COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Mental Health and Learning Disability Alliance
on the implementation of the Bamford Review
29 January 2009
Members present for all or part of the proceedings:
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Ms Claire McGill
Witnesses:
Mr Colin Harper )
Ms Rebecca Shea ) Mental Health and Learning Disability Alliance
Mr Nigel Spiers )
Ms Victoria Taylor )
The Deputy Chairperson (Mrs O’Neill):
I welcome Colin Harper from Disability Action; Rebecca Shea from Mencap; Nigel Spiers from the British Association of Social Workers (BASW); and Victoria Taylor from the National Deaf Children’s Society (NDCS). I invite you to start off with your presentation, after which members will ask questions.
Ms Rebecca Shea (Mental Health and Learning Disability Alliance):
I will start by introducing the members of the Mental Health and Learning Disability Alliance. Although we have spoken to the Committee previously, I want to refresh your memories as to who we are and what we do.
The alliance aims to campaign for positive changes to policy, service provision and legislation for people who have mental-health issues and/or learning disability, while working to enhance the capacity of organisations that have an interest or role in mental health and/or learning disability in order to build links with one another and to educate others. The alliance was established in 2007 and is convened by the Law Centre Northern Ireland.
Central to the alliance’s work — which includes dealing with responses to the Programme for Government and the Government’s response to the Bamford Review, as well as meeting health spokespersons to discuss the review’s implementation — is equality, respect for the rights and inherent value of people who have mental-health difficulties and/or learning disability.
The alliance has quite a broad membership, which obviously could not be represented fully at the meeting. I want to take a few minutes to allow each member of our delegation to explain their specific expertise and the area about which they are comfortable answering questions.
Ms Victoria Taylor (Mental Health and Learning Disability Alliance):
My name is Victoria Taylor. I am policy and campaigns officer for the National Deaf Children’s Society. At present, we are working to tackle the unmet mental-health needs of deaf children and young people. We are particularly interested in child and adolescent mental-health services.
Mr Colin Harper (Mental Health and Learning Disability Alliance):
My name is Colin Harper, and I am the human rights manager for Disability Action. My job involves quasi-legal work, and I am particularly interested in issues around law reform and the development of the law regarding mental capacity.
Mr Nigel Spiers (Mental Health and Learning Disability Alliance):
Good afternoon. My name is Nigel Spiers, and I represent the executive committee of the Northern Ireland branch of the British Association of Social Workers. Until quite recently, I worked as a social worker and manager, and my focus was mainly on the area of mental health. Should members have any questions, I am interested in the normal covenants of the law, but also in service user and care participation, mental-health promotion and tackling stigma.
Ms Shea:
I am Rebecca Shea, and I am the campaigns manager for Mencap. My job is to examine the area of equal rights and opportunity for people with learning disabilities, their families and their carers.
In the briefing paper that was circulated, we highlighted a number of issues and concerns that the Mental Health and Learning Disability Alliance has, including: law reform; funding; service users and care participation; promoting mental health and tackling stigma; learning disability; and children and young people’s mental health. I will introduce quickly some of our issues under each of those headings, with the intention of providing more information and detail during the question session.
Given the legacy of underfunding of mental-health and learning-disability services, the Mental Health and Learning Disability Alliance wishes to see the development of those services protected from the efficiency savings.
A strong and representative service user and carer structure and participation in the ongoing work of monitoring are essential.
There is a need to focus on the promotion of mental health, prevention of illness and access to services. Clear focus must be placed on taking action to challenge the stigma that is associated with mental illness and learning disability, as it contributes to social exclusion and a denial of the rights of people with mental-health difficulties or learning disabilities.
It is important to recognise that there are distinct differences between mental-health difficulties and a learning disability and that those are relevant to the implementation of the Bamford recommendations. As a result, a separate action plan for learning disability should be developed to respond to the unhappiness and frustration that was demonstrated during the consultation process. That action plan should include clear, measurable and time-referenced targets for implementation.
At all times, children and young people aged under 18 should be treated in developmentally appropriate settings with a managed transition from child to adult services.
I will now hand you over to Colin.
Mr Harper:
I used to be a professional philosopher. The complexities of philosophy are a virtue, whereas the simplicity of the law is the ultimate virtue. Although I am not a legal practitioner, I now deal increasingly with legal issues, and I have come to realise that in law, simplicity comes after justice. The Mental Health and Learning Disability Alliance remains concerned at the Department’s approach to having two pieces of legislation. It seems strange that the Department wants to have two Acts within a single legislative framework.
The Mental Health and Learning Disability Alliance includes service-user and carer representation, professional organisations, social workers, and psychiatrists. Our view is that the law would be more effectively and efficiently implemented if it is captured, more simply, in one Act. That will also make it easier for people who are detained under mental-health law or for those who have had the ability to make decisions taken away from them. Their ability to understand what is happening to them would be better facilitated by a single Act.
One of our key priorities is to have the legislation simplified We believe that great efficiencies exist as regards staff training for the effective and efficient delivery of the provisions of the legislation and the accessibility of law for the people who are most directly and immediately, and sometimes dramatically, affected by it.
Across the breadth of the Mental Health and Learning Disability Alliance, we feel that there is a need to focus on one piece of legislation, rather than two. We are still not entirely clear as to the reason that having two Acts is preferable to one.
We also believe that the law must be based firmly on the decision-making capacity of the individual. That is another reason that we do not see two Acts working. In a sense, the capacity side of the vision set out in the Bamford Review is a core part of the whole thing. It is not as though two separate Acts can be underlined by different principles. Like the fundamental respect for autonomy, which is a basic principle that was articulated in the Bamford Review, emphasis on the decision-making capacity of the individual, and respect for that capacity, is not one of two parts.
Our fear is that if the Bamford vision is implemented separately from a law reform programme or a new mental-health Act for Northern Ireland, it will not be captured in such an Act in the way that it needs to be. Practitioners, service users, professionals, carers, campaigning organisations and other related bodies across the breadth of the Mental Health and Learning Disability Alliance all feel that having one piece of legislation is the way for Northern Ireland to go. A real opportunity exists in Northern Ireland to create a vibrant, modern, standard-setting piece of mental-health legislation that meets the needs of society as a whole and the needs of service users. We welcome the Committee’s activism on this issue.
The Deputy Chairperson:
We will now give members the opportunity to ask questions.
I want to explore the issues around the two pieces of legislation. Mr Harper made a comment about standard setting and said that there was an opportunity to create a single piece of legislation that other jurisdictions would look to and wish to follow. Are England, Scotland and Wales covered by two separate pieces of legislation?
Mr Harper:
They have two. Their legislative histories and settings are quite different. That is not a consequence of principle; it is a consequence of the pragmatic nature of law reform in those jurisdictions. What led to that is what we are considering here, and there is an opportunity for Northern Ireland, because it is clearly distinct, has its own agenda and the ability to make decisions such as these. There is no reason that Northern Ireland cannot enact a single piece of legislation to deal with these matters. The phrase “twin tracks” is mentioned in the consultation paper on law reform. However, if the process can be twin-tracked, it can also be single-tracked, because, achieving efficiencies is the work of the Assembly as well as that of service users and professionals.
The Deputy Chairperson:
The Minister will appear before the Committee next week, and that is one of the issues that we will raise with him. I assume that the Mental Health and Learning Disability Alliance will also respond to the consultation document. We would appreciate a copy of your response once it has been formulated.
Mr McCallister:
There are two issues that I wish to address. In my constituency, I have dealt with people who need respite packages. It will be important to do more work on that issue — more needs to be done to co-ordinate those programmes and keep people on an established routine. How can the key issues of promotion of mental health and tackling the attached stigma be addressed in any legislation? What are the main elements that you wish to see included in any such legislation?
Mr Spiers:
Any proposed legislation would be about protecting people — assuming that they have the capacity to make their own decisions — and intervening in a careful and proportionate way when they cannot do so. We must have a legislative framework that protects people from their own actions, and sometimes to protect others in society in general from those actions. The new legislation would have to be fairly broad based. The current legislation — The Mental Health (Northern Ireland) Order 1986 — has a certain amount of capacity, but it refers only to the workings of the Office of Care and Protection and is to do with managing people’s finances, more usually for people with significant amounts of money rather than less. It does not deal with a person’s needs for protection for other reasons, from family or society in general.
Did you refer to respite packages?
Mr McCallister:
I wanted to know how to tackle stigma. How will that be addressed? There needs to be more than a promotion strategy; it is about building awareness. I am not sure how that could be addressed in any proposed legislation. There is a need to build a culture change.
Mr Harper:
I have often wondered about the reason that we have mental-health legislation but not physical-health legislation. In some respects — and relevant to our initial comments about the twin track — the very idea of mental-health legislation under which someone can be sectioned, and even the very idea that there is a need for special legislation to deal with people with mental-health difficulties, itself creates a stigma. What is actually needed is legislation that will provide the care, treatment and protection of people who have difficulty making decisions and, as a subsection of that legislation, extra provision for people who have difficulty making decisions and who also pose a risk or threat to themselves or others.
The simple and direct way in which the legislation could address stigma is if it were called something other than the mental-health Act. There should be a capacity Act, a section of which should deal with those particular issues. If that applied across the board — there could be additional provisions in the detail of the Act to deal with marginal situations where someone poses those kind of risks — the core stigma or discrimination against people with mental-health issues could be addressed by the structuring of the legislative reform.
Mr McCallister:
I agree that it is important to tackle the stigma much lower down on the mental-health agenda, as well as at the more extreme end.
Ms Shea:
In regard to your comments about respite, during the consultation period of the Executive response to the Bamford Review, Mencap held six consultations. One of the issues that came up repeatedly — from parents in particular, but also from carers and young people with learning disabilities — was that they were very upset with the respite packages that were offered. Mencap produced a report in 2006 called ‘Breaking Point’, which may be familiar to members, which said that eight out of 10 families including a child with a learning disability were at breaking point, and they felt that they could not cope without some sort of support system. The provision of 200 respite packages does not really address the needs of those 80% of families with a child with learning disabilities, so it is a really pressing issue for families. There are 4,500 people with a profound learning disability in Northern Ireland, which is quite a lot of people. There are only 200 additional respite packages to address that largely unmet need.
The Deputy Chairperson:
I read your organisation’s response to the Bamford Report, which highlighted the view that the issue of advocacy was one that was lacking or was not being tackled properly. Will you clarify the thinking behind that view?
Mr Spiers:
I will pick up from where Colin left off. People in receipt of services generally — especially if they are significantly disadvantaged by their intellect, by mental incapacity or severe mental illness — can be very disempowered. That goes without saying. They can be disempowered in respect of services that are provided by the statutory, and indeed by other, organisations. Sometimes there is a sense of a need for an equality of arms. People must be able to give their opinion, but they may not have the language or the strength to articulate that. There is a concept of advocacy that involves formal advocates — non-legal advocates — who would be provided, ideally, by a non-statutory organisation to represent people’s needs to the formal organisations. In England there are independent mental-health advocates.
In the context of the current, or indeed, any new legislation, in situations where someone’s liberty has been taken away from them or restricted, those people and their families would also have access to an advocating service to represent their views. There is also the concept of peer advocacy, where people with different degrees of disability in groups would also receive some guidance and training and could help each other advocate for that group. It is a very important concept, and we would certainly like the Committee to consider it and take note of our views.
Mr Harper:
Part of my job is to work as an advocate for people with different kinds of disabilities. Yesterday I was in hospital with a young man — and his mother — who is being detained under The Mental Health Order ( Northern Ireland) 1986. People find it difficult and challenging to articulate their concerns.
Inserting a statutory right to have an advocate can seem a costly intervention. However, there is a pay-off with regard to compliance with treatment programmes, general behaviour and addressing complaints, which can all be nipped in the bud. People build up frustrations, and if they have support and can articulate what is causing them concern at the beginning of the process, that can prevent a lot of problems down the line, including tensions between professionals in a healthcare team. It is very important for people to have that service.
It is also important that the advocacy is independent; the person should not have the sense that the advocate is in any way beholden to the trust or to anyone that they are meant to be advocating against. It is not advocacy unless it is independent in that sense, and that is an important part.
There is a justice issue. It is a big thing for the state to tell someone that he or she will be deprived of their liberty, or that it will take away his or her ability to make certain decisions that we often take for granted. When the state is going to make do with that kind of intervention in an individual’s life, proportionately there is a need to ensure that that person has the ability to challenge those actions of the state. That goes to the core of our society. The key measure is for the state to ensure that it is not overstepping the boundaries of what is appropriate or proportionate. It must ensure that that person’s voice is represented throughout the whole process, whether that be in detention or treatment, and genuine independent advocates are a key measure in that respect.
Mrs Hanna:
Thank you. I apologise for being late.
Any capacity legislation would be quite complex. I saw a flyer in my office advertising a conference that will be held on the subject in the next few weeks. I do not know whether you are involved in that or not. Why is the Department looking at a twin-track approach? Is it simpler? Why is it not more open to going back to the drawing board and getting away from the mental-health legislation — as you said — towards capacity legislation?
You responded to the Executive’s statement, which has been criticised as far as mental health is concerned. What is the most important thing that you would have expected and hoped that the Executive would say? Would it be around the needs and gaps that exist? I know that the Bamford Review is very complex, and anyone who has tried to respond to its consultation would say that. I have some sympathy with the Executive, but, at the same time, I do not know how many people they talked to before they put their response together, because there was not an awful lot in it. However, what do you think was the most important aspect that should have been included but was not? Can you say a little more on the capacity legislation and the reason that the Department appears to want to continue to go with the twin-track approach?
Mr Harper:
I cannot speculate about the Minister’s or the Department’s intentions; I need to be very careful about what I say.
A precedent may be thought to have been set with Scotland, England and Wales having two separate pieces of legