealed that 84% of farmers under the age of 40 believe that mental health is the biggest hidden problem facing farmers. It is therefore important to reach out to harder-to-reach groups and intervene early in order to prevent the onset of mental health problems. That is why we have put forward action point 15 about the creation of mental health hubs. Those hubs will be supported to make sure that people can access that support when and where they need it rather than having to go elsewhere so that there is a "no wrong door" approach to mental health and that people can get support when they need it.

Photo of Robbie Butler Robbie Butler UUP

You are clearly a Minister who tells people what you are going to do and who then delivers on your promises. Today, you have delivered the good news on what you promised to do. As the mental health spokesperson for the Ulster Unionist Party, it is great to take part in the announcement today.

The publication is very welcome. The Minister is well aware of pressures, particularly around child and adolescent mental health. I know that the Minister also recognises the sterling work of Pure Mental NI and the Crisis Cafe, among other youth groups. What commitments from the strategy might help to transform child and adolescent mental health services?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. As I mentioned earlier when I was answering questions from the Deputy Chair of the Committee in relation to CAMHS, a number of actions in the strategy are designed to improve support for children and young people with mental health needs.

Those are to promote:

"positive social and emotional development throughout ... childhood, ... enhanced and accessible mental health services for those who need specialist mental health services, including children and young people with disabilities ... parents and families".

The strategy also includes a commitment to increased funding for CAMHS to:

"create clear and ... consistent urgent, emergency and crisis services for children and young people".

My team worked closely with organisations such as the Northern Ireland Commissioner for Children and Young People (NICCY), the Prince's Trust and Action Mental Health during the consultation and development of the strategy to ensure that children and young people were involved. A children and young people's version of the strategy was produced to encourage and facilitate the engagement and involvement of children and young people in the consultation process.

Photo of Paula Bradshaw Paula Bradshaw Alliance 11:00 am, 29th June 2021

Thank you, Minister, for the statement. I look forward to reading the blueprint in more detail later today.

You mentioned mental health hubs. Before I entered politics full-time, I worked in the community sector and was aware that mental health hubs were being set up. Part of the issue was that there was a lack of resources and support when people came forward. Are you satisfied that enough money will be put into the hubs to make a difference? What engagement have you had with the Minister for Communities on additional funding for the community and voluntary sector? The sector has a vital role to play in dealing with issues such as isolation.

Photo of Robin Swann Robin Swann UUP

I thank the Member for her question. The funding for the mental health hubs is laid out in the document that goes along with this showing what the recurrent financial commitment will be over the 10 years. As I said, publication of the strategy does not indicate that I have the funding to deliver it. The strategy is about the direction of travel, which is what I was asked to undertake and produce and what we have done. It is now about seeking the further, long-term, recurrent investment in all the aspects that need to be stepped out over the next 10 years to provide the support and the change of service that we need.

I have ongoing conversations with the Minister for Communities on how we can further support the voluntary and community sector. The Member will be aware that I announced a £10 million mental health support fund, which will open on Monday. The fund is open to all charitable organisations that offer support services to people with mental ill health throughout Northern Ireland. Groups will be invited to submit proposals on themes that are key supports to mental ill health as a result of the COVID-19 pandemic and strengthen the person-centred approach in the new 10-year mental health strategy, so that funding ties in with the work that we have announced today.

Photo of Jonathan Buckley Jonathan Buckley DUP

I thank the Minister for his action plan. One of the most startling elements of the statement is the estimated 32% increase in mental health referrals due to COVID and the restrictions. It is fair to say that it is not just legacy restrictions; current restrictions are having a terrible impact on the mental well-being of many of our citizens. Last week, I saw a distraught constituent who could not visit their gravely sick mother because of restrictions in the hospital that she was in. That was not the first instance that I have had. Will the Minister intervene to end the visitation fiasco that is having such a devastating impact on the mental well-being of many of our citizens, who are already in a difficult situation regarding the health and well-being of their loved ones?

