You may have read statements recently from a number of elected representatives relating to the Stormont Draft Mental Health Strategy 2021-2031, now out for consultation. Whilst movement on the issue is to be welcomed, from an initial review of the proposed strategy this would appear to be a highly sophisticated framework dependant on funds, the will of an unsophisticated ‘government’ and the implementation of past policies to effectively address key areas of the draft strategy.
· New ways of working
· Promoting wellbeing and resilience through prevention and early intervention
· Providing the right support at the right time
I know this is going to sound cynical, but anything that comes from Stormont in my opinion should come with a warning label telling the public that it should be viewed with caution and may not do exactly what it says on the tin. Yet, even in my well warranted cynicism I do try to be cautiously optimistic.
As a society, we are increasingly more aware of the impact of poor mental health and mental illness, something that has become more prevalent since the planet was hit by the Covid pandemic. But predating Covid, the fact that more people died through suicide in the twenty years following the signing of the Good Friday Agreement than over the course of the troubles made people sit up and notice. Here in the N. Ireland we have higher levels of mental illness than England , higher levels of anti-depressant use and in a survey (young life & times) 26% of 16 year olds had serious personal emotional or mental health problems, and shockingly the figure increased to 43% for those from ‘not well off backgrounds’. These are only some examples and they predate Covid.
The scourge of poor mental health and addiction has hit this city hard, and if you cast your mind back a couple of years there was a high profile campaign for a detox centre for the city, yet despite the overwhelming public support for this, a local detox facility was not established. There is a crisis intervention service that has provided a much needed lifeline for many, allowing people to receive immediate support so interventions can be implemented. Yet even this service is piecemeal in comparison to what is needed. That’s not a reflection on those who operate the service, the fact that this service was not properly funded and resourced from the outset is a scandal.
Sadly the deaths through addiction and mental illness continue, most recently in the city a young mother of three lost her fight with addiction. Louise White’s daughter bravely spoke about her mother and the lack of a detox service, and sadly this young family have lost other family members before to addiction & suicide. It’s welcome that the strategy makes provision for a needs led approach to dual diagnosis in that instead of expecting a person to fit into a service the service should fit around the individual. Something which may have benefitted someone like Louise White whose daughter said that her mother felt uncomfortable and hated going to the hospital and never got the right support. Louise’s family have launched a petition calling for detox facilities and I would call on everyone to sign it.
There are many factors which can impact negatively on someone’s mental wellbeing, these risk factors are generally not individual factors but a culmination of different elements. The new strategy does propose to address these factors, but how it will achieve this is another matter.
Section 35 of the draft document looks at cultural, environmental and social and economic factors. The section further highlights the long term impact that poverty and disadvantage can have on mental illness. In addition to this, it highlights the need to; implement existing policies designed to address deprivation, poverty and social cohesion issues and the other detriments to mental health. And here’s where my scepticism lies, if older strategies continue to gather dust on abandoned shelves then why would this time be any different? An example of dust gathering being, when Stormont fell the Protect Life 2 Strategy sat on the shelf as many lives were lost to suicide.
As I mentioned near the start of this article, the ongoing pandemic has brought a number of issues to the fore. These include the growing poverty and mental health crises. The need for financial intervention to address the welfare reform deficit and issues stemming from the pandemic has become more apparent through a number of government and community led schemes. These initiatives have been a lifeline for many families but in reality act as a short-term solution to a long-term manmade epidemic, poverty. Equally, intervention is urgently required to begin to address the growing mental health crisis at a grassroots level . This through lobbying, utilising skills and resources, awareness raising , community education, upskilling and capacity building. The strategy does talk about increased involvement from the community and voluntary sector but this needs to go further than the current structures and local council community planning.
An example of addressing health issues effectively at a grassroots level would be the Portuguese drug model . Addressing the drug crisis the Portuguese people faced didn’t involve reliance on government it was spearheaded by ordinary people , from their homes. These were ordinary people with lived experience through which they recognised the need for immediate help and intervention. In addition, a key focus of the model was to address the criminalisation of people who were being imprisoned without consideration being given to the factors impacting on them including inadequate support systems.
A similar situation was raised locally a number of years ago by local Magistrate Barney McElholm, Mr. McElholm who actually went as far as to accuse the Department of Health at Stormont of misspending public funds and criticised the lack of funding for mental health services. This stemmed from an incident with a young lady with a diagnosis of personality disorder. The NI Personality Disorder Strategy was published in 2010, yet by the time of this incident in 2019 few of it’s recommendations had been implemented by health ministers here. And you wonder why I’m cynical?
From experience of the frontline I have witnessed first-hand the impact that poverty continues to have not just on the economy but on mental wellbeing and addiction. Obviously poverty is not the only factor but it is playing a significant part in the increase of people with poor mental health and addiction problems. With this the case we must question why a ‘government’ would choose not to directly and adequately provide for those in need especially at this time. The evidence that our physical and mental health impact on each other by cause and effect is there, it just seems that those in power haven’t seemed to grasp this.
At the beginning of welfare reform there was a lot of emphasis on cost saving, but at what cost is the question? Adequate financial provision whether through earnings, taxation or benefits ensures a healthy economy, less pressure on existing health services and additional resources.
In contrast, growing poverty places undue pressure on current services, the NHS, the economy and existing resources . Therefore the system in place is illogical and arguably an attack on the most vulnerable in society by those whose only experience of limited finances and benefits would be a subsidised canteen and a generous expenses account.
The mental health strategy further looks at preparing those
working in mental health services, however, surprisingly, it does not look at problems
people face in the workerplace. In
figures presented by the Centre for
Mental Health in 2017 staff turnover due to mental health illness cost the UK
£3.1 billion and sickness absence cost £10.6 billion. From experience employers can play a part in declining mental health both through act and omission. The long-term effects of this and the failure to provide legal support through the legal aid budget for those suffering as a consequence of unscrupulous employers and seeking redress needs to addressed .
The current Tribunal system is a minefield and in need of overhaul to ensure a fair and attainable system otherwise some employers will continue to opt in and out of organisational policies at their discretion with no regard for; consequences , equity of arms, human rights or workers rights. I have experienced this recently with an organisation that prides itself on being established to address social inequality and disadvantage in early 1900s. Sadly it would seem that they too have lost all sight of their foundation and no longer do what they claim on the tin and they're not alone in this.
In closing, if implemented in full and with the inclusion of additional elements the mental health strategy could have a positive impact. I hope that my cynicism is proved unwarranted. There is too much at stake, namely human life. The foundations for the next generation are here and can be achieve if the strategy is implemented. Therefore it is important that we all contribute to this consultation which ends on 26 March 2021. There is sufficient research into the causes of poor mental health, the challenge now is ensuring that the appropriate steps are taken to build resilience in communities and protect life too..