Mental Health in Northern Ireland
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M e n t a l H e a l t h i n N o r thern I rel and: Fundamental Facts
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Developing an understanding of the fundamental facts around mental health clarifies exactly what challenges we face as individuals, families and communities. As a UK research, policy and innovation charity that is committed to building public knowledge and advocacy around mental health, Mental Health Foundation intends that our annual Fundamental Facts illustrate the scale of the challenge and stimulate debate to create change. Facts on mental health help inform and influence public debate, can generate greater public awareness and ultimately change people’s lives for the better.
What should you know about mental health in Northern Ireland?
Mental health problems can damage lives and weaken society yet three quarters of those with mental health problems receive no ongoing treatment. Mental Health Foundation’s contribution focusses on prevention:
The figure of 1 in 4 that is used across the UK for the number of people experiencing a mental health problem during any one year comes from the 2007 Adult Psychiatric Morbidity Survey. This 2007 Survey reported Northern Ireland as having a 20-25% higher prevalence rate of mental health problems than the rest of the UK, with associated costs running at £3.5 billion1. The Adult Psychiatric Morbidity Survey is being repeated this year and will be used to update the Fundamental Facts in October.
• preventing mental health problems from developing in the first instance, • preventing mental health problems from getting any worse by providing early interventions to individuals and families experiencing distress, and • preventing mental health problems from having longterm or life-long impacts by supporting recovery. As a research charity we know that the evidence exists to achieve the transformation of Northern Ireland’s mental health through prioritisation of investment in prevention. Of course, we also need to invest in research and data to ensure that we get a clear picture of what the mental health issues are, who they affect, and what works to build a mentally healthy society. This includes ending stigma and discrimination against people with mental health problems and their families. At the moment only 5.5% of health research funding goes to mental health. Fundamental Facts is updated annually to celebrate World Mental Health Day in October. Mental Health Foundation’s researchers also produce a wide range of evidence based, mental health information available free on www.mentalhealth.org.uk. • Online A-Z • How to Guides (online and in booklet form) • Infographics Keep in touch with our work by signing up to our e-newsletter and following us on Twitter @mentalhealth.
is a very significant overall treatment gap in mental healthcare, with about 75% of people with mental health problems receiving no treatment at all. Only 13% of the NHS healthcare budget is spent on mental health problems. Figures for Northern Ireland for the period 20062007 placed spending at 9.3% of public expenditure, despite the overall cost in that region being greater than all conditions combined3.
Depending on the questions asked by different surveys, the rates of mental health problems in Northern Ireland vary. The 2011 Census found that 1 in 5 people in Northern Ireland reported having mental health problems.
Mental health legislation In Northern Ireland, between 2013 and 2014, there were 996 compulsory admissions into hospitals under the Northern Ireland Mental Health Order (1986)4 . Of these admissions: - - - - - - -
In the 2013-2014 Northern Ireland Health Survey 19% of respondents showed signs of mental ill health. Of these, 45% of females and 29% of males were taking medication for stress, anxiety or depression. A total of 268 suicides were registered in 2014 and from this figure, over 75% (207) of suicides were male2.
54.7% were males 45.3 % were females 2.4% were aged under 18 47.1% were aged 18-44 28.2% were aged 45–64 7.1% were aged 65-74 15.2% were aged 75 and over
Compulsory admissions into hospitals under the Nortern Ireland Health Order
The cost of mental health problems We have very limited information on the costs of mental health to the Northern Ireland economy and society compared to other parts of the UK. The last costing of mental health problems in Northern Ireland was the 2004 ‘Counting the Cost’ study. Mental health problems constitute the largest category of NHS ‘disease’ expenditure in the UK. Despite this, there
Access to postnatal mental health services Eighty of women in Northern Ireland have no access to specialist perinatal support. To put this in context, this figure sits at 40% in both Scotland and England, and at 70% in Wales5.
Abuse and neglect Adverse, traumatic experiences including abuse in childhood can lead to significant mental health problems. The rate of children subject to Child Protection Plans and on Child Protection Registers has increased in all four parts of the UK. Between 2002 and 2014, there was an increase of 31% in Northern Ireland which was notably lower than in England (72%), Wales (72%) and Scotland (51%)6. During this period, the population of children declined in Northern Ireland, as well as Wales and Scotland, and increased in England.
What is missing?