Photo of Robin Swann Robin Swann UUP

We keep hospital visitation under constant review. The next review is due on 9 July. We will look at the where the pandemic is then and will make a risk assessment. I want to correct the Member: I did not say that the 32% increase in referrals was due to restrictions; I said that it was due to the effects of the pandemic. There is a complete and justifiable distinction between the mental health effects of the pandemic and the effects of the restrictions that were put in place, which the Member was referring to.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Minister for his statement. Supporting those with a dual diagnosis of addiction and a mental health condition has been a long-term failing. I know that my colleagues Carál Ní Chuilín and Órlaithí Flynn have raised the issue numerous times.

I note that the draft strategy mentions creating a "managed care network". What assurances can the Minister give that, in a year's time, those who access the managed care network will see an improvement in their lives after being repeatedly let down?

Photo of Robin Swann Robin Swann UUP

I thank the Member. She asks what will happen in a year's time. I ask her for her support, along with that of her party colleagues, especially the Finance Minister, to ensure that, in a year's time, I have the funding commitment that is set out in the funding plan, not just for a year but for the 10 years as set out in the entire strategy, to do what is needed.

The Member raised dual diagnosis with me, and she and a number of her colleagues have often raised that. There is a specific section in the mental health strategy, from point 183 onwards, where we look at the outcomes for those with co-current mental health and substance use issues. The strategy targets these outcomes:

"A reduction of patients with a co-current mental health and substance use issue that are non-compliant with mental health treatment A person centred approach to care that focusses on the person, rather than expecting the person to fit the system. Better health and social outcomes for those with co-current mental health and substance use issues. People with co-occurring mental health and substance use issues receive high quality, holistic and person-centred care."

The strategy also states that the guidelines on dual diagnosis are clear in that services should work collectively to address the person's needs. I will go back to an earlier comment and say that, in this strategy, we want to focus on how:

"A managed care network will be created to ensure a no wrong door approach" and that the person will receive the support that they need when they go to the first door.

Photo of Nicola Brogan Nicola Brogan Sinn Féin

I thank the Minister for his statement this morning. Minister, I welcome your commitment to include infant mental health in the overall strategy. In relation to funding the strategy, will you outline where the £285 million one-off capital investment will go? Will it go into a perinatal mental health unit, an eating disorder inpatient unit or maybe even the acute mental health unit in Omagh that was agreed in 2016?

Photo of Robin Swann Robin Swann UUP

I thank the Member for raising that last point. I heard the tail end of her petition yesterday, when she referred to the £400,000 for the mental health facility in Omagh as a "sticking plaster". Bringing that facility up to an acceptable standard is necessary work. The Member will see in the funding plan that the £285 million will go to the commitment to wider capital investment that we need to put in place. The majority of it is earmarked for the three mental health hospitals that have been identified across Northern Ireland. Part of that input is for the Omagh facility that the Member has called for and submitted the petition for yesterday. I have not yet received the petition, but I will respond formally to her on it.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Minister for his statement. It signals a positive step forward in our long-running battle to reform mental health services to make them more widely available and accessible and to ensure investment in mental health. Mental health is a massive issue and problem here that must never again be swept under the carpet or suffer from chronic underinvestment.

The challenge for all of us and for all Departments is to make sure that Departments do not just buy into the strategy but pay into it. What confidence does the Minister have that Departments will work beyond their silos and, in particular, that the Department of Education will ensure that building mental well-being and resilience is central to our children's education?

Photo of Robin Swann Robin Swann UUP

I thank the Member for those two points. There is a specific section in the strategy on supporting young people from early years onwards. The Member will also be aware that, recently, the Minister of Education and I co-funded a support package for schools. The Department of Education put in £5 million, and we supplied £1·5 million for that support. It is about early intervention, which leads to prevention. In light of that, action 5 in the strategy seeks to expand that early intervention process. The strategy also highlights the use and delivery of alternative methods of therapy, including art therapy, music therapy and the incorporation of different methods of delivery in our day-to-day models.

