Northern Ireland’s Mental Health Crisis

We’re in a mental health crisis. It certainly feels like that when five people died by suicide during the Christmas period and mental illness continues to claim the lives of people we love in 2020. There is much to struggle with in these recent deaths. An 11 year old child. Parents of young children. For anyone who hasn’t experienced mental and emotional pain so deep and chronic that it disorders your thinking and twists your reality, such events are utterly confounding.

Journalist Allison Morris quoted a Twitter follower she had engaged with after posting about the death of someone known to her, reflecting that “Depression lies to you and it is a lie. The people that you love and who love you are not better off without you.” It’s a crucial message and while it might appear more confrontational than the usual offers of comfort, “It gets better” or “You are loved”, perhaps it’s time to be unafraid in offering people a more robust language as they confront the sophisticated demons in their heads.

Like many people reading this, I have someone in my life who suffers from clinical depression and uses a mixture of medication and talking therapies to manage it. Every time suicide is in the spotlight with media reports of shocked friends and colleagues, heartbroken spouses and parents, I sit them down and have ‘the talk’. Just checking in. You know I’m here. Reassure me that you’re OK.  And I look at my kids with a renewed anxiety about what the future might hold for them. They’re young still, but 11 year olds? That’s terrifying.

It dawned on me today that with over 300 people dying by suicide every year in Northern Ireland, more than 5000 since the Agreement was signed in 1998 and much higher than the rate in GB and Ireland, we are dutifully recreating the psychological conditions we lived under during 30 years of conflict. Where once our collective anxiety and slow burning complex PTSD was sustained by the sporadic nature of bombs and shootings that could take anyone at any time, now it is fuelled by the creeping reality that suicide can have the same devastating impact. Your son’s been spending a lot of time in his room. Why didn’t your boyfriend come home from his night out? You should ring round all his friends. That new girl didn’t come back to parent and toddler group this week – has anyone seen her?

Maybe I’m projecting – my own mental health struggle is with anxiety so I have a tendency to worry – but I reckon that as a society we’re further away from recovering from the trauma of conflict now than we were in 1998 as the ripple effect of suicide spreads further and further.

In 2008 when I worked for a children’s charity, I supported a teenaged girl whose mum had taken her own life. A few years later I attended her funeral.

Work on the intergenerational impact of trauma by local experts like Prof Siobhan O’Neill is finally gaining attention from policy makers but without any real commitment to act on it. Siobhan argues that our entire approach to mental health treatment and support needs to be ‘trauma informed’ because of the way traumatic events shape mental health through relationships, families and communities for years to come.

This is common sense, given our post-conflict circumstances. But any trace of this thinking in our clinical or community services is hard to find. And as the political agenda remains obsessed with the legal implications of ‘legacy issues’ while side-lining conversations about trauma and recovery almost out of existence, we are creating an incredibly unstable peace. In fact for many of us it doesn’t feel like peace at all.

As public anger at the Stormont stalemate begins to grow, the health service and in particular mental health, has become a focal point in recent weeks. I’m not one for trying to sidestep the complexity of balancing political power in this place, and there are rights issues on the negotiating table that have to be fully appreciated. But come on. Our loved ones are dying because they can’t get to see a counsellor, or their GP is so overworked they missed the signs, or midwives can’t get a day off for training so they aren’t up to speed on perinatal mental illness, or no one will release the money to roll out the things that do work like crisis intervention centres, peer support groups, mother and baby inpatient mental health beds, drug and alcohol harm reduction services.

It’s great to see young people taking to the streets to challenge the political parties under the banner of Pure Mental NI, and bereaved families leading the 123GP Campaign to have counselling services in every GP practice, something that the budget already exists for yet isn’t happening.

But we need action now. We can’t wait for the negotiations deadline, or another election. As grassroots human rights organisation Participation and the Practice of Rights urges the Department of Health to understand, this is an emergency.

In my own work helping with the campaign for perinatal mental health services, I have been frustrated to watch the Permanent Secretary of the Department for Health fail to secure vital specialist services for mums despite resounding agreement from the Chief Medical Officer and departmental officials that the lack of services in unacceptable. Suicide is the leading cause of maternal death, with over half of these cases attributed to a severe form of perinatal mental illness called post-partum psychosis.

If the leading cause of death was a physical condition such as post-partum haemorrhage, believe me, the Department of Health would have done something about it by now. We are told that Permanent Secretaries can’t act if the decision wasn’t signed off by the outgoing Minister. But bereaved families, campaigners and even the medical professionals delivering services on the front line have all been critical of the Department’s inaction.

The health inspection body the RQIA published a damning report into perinatal mental health services in Northern Ireland, or lack thereof, in the last weeks of the outgoing assembly at the end of 2016. They made two urgent recommendations; an inpatient mother and baby unit and specialist perinatal mental health teams in each trust. Despite the PHA establishing an implementation group made up of incredibly skilled and experienced healthcare professionals, three years later those urgent services still do not exist.

A prominent campaigner on perinatal mental health, Lindsay Robinson, worked hard to secure a political consensus statement signed by the leaders of every party in the Assembly. There might not be a Minister in place, but no one will challenge the Permanent Secretary on this spending decision. Keeping vulnerable mums alive and well to care for their babies is probably the most uncontentious item on his to-do list.

I sat down to write this post through tears over our recent losses. We need both our political leaders and our high ranking public servants to feel this grief and understand that they hold the power to do something about it. That ‘something’ might not be enough for everyone who suffers, but it would be ridiculous to pretend that we aren’t failing people. The Department of Health’s own reporting states that 72% of people who died by suicide last year weren’t engaged with any mental health services in the last 12 months. This tells me that at least some of them could still be alive if policy makers listened better to what people are telling them about the barriers to accessing services and took meaningful action to address these.

Protect Life 2, our suicide prevention strategy that was 5 years overdue, sets the frankly offensive target of reducing the suicide rate by 10% by 2024 which would save only 6 lives a year according to the Mental Health Rights campaign group supported by Participation and the Practice of Rights.

That’s not good enough for any family who has lost someone. It’s not good enough for all of us who desperately need to move forward as a society coming out of trauma, fear and loss.

For all the grieving families, especially those bereaved in recent days and weeks – your pain must be immeasurable. While it won’t lessen it, please know that thousands of us in this wee place are carrying fragments of it within ourselves and we want to walk with you and do whatever we can to make things better.

 

Photo by Arantxa Treva is licensed under CC0