Despite being described as a priority policy issue, mental health services in Northern Ireland are being left to fail. Patients and service users struggle to access both routine and urgent care. Their inability to access the help that is required is having a severe knock-on effect on other parts of the health service.
Frequently, people in crisis are forced to go to emergency departments in search of assistance. These busy, noisy, challenging environments are completely inappropriate for those presenting with mental health issues.
In a recent report the Audit Office warned that Northern Ireland’s mental health crisis is costing the region more than £3 billion a year. Spiralling waiting lists, underfunding, a depleted workforce, fragmented services, lack of access to services are just some of the issues.
The inability of the system to cope with demand in an appropriate way means tragic stories of anguish to individuals, families and communities are all too commonplace.
In July a Belfast court was told that a former BBC security guard who killed his wife in a hammer attack had made over 570 calls to his GP practice in a bid to seek help, but none were answered.
Recommendations from serious adverse incident reviews have not been implemented and the same errors are repeated. A lack of independent oversight means follow-ups do not happen and change is not followed through.
The voluntary and community sector who provide essential services are under unsustainable pressure. A number are at a risk of closure as budget constraints mean that they are stretched beyond their limits.
For the first time in its 30-year history Men’s Action Network in Derry are unable to take new referrals. Last week West Wellbeing, a suicide prevention charity based in Belfast, highlighted the battles for crisis support, diagnosis and treatment. Their frustration was palpable. Despite their best efforts they were unable to secure appropriate care and support for those who had reached out for help. They describe a system that is profoundly broken.
The number of people waiting to access mental health services continues to spiral. Latest figures, for December 2023, record a total of just over 17,500 people awaiting a first appointment. Within this, psychological therapies represent a disproportionate share, with around 6,500 people waiting to access services.
Alongside this, performance against waiting time targets has also continued to deteriorate. Worryingly, around three-quarters of those on psychological therapies waiting lists, as of December 2023, had been waiting longer than the 13-week target time. As a result, service users and their families feel that they cannot get the help that they need. Without timely treatment, however, peoples’ conditions will deteriorate, becoming more difficult and costly to treat.
People are not getting the help that they need, they are not assessed quickly enough, and often are unable to contact crisis teams directly
Many mental health issues are preventable and therefore the costs to society could be reduced or avoided. Research has shown that early intervention works and is cost effective. Yet in March 2023 the only funded primary school counselling programme, Healthy Happy Minds, was axed due to budget cuts.
Waiting until someone is in crisis and asking them to navigate a system not designed for their needs is bound to end in failure. People are not getting the help that they need, they are not assessed quickly enough, and often are unable to contact crisis teams directly.
Being turned away because you are not “suicidal enough” or waiting for hours in a hospital to be told to contact your GP in the morning is not unusual. There should be no wrong door for people seeking help and assistance.
In June 2021 a 10-year mental health strategy was published which set out a blueprint to modernise and transform services. Professionals and community and voluntary groups invested a great deal of time and energy into the development of this plan.
It is incredibly disappointing that the funding required to implement this strategy has not been forthcoming. This year the Department of Health will provide an eighth of the necessary investment to implement the plan. How can this be acceptable?
Northern Ireland is reported to have the highest prevalence of mental illness in the UK. Yet at 7%, the proportion of the health budget allocated to mental health remains significantly lower than that of the other regions. The most recent figures indicate that the proportion in England is 11.39%, in Wales it is 13.32% and in Scotland it is 9.41%.
Progress in this policy area has been at a snail’s pace, there is no urgency, stakeholders are understandably frustrated and disillusioned. Vulnerable people and their families have been repeatedly let down, causing needless suffering and distress.
We have a blueprint for change but without drive and funding, the devastating consequences a broken system will continue to blight this society.
