Improving local mental health needs both tangible services and better strategic thinking

Last Monday was World Mental Health Day.

By no coincidence whatsoever, Health Minister Robin Swann chose October 10 to announce plans for a new Regional Mental Health Service.

Regional, in this sense, means universal. This is a quirk of language arising from the fact that Northern Ireland is a region within the United Kingdom. By the conversational use of the word, we currently have a regional service – or, rather, five regional services individually run by each Health and Social Care Trust – and we are swapping that for something centralised and which we will call regional.

This is good news. NI’s mental health services have always been behind the curve. Making them better was one of Health Minister Robin Swann’s major areas of interest when he took up the job.

Unfortunately, something got in the way. Nevertheless, a ten-year Mental Health Strategy was published last year and included the establishment of the Regional (universal) Mental Health Service (RMHS) as one of its priorities. The strategy said the RMHS would lead to:

• A regional approach to mental health with regional consistency in service delivery
• Less confusion for patients using services across Trusts measured through service user satisfaction surveys
• Improved experiences for those transitioning between Trusts
• People having access to high quality, regionally consistent but locality-based services within local communities

No more postcode lotteries, less confusion, better communication between trusts – and also between mental health and other connected services.

The RMHS will be part of the new (or newish and growing) Integrated Care System, which is designed to break down barriers between different parts of our unavoidably-enormous health and social care system.

However, within the new model Trusts and other providers will remain individually accountable for the delivery of their services, while a newly-established Regional Mental Health Collaborative Board will be responsible for regional leadership and oversight of mental health services development and delivery.

If this all works, and let’s hope it does, it will be a good example of how better structures can improve services despite the fact those services are, in some fundamental sense, operating in ways that are similar to or even the same as before (structural improvement like this also tends to be a lot cheaper than just more of the same, which is crucial given the state of public finances).

Mr Swann said: “I am able to announce new arrangements to create a Regional Mental Health Service, which has at its core the objective of providing people across Northern Ireland with equitable access to high quality, regionally consistent but locally based mental health services, working across primary and secondary mental healthcare and with the full integration of the community and voluntary sector.”

Third sector

The third sector does a lot for mental health in Northern Ireland. There are many organisations that have mental health as one of, if not their only, core missions. These can be niche organisations, looking at mental health within certain parameters, or they can be broader.

One of the broadest is Inspire Wellbeing, which is an all-island charity and social enterprise with the aim of “wellbeing for all”.

Last Monday – the same day as Mr Swann’s RMHS announcement – Inspire led a delegation of four local organisations to Stormont, where they kicked off a new campaign.

Along with the Trussell Trust, Carers NI and Age NI, Inspire announced Release the Pressure, which highlights how rising prices for food, energy and housing is affecting people’s mental health and calls for statutory help for the cost-of-living crisis:

Inspire also released data from a survey they carried out into how inflation is impacting on wellbeing. Findings include that:

• 79% of people said the cost-of-living crisis was having a negative impact on their mental health – 29% said the negative impact was significant
• 46% of people have asked for help or support – 10% have talked to their GP about it and 24% of 16-24 year olds have talked to their GP about it
• 66% are anxious about their finances over the next 12 months – 25% are very anxious
• 52% are going to find it hard to afford essential items like food, fuel and clothing – 9% said it will be really difficult/impossible

This sort of work is important, because it highlights the tangibility of mental health and wellbeing, and the factors that affect both.

Which is not to say abstract stuff, like service-delivery structures and ten-year strategies, aren’t important too.

RMHS

Back to the new regional (universal) service.

There was no timeframe for its establishment in Mr Swann’s statement from last week. Hopefully there will be clarity on that soon, although this lack of detail isn’t that unsurprising.

It was only this month that the Department of Health published a summary report called From Silos to Systems, which examines how the RMHS should work.

Following the announcement of the RMHS, Mental Health Champion Prof. Siobhan O’Neill said: “The creation of a Regional Mental Health Service is one of the most important actions in our Mental Health Strategy, and I warmly welcome today’s announcement.

“In addition to delivering consistency of access to specialist mental health treatments and services across all parts of Northern Ireland, the new Regional Service encompasses the community and voluntary sector, who have played a key role in the delivery of services across the region.

“The Service also includes mechanisms to ensure that the views of those with lived experience of poor mental health are heard, and that services are co-designed with service users. These key features will be central to the success of the Service in meeting the needs of our population.

“I look forward to working closely with the Collaborative Board, and engaging with service users and other stakeholders, to monitor the rollout of the Service, and to ensure that the commitments outlined in the model for the Service are delivered in full.”

For years, local politicians were quite open about how mental health was the Cinderella Service within NI health care. Hopefully that can now change.