Geraldine Scott-Heyes
reports on issues facing clinical psychologists in
Northern Ireland
Spare a Thought…
It is pleasing to have news of additional investment in mental health services in England, especially following the boost in 2014 which came with additional investment specifically for perinatal mental health services. However while colleagues in England consider the merits and limitations of this latest commitment, it seems pertinent to spare a thought for Northern Ireland (NI) where funding of mental health services has historically been lower, and continues to be lower than in the other nations of the UK, despite higher levels of need.
Mental illness is the single largest cause of ill health and disability in NI with higher levels of mental ill health than any other region of the UK – 1 in 5 adults and around 45,000 children in NI have a mental health problem at any one time (Mental Health in Northern Ireland, Betts & Thompson, 2017). The rising suicide rate, including male suicide at almost double the rate in England, has been referred to as an epidemic. A lack of assertive outreach services, which emphasise maintaining contact with patients in England and Scotland, may well explain the pattern, which seems to be exclusive to NI, where patients missing a final appointment with mental health services can be an antecedent to suicide.
Perinatal mental health services in England have gained particular benefit from additional funding in recent years, while NI has made no progress. The contrast is informative and stark. While four additional Mother and Baby Units (MBU) have been commissioned in England, bringing the total to 17, in NI there is still no MBU provision. In addition, eighty per cent of women in NI have no access to a specialist perinatal mental health service. Only 1 of the 5 Trusts provides a specialist community perinatal mental health team, which is under-resourced and lacks clinical psychology.
The DCPNI workforce review in 2015, found that NI had the lowest proportion of Clinical Psychologists and the lowest number of training commissions, per heads of population across all four UK nations. Although the difference is small compared to Wales, both are significantly below the level of clinical psychology provision in Scotland and England.
The purpose of the Barnett Formula is to enable proportional funding to be allocated to Scotland, Wales and NI, however there is no evidence that it was applied to the 2014 additional investment in mental health services. Of course there is now the additional problem of not having a government. There were hopes of improvement when, after 18 months of deliberation, the NI Assembly produced a Programme for Government in January 2017. The signing off was anticipated with enthusiasm as it included a clear emphasis on mental health as a priority and, in addition, perinatal mental health. Sadly the politicians withdrew their services before signing off the document so no new policy decisions are being taken. There is still no government in place. The relative shortfall in mental health services continues to grow almost two years on.
Geraldine Scott-Heyes,
ACP-UK Director and Northern Ireland Representative