On the financial commitment, I listened to the Minister of Finance making his statement yesterday, when he said that health was an Executive priority. Mental health is a Department of Health priority. We have to rebalance the imbalance that has been there over the past number of years in investment in our facilities and our workforce, and we need to fund the work that needs to be done. There is a challenge and a job to do. That is why we deliberately set about publishing not just the strategy but the funding plan needed to deliver it. It is not just an abstract document that will sit there. We can see what the money is needed for, where it can be invested and the outcomes from that investment.

I acknowledge that the Minister from the Member's party, the Minister for Infrastructure, has already made a commitment that, if it is necessary for surrenders to be made from departmental budgets, she is up for that, so that we can get health back to where it should be in Northern Ireland.

Photo of Alan Chambers Alan Chambers UUP

It is to the Minister's credit and that of his staff that his Department can bring forward such important work while still dealing with the COVID-19 pandemic and all its associated consequences.

I thank the Minister for his statement. For the first time, it appears that we have a Minister who not only recognises the historical underfunding of mental health services but is prepared to take action to rectify it. As other Members have mentioned, the strategy has a big financial ask. Is the Minister confident that he will have the full support of the rest of the Executive to deliver on the actions and improvements in the strategy?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. In my opening comments, I said that the time for warm words and platitudes was over. That is what the action plan and the funding plan are about, so that I can present the financial ask to ministerial colleagues. What is needed to deliver the strategy has been costed by my departmental officials. I will continue to engage with ministerial colleagues on the necessity of investing now. It is really about investing to save. We have to invest now in the mental health and well-being of the people of Northern Ireland so that we do not see increasing pressures and expanding waiting lists as we try to address the mental health needs of our population.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

Minister, over the past number of months, I have engaged with school leaders in my constituency, and it is clear that the mental health support system in our schools is under considerable pressure. It was under considerable pressure and has become all the worse as a result of the pandemic. Given that mental health in our schools is a cross-cutting issue, what engagement have you had with the Education Minister or Ministers over the past while? What will you do to ensure that our young people get the support that they need in the school system?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. Having transferred from the Health Committee to the Committee for Education, he brings knowledge about what work can be done across the system.

The mental health strategy's specific section on young people includes, as I said earlier, the "'no wrong door" approach, especially for CAMHS. Should we get to that stage, action 7 of the strategy is:

"Create clear and regionally consistent urgent, emergency and crisis services to children and young people."

The Member asked about the investment that the Department of Health and the Department of Education could make together. As I said in response to an earlier question, a number of months ago, the two Departments announced a joint funding package for mental health supports in schools. Some £5 million came from the Department of Education, which was supported by £1·5 million from my Department. That is the first step. That is an investment in the mental health and well-being of our young people to build in early-age resilience.

They know now that mental ill health is not a stigma that needs to be hidden. They should be talking about it, should they feel that they are under strain and pressure from social media and all the other changes in society that the Member and I did not have to face at that age.

Photo of Christopher Stalford Christopher Stalford DUP 11:15 am, 29th June 2021

I dare not venture to guess when it was that you were that age, Minister.

Photo of Stewart Dickson Stewart Dickson Alliance

I thank the Minister for his statement. It is important, because Northern Ireland has fallen dramatically behind on mental health care. What engagement has the Minister had with the mental health strategy developed by the youth mental health steering committee's Elephant in the Room project and the specific recommendations that it made on mental health and young people?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. As I said earlier, my officials have engaged widely with stakeholders and groups on the consultation and in other engagements that we have had on producing not only the strategy but the action plan.

I was introduced to the Elephant in the Room group by the Member's party colleague Chris Lyttle, in his role as Chair of the Education Committee. At that point, we were able to bring the group to present to the Executive subcommittee on mental health, resilience, well-being and suicide prevention. The organisation has therefore had direct input not only into how we developed and worked on the strategy but into the Executive subcommittee. I think that there were follow-up meetings with the then Minister for Communities, Carál Ní Chuilín, on how she could support the work that it was doing.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I welcome the statement, and I hope that its important initiatives will produce important, positive outcomes. We often see much focus on physical conditions, but mental ill health is the unseen condition that, as my colleague said, unfortunately has been swept under the carpet for too long. I appreciate the commitment to additional support for CAMHS.

Can the Minister assure me that children in schools will not be forgotten about? Before they have mental health issues, can they be taught the resilience that is so important for preventing such issues impacting on their lives? How important a role can sport and education play? What supports are in the strategy for children and young people with learning difficulties who have suffered through the pandemic? People such as the Taylor boys in Armagh, their mum, Kathryn, and the rest of the family have had no access to respite, and, as a result, their mental health has deteriorated enormously.

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point about respite. He will be aware that the issue was debated in the House recently. The strategy covers where we want to go and what we intend to do with child and adolescent mental health. The outcomes envisaged by the strategy are supports for infants in child and adolescent mental health services, where children and young people should receive the care and treatment that they need when they need it, without barriers or limitations. That should be evident from a shorter waiting list.

The strategy includes an outcome for a reduction in difficult transitions for children and young people by having improved outcomes from 10,000 More Voices and similar user surveys. I think that the Member is referring to having a regional approach to the delivery of child and adolescent mental health services that, because there is a different level of delivery across our trusts, we are not currently seeing. That is why one of the key aims of the strategy, and one that we are able to commence with the funding that my Department has committed, is to look at how to develop a regional service to deliver a consistent approach across Northern Ireland.

Photo of Rachel Woods Rachel Woods Green

I thank the Minister for his statement, and I look forward to reading the strategy later. I also look forward to the funding that is clearly needed being allocated.

I will bring the Minister back to the issue of dual diagnosis and ensuring that people who have co-occurring disorders receive the support that they need. Will the Minister outline how the actions in the strategy tie in with the substance misuse strategy and ensure that they support those with dual diagnosis, especially those trying to access housing. He will be aware that that is an issue. How will that be part of the joint working that is envisioned?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her question. She will see that the substance use strategy is mentioned in the strategy in the context of the specific sector. Dual diagnosis is also mentioned. The strategies and pieces of work all came from my Department, and we have made sure that there is crossover with dual diagnosis in the strategy. As the Member is fully aware, in regard to dual diagnosis, service users often report difficulties in accessing services, with unclear lines of referrals. The response that we want to envisage from this must therefore ensure that mental health services and substance-use services consider the patient first and that the justice system fits the patient rather than expecting the patient to adjust to fit the system. That is laid out in the strategy.

I thank the Member for her comments regarding the funding. I will do my utmost to ensure that this strategy is funded, as, I hope, will all the Executive parties and all the other Members in the House in support of the vital work that the strategy sets about doing to deliver for all the people of Northern Ireland.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

In regard to the estimate of an extra 32% in referrals arising from the pandemic, if that does not include those resulting from lockdown, what is that figure? If it does include that figure, what proportion of that arises from lockdown? Is there any acknowledgement on the part of the Executive that the severity and duration of the lockdown in fact adversely impacted on mental health issues, as it did on cancer services and everything else?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. I will clarify the point: the 32% more referrals is from the effects of the pandemic. That will include some of those who have suffered from the effects of restrictions and regulations that have been put in place, because we are aware of the impact that it has. The Member will be able to read back in Hansard what I said in my opening statement, and, if there was a misperception from my response to Mr Buckley earlier, I will correct that quite happily in the record. That 32% includes all the long-term mental health effects of the pandemic.

When the Member talks about the Executive's decision, I do have to point out that the mental health impacts are being experienced not just in Northern Ireland but across the United Kingdom, in the Republic of Ireland and in every other country where the virus has had serious impacts not just on the physical health of people but on their mental health. We have never faced, in our lifetimes, a pandemic like this, and I hope that we never have to face it again. We had to take the decisions that we have taken as an Executive. We have not taken them in isolation, yet many Members seem to indicate that we were doing something that was unique to Northern Ireland. The decisions that we made were replicated in many other jurisdictions, and, as I said in response to the Deputy Chair of the Committee, when we were coming forward with the recommendations and the decisions were being taken, the Chief Medical Officer always had his input on the societal matters and mental health and well-being of the population.

