David Babington: Where now for mental health in Northern Ireland?
Ahead of a discussion forum in Belfast tonight, David Babington, chief executive of Action Mental Health, says funding cuts threaten to make what is already a 'Cinderella' service into a 'forgotten' service
T here is by now a long list of public services which can claim to be underfunded and to be suffering from the ongoing political vacuum which makes it difficult to set short and long-term strategic goals and plans.
Roads, schools, hospitals, higher education, the arts - all these sectors are impacted by a policy and decision vacuum, as well as being under-resourced.
Within the health sector, that is often broken down into more specific areas, like waiting-lists, pressure on emergency departments, the provision of social care for the growing elderly population.
But I would contend that, above all of those issues, the question which we will address tonight in the MAC is the most pressing: where now for mental health in Northern Ireland?
At its most basic, the issue for mental health provision in Northern Ireland comes down to this: we have higher incidence of mental ill-health than anywhere else across these islands and the funding we provide to tackle mental health issues is smaller than any other part of the UK.
If we don't break that cycle, it is self-evident that the problems will continue to mount and that mental health provision will continue to be the forgotten service in our NHS locally.
Mental health services are not stand-alone - improved mental health and wellbeing across the population can and will bring wider benefits, including in employment and productivity and educational attainment.
The NHS recently celebrated its 70th anniversary, the wonderful, frustrating, expensive-to-run and politically complex NHS.
Action Mental Health joined in the celebrations of the NHS in Northern Ireland - and rightly so; its achievements are remarkable over seven decades and there are so many incredible individual stories that highlight the great work that has been done and which carries on.
But in celebrating the achievements, it would be dishonest if we were to we ignore the problems and realities that are faced by the service today. The sad truth is that mental health provision is in danger of becoming a forgotten service.
In fact, between 2008-2014, actual spend by our health trusts on mental health services has been 25% less than planned, with year-on-year reductions. The portion of Northern Ireland's health budget going into mental health has fallen progressively from 7.72% in 2012-13 to just 6% in 2016-17.
To compare our investment in mental wellbeing with our neighbours, consider that we have a 25% higher incidence of mental illness than in England, yet they spend almost 12% of their total healthcare budget on mental health services. The last decade has seen our spend on mental health going down, while in England their spend continues to rise.
We have the highest suicide rate in the UK and the highest rates of medical prescription, all of which has to be considered in the context of the legacy impact from the Troubles. We also have increased instances of mental ill-health in children and, while it is recognised that adolescent years are a peak time for the onset of mental health problems, we are committing less than 8% of a stretched budget to teenage mental health provision.
How can we deal with the problem of mental health if we are not prepared to properly fund the services?
Addressing the situation on a UK-wide basis, even the Prime Minister, Theresa May (left), acknowledged that, "As the NHS has grown, mental health was not a service that was prioritised."
I can say without fear of contradiction that assertion applies in Northern Ireland as much as anywhere else.
The work of Action Mental Health puts us on the frontline of mental health service provision, right across Northern Ireland. We operate in 11 centres, where my colleagues do wonderful work in helping people who are in distress, who need assistance and who need to be referred to a well-resourced, longer-term source of medical support.
The most recent boost to the delivery of mental health services was the announcement of £50m over five years in the Conservative/DUP "confidence and supply" agreement.
However, a year into that agreement, we are yet to see any evidence of this new money being provided and bringing a positive impact to frontline services.
We are told the first tranche of money is there "in the system", but I fear it is simply being used to cover cracks and to prop up services which were already in existence, but underfunded, as appears to be happening with the money allocated to education.
This pot of new money should have been the starting-point for a genuine investment in the transformation of mental health services in Northern Ireland; to date, it certainly hasn't been - and that is a real shame. The illusion of increased spending is, in fact, an insult to those who need the services the most.
In that context, tonight's event at the Mac is very welcome. It brings the wonderful Fragmented Mind exhibition to a close and the fact that is fully subscribed, even in the July period, is a credit to the team at the Mac, who have embraced the challenge of putting the spotlight on mental health issues over the last three months through the Fragmented Mind series of exhibitions and talks.
Mental health provision in Northern Ireland is lacking, it is falling further and further behind the rest of the UK and much needs to be done. Talking about it is a good start.
Here are a number of key steps that must be taken if we are serious about tackling the mental health difficulties faced across society. This includes a long-term mental health strategy, looking over 10 years, to plan services from cradle to grave provision, rather than ad hoc reactions.
Alongside this, the proposed Mental Health Champion could be an advocate to help bring focus on tackling stigma and building consensus. To achieve this and ensure that action on tackling mental health is taken seriously, we must see that funding for these services are ring-fenced.
Without this, the problems faced will only increase each year and mental health will never achieve the parity of esteem with physical health it deserves.
The discussion, Where Do We Go From Here? The State of Mental Health Provision in Northern Ireland, takes place at the Mac, Exchange Street West, Belfast tonight (7pm). See https://themaclive.com for details