In 2013, there were 815,827 people living with dementia in the UK. This means that 1 in every 79 people of the total UK population, and 1 in 14 people aged 65 years and over, had dementia. Of the total amount of people living with dementia, 2% lived in Northern Ireland with the majority living in England (84%)11 .
When exploring the extent to which mental health problems affect Northern Ireland, and the factors relating to mental health problems, data was far more limited in comparison with England in particular, but also when compared to Wales and Scotland. There were notable restrictions as a result of this lack of statistics.
In Northern Ireland between 2013 and 2014, 12,741 patients enrolled in a patient education/self-management programme, which was a 10% increase from the previous year. Of these, 18% attended a programme specifically for dementia12. Mental Health Foundation has an extensive dementia programme.
Statistics were more readily available detailing treatment and care for mental health in Northern Ireland through data available through the Department of Health, Social Services and Public Safety14.
Informal care A health survey conducted in Northern Ireland between April 2013 and March 2014 with over 4,500 responses, revealed that 52% of carers spent 20 hours or more per week caring for someone13.
In 2014, there were 1,914 children in Northern Ireland subject to a child protection act7. The number was significantly higher in England at 48,3008 as well as in Scotland (2,882)9 and Wales (3,135)10.
We are actively lobbying for more mental health data to be made available and for greatly increased transparency so that people can have information on the prevalence of different mental health issues in their area and the services available to help people manage their mental health problems and to prevent them occurring. We will publish an updated Fundamental Facts every year. New and updated data will mean that users of Fundamental Facts can be confident that the content is current.
When it came to the cost of mental health services, there are some figures relating to the economic factors15 available for Northern Ireland, but the information is not conclusive and there is a severe lack of on the other determinants of mental health, such as the cost of lost employment, poverty and violence on people’s wellbeing. There is also an absence of information on mental health across all stages of the life course, and for different groups and populations such as BME groups, LGBT, carers, homeless, refugees and asylum seekers.
It should also be noted that being on the child protection register may include children held to be at risk of abuse Therefore this may lead to figures being either an overestimation or an underestimation of the issue.
Similar to the rest of the UK, there is an urgent need for research and data gathering on prevention and early intervention for mental health.
11. Prince M, Knapp M, Guerchet M, McCrone P, Prina M, Comas-Herrera A, Witten-
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of child protection in the UK. London: NSPCC. 7. Waugh, I. (2014). Children’s Social Care Statistics for Northern Ireland 2013/14 Table 2.4 Belfast: Northern Ireland, DHSSPS. Available online at http://www.dhsspsni.gov. uk/child-social-care-13-14.pdf [Accessed August 2015]. 8. Department for Education, (2014). Characteristics of children in need in England, 2013-14. [online] London: Crown. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367877/SFR43_2014_Main_Text.pdf [Accessed 25 Aug. 2015]. 9. Scottish Government (2015) Table 2.1a in Children’s Social Work Statistics Scotland, 2013-14. Available online at http://www.gov.scot/Publications/2015/03/4375/downloads [Accessed August 2015]. 10. Welsh Assembly Government. (2014). Children on child protection register by local authority, category of abuse and age group. [online] https://statswales.wales.gov.uk/ Catalogue/Health-and-Social-Care/Social-Services/Childrens-Services/Service-Provision/childrenonchildprotectionregister-bylocalauthority-categoryofabuse-agegroup [Accessed August 2015].
F E B R U A RY
The Mental Health Foundation, a UK wide charity, has been in existence for 65 years. We focus on researching and evaluating fresh approaches to mental health with a view to advocating helpful policy change and the roll out of best practice more widely. Our work is centred on prevention – we believe that there is far more scope for interventions that prevent people developing mental health problems and which sustain recovery. Access to mental health services is critical, but as a society we also need to focus on bringing down the need for these services and developing good mental health for all.
London Office: Mental Health Foundation Colechurch House 1 London Bridge Walk London SE1 2SX
Glasgow Office: Mental Health Foundation Merchants House 30 George Square Glasgow G2 1EG
Edinburgh Office: Mental Health Foundation 18 Walker Street Edinburgh EH3 7LP
Cardiff Office: Mental Health Foundation Castle Court 6 Cathedral Road Cardiff, CF11 9LJ
Registered Charity No. England 801130 Scotland SC039714. Company Registration No. 2350846.