The successful implementation of Northern Ireland’s 10-year Mental Health Strategy is at risk without sustained, additional investment. That is among the main conclusions of a report on Mental Health Services in Northern Ireland, published today (Tuesday 23 May) by the Comptroller and Auditor General, Dorinnia Carville.
The report provides a high-level overview, considering issues around mental health strategy, funding, activity and data. It highlights the prevalence of mental health problems in Northern Ireland, which are approximately 25 per cent higher than in England. One in five adults here show signs of mental health problems, with an estimated one in eight young people experiencing anxiety and depression. This higher prevalence has been linked with both greater levels of deprivation in Northern Ireland, and with the impact of the ‘Troubles’.
In 2022-23, a total of £345 million has been allocated for mental health services, representing 5.7 per cent of the overall health and social care budget. Despite higher prevalence levels, funding for mental health in Northern Ireland is lower than elsewhere in the United Kingdom and Ireland The report estimates that bringing funding levels into line with elsewhere in the United Kingdom would require additional funding, which could be as much as £190 million annually.
The report welcomes the publication of the overarching Mental Health Strategy 2021-31, launched by the Department of Health in June 2021. The total cost of the strategy’s reforms of mental health services are estimated at £1.2 billion over the 10 years to 2031. However, the report notes that funding for these reforms is not available from within existing departmental resources and will require additional funds to be secured through an Executive. This absence of additional, secured funding has meant that progress on delivering the Strategy has been limited.
Commenting on the report’s findings, Dorinnia Carville stated:
“The costs of mental ill-health are significant in Northern Ireland. As well as the human cost, the financial impact to society as a result of care, treatment and lost productivity is conservatively estimated at £3.4 billion annually in Northern Ireland. There are, therefore, significant benefits to be derived from improving mental health here.
“The Strategy for Mental Health 2021-31 provides a direction of travel for achieving the reform and improvement of services that is needed. However, adequate and sustained funding will be necessary to realise the Strategy’s vision.”
The report also considers the impact of Covid-19. While services were maintained throughout the pandemic, a combination of changes in people’s health-seeking behaviour, and reductions in the availability of some services, saw the number of referrals reduce. In 2021-22, referrals were approximately one fifth below pre-pandemic levels.
Despite this reduced levels of referrals, mental health waiting lists have continued to grow. Today’s report notes that, at March 2022:
- around 16,000 patients were on a waiting list, almost 20 per cent higher than pre-pandemic.
- performance against waiting list targets have deteriorated. Around half of those on mental health waiting lists wait longer than the nine and 13-week target standards, with particular issues identified in relation to psychological therapies. Workforce issues are identified as a key barrier to access and performance against waiting time standards.
The report also draws attention to data limitations in mental health in Northern Ireland. It recommends improvements to how outcomes are measured, in order to better evaluate the effectiveness of services in improving people’s mental health, and to determine whether services represent value for money.