Mental Health

Over 19% of the total burden of disease in Western European Countries is attributable to mental illness compared to 17% for cardiovascular disease and 16% for cancer (WHO 2004). Northern Ireland has a 20% higher incidence of mental health problems that the rest of the UK. At the same time, mental health and learning disability provision in Northern Ireland is weak in the context of both the United Kingdom and wider western world, with significant inequalities in access, treatment and opportunity, accompanied by major funding and legislative failures.

Addressing mental health fits the Alliance Party's core principles, noted in the party's response to the NI Executive's Programme for Government in January 2008, namely:

• tackling segregation - addressing the exclusion of those with mental health and mental health issues;
• re-balancing the economy - addressing the costs to businesses and the loss of GDP that arises from mental health and learning disability, and allowing people to develop to their full potential; and
• providing of sustainable public services - delivery of a modern system of properly funded services.

In October 2002, the DHSSPS initiated a major, wide-ranging and independent review of the law, policy and provision affecting people with mental health needs or a learning disability in Northern Ireland. The impetus for this review lay in:

• recent reviews of legislation in neighbouring jurisdictions
• the need to ensure that law, policy and practice is in keeping with human rights and equality legislation; and
• the need to reflect current evidence of best practice.

The Bamford Review on Mental Health and Learning Disability therefore shapes the debate on policy and the provision of services. Alliance is pushing for its full implementation. This could take 10-15 years to deliver.

Funding
There are major financial issues relating to mental health and learning disability at three levels in Northern Ireland.

First, the overall level of health funding in Northern Ireland is inadequate. Despite the headline figures of record investment with respect to the current NI Budget 2008-11, investment in health services had fallen behind the rate in the rest of the United Kingdom. While expenditure per person in Northern Ireland may be higher than elsewhere, this reflects the relative poorer position regarding the health of the population.

Second, the proportion of the overall NI health budget which is devoted to mental health and learning disability is inadequate. With respect to mental health, it currently receives 9% of the overall funding. This compares to a UK average of 12%. This gap is considerable, and the increased funding for mental health announced in the 2008-2011 Budget is inadequate to address this gap.

Third, the funding balance between adult and child and adolescent mental health services is inadequate, with the latter being underfunded.

Alliance will seek to address all three of these aspects of funding.

Key Issues and Principles
The visions, principles and policy/values of the Bamford Review are consistent with aims and objectives of the Alliance Party

Principles

• Services should be person centred
• Age-appropriate services should be provided in appropriate environments
• Services should be needs-led and determined by evidence
• Services and treatment must aim for recovery

Issues

• Proper provision of human and financial resources
• Promotion of mental health and well-being of all as well as treatment
• Increased access psychological therapies to all ages including elderly
• Dealing with stigma and discrimination, including with respect to health professionals, public and media
• Greater focus on the needs of carers
• Liaison between all parts of services statutory, voluntary, community
• Workforce planning
• Information and information management
• Research and development

Key Problems with the NI Executive Response to the Bamford Review
Alliance has identified the following flaws within the response of the NI Executive to the Bamford Review:

• Insufficient attention given to learning disability, and ignored the Equal Lives report
• Separate structures for learning disability not acknowledged
• No mention of those with LD and mental health problems
• There is no clear road-map for the implementation of the Bamford recommendations, with targets and timetables unclear
• Vague commitments to some outcomes e.g. 'as resources allow'
• There is a lack of cross-departmental targets, and joined-up government
• Legislative framework for delivery is flawed
• Insufficient focus on stigma and discrimination
• Particular underfunding in child and adolescent mental health services and learning disability, including for example respite packages
• Voluntary and community sector neglected

Legislation
The current legislative framework in Northern Ireland is no longer fit for purpose, and notably has significant gaps, for example with respect to mental capacity. As part of their response to the Bamford Review, the NI Executive originally set out plans for two pieces of legislation one in 2011 and the other in 2014, dealing with mental health and mental capacity. Two separate pieces of legislation would have posed problems for both people with mental health problems and practitioners, particularly at the interface. A single bill would provide a much more seamless and continuous service and reduces risks of confusion. It would also help avoid stigma for those with mental health issues. The Minister of Health has now accepted the principal of a single bill. Northern Ireland now has the opportunity to be a world leader in mental health legislation.