There was also a considerable piece of work in regard to the cohort that we asked to shield during the first wave of the pandemic. We asked the Patient and Client Council to engage with those people to indicate what additional mental health strains they were experiencing due to shielding. That was part of the feedback that we took into consideration when we came to the second wave and did not take as aggressive a stance on shielding that community as we had done in the first wave.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I thank the Minister for his statement. Minister, you referenced heartbreaking cases of people under eight years of age needing specialist treatment for eating disorders. Recently, the mother of a young person was in contact with me about her child being severely distressed and forced to wait months to get access to private services because the NHS and trusts are so overwhelmed. Unfortunately, that seems to be commonplace.

My question for the Minister is around funding. The statement states that £1·2 billion of funding is needed — I suggest that the figure is probably greater than that — to tackle the pandemic's mental health crisis over so many years. Where does the Minister envisage that money coming from? There has been some suggestion around waiting lists that we take money from services here to fund waiting lists here. I suggest that that is a short-term and misguided strategy and that looking at those who have financially blossomed during COVID would be a better strategy. Where does the Minister see the money to fund this coming from?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. I have been clear that this is not about having to shift funding within the Department of Health. There is no point in my robbing Peter to pay Paul to deliver a mental health service while, at the same time, underfunding or reducing funding and support to another part of the health service. The last number of statements that I have made to the House in regard to elective care, no more silos and the work that needs to be done now in the mental health strategy indicate 10 years of underinvestment in the entire health service. The £1·2 billion that we have indicated that we need over the next 10 years to correct that underfunding is the cost that we paid for those 10 years of underinvestment. If we had kept level, or at least kept with a realistic service provision and support mechanisms over the past 10 years, that need and that capital expense now would not be so big.

This is about taking tough decisions and having tough conversations at Executive level. If our block grant from Westminster does not increase, there is a need to find the money and invest it in the people of Northern Ireland. You cannot have a sustainable workforce if their physical or mental health will not allow them to go to work. You cannot have a sustainable education service if the children who attend it or the teachers or people supporting them are not physically or mentally able to carry out the work that they need to do. We need to invest in our health service for the future. We need to see Northern Ireland travel in a direction where we can support education and our economy, but we have to do that with a healthy, physically and mentally able population. We need to start that now by investing in the strategy and delivering the 35 outcomes that have been indicated through the co-production and co-design.

Photo of Jemma Dolan Jemma Dolan Sinn Féin

I thank the Minister for his statement. As part of Sinn Féin's submission to the strategy, we highlighted the lack of reference to actions to reduce long-standing and ingrained health inequalities. We know that we need population-level changes, but we also need targeted interventions. What actions are dedicated to reducing mental health inequalities?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her point. With regard to the specific inequalities, a number of specific groups that we have to tackle have been identified. In an earlier answer, I mentioned our rural population and how that needs to be addressed. At point 54 in the strategy, we need that renewed focus to ensure that mental health promotion meets the needs of early interventions. That includes targeted approaches to groups more likely to be adversely affected by mental ill health, such as BAME groups, refugees and asylum seekers, people with a specific trauma exposure, LGBT+ people, people with a physical or sensory disability and persons with an intellectual disability. That is one of the leading actions, and is at action 2 of the strategy and how we identify those individuals and also promote mental health through early intervention and prevention with year-on-year actions covering a whole-life approach.

Photo of Christopher Stalford Christopher Stalford DUP

Thank you, Minister. No other Members have indicated that they wish to ask a question, so Members may take their ease for a few moments before we move on to the next item of business, which is the Charities Bill. If you are leaving the Chamber, do not forget to sanitise where you have been sitting.

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