Northern Ireland's mental health crisis: is the worst yet to come?

13 Nov 2015 Nick Garbutt    Last updated: 13 Nov 2015

Northern Ireland has the highest incidence of mental ill health in the UK and yet spends less on its prevention and treatment than anywhere else. 

Action Mental Health has just published an analysis of mental health provision in Northern Ireland which it commissioned from researchers at Queen’s University. It’s a sobering read.

It acknowledges progress made in dealing with mental health issues but highlights the low levels of spend on mental health compared to other parts of the UK, despite our having higher incidence of mental health issues.

Because Northern Ireland has an integrated health and social care system it should be well placed to reverse the funding gap and to make progress in treatment.

Yet the prospects of this actually happening are remote, despite the apparent good will of politicians and considerable public support for change, the report notes.

Researchers point to three main factors which result on one on five of the population here having mental health issues, a figure 25% higher than in England.

  • We have higher levels of poverty and deprivation, both significant factors influencing mental well being,
  • There are lower levels of general health, itself a function of higher levels of poverty, and physical ill health can lead to poor mental health.
  • Northern Ireland is a post conflict society which affects those who lived through it, and is also being passed on from one generation to the next: traumatised parents often triggers trauma in their offspring.

Sadly the prognosis is not good. Further austerity measures, welfare cuts will increase financial hardship and therefore make even more people vulnerable to mental ill health.

We can therefore predict that the demand for services will rise. Yet at the same time funding is looks certain to fall despite the fact that at present levels we already spend less than is spent in England which has lower levels of mental ill health.

The report analyses spending records over the past decade. It is difficult to be definitive about the precise levels of spend because of the way that records are kept but it would appear that in Northern Ireland around 8% of the health budget is invested in mental health, whilst in England the figure is around 13%, according to sources quoted.

The report notes that much progress was made in the immediate aftermath of the landmark Bamford review of Mental Health but that the action plan to implement it has stalled before all the changes envisaged have been implemented and with spending on mental health running at 25% less than Bamford proposed. 

Health economists have often pointed out that investment in mental health services actually saves the state money, by prevention and effective treatment of conditions. Yet, as the report points out this does not appear to have been fully accepted by health authorities in Northern Ireland when evidenced by their spending decisions.

The report states: “In the current climate for public finances, it is difficult to envisage how such investment might actually be secured in budgetary or political terms.

A few years ago it looked as if the issue of under-investment was becoming to departmental thinking. The Transforming Your Care document explicitly acknowledges it when it states: “Investment in Mental Health, Learning Disability and Children and Family Services in NI is up to 30% less than in other parts of the UK because our model over consumes resource in hospital provision.”

TyC and subsequent reviews, like the Donaldson Report argue that transformation of services can only occur by reducing the number of acute hospitals in Northern Ireland – and to date there has been no progress on this, and so therefore no opportunity to divert funds into health, and mental ill health care in the community.

Sadly it appears that the current budgetary crisis makes such actions all but impossible.

Back in 2014 the Department estimated that additional funding of £420 million was required to meet existing policies, but only managed to secure £90 million in increased funding. It did manage to find savings of £170 million leaving a shortfall of £160 million.

In the current budget the department is still committed to reform but “only within the resources available”. Given the budget crisis it will take radical action to invest any extra money anywhere.

This means that the prospect of reversing under-investment in mental health is remote.

The report is an important and sobering insight into just how far the health service has drifted into crisis. The need for change is recognised. Politicians and policy makers recognise this, but when push comes to shove, the leadership required to make the necessary tough decisions is not there.

It is one of many examples of why we need a radical transformation of our health service, and of the damage that is being done to so many lives by the failure to date to address this most pressing need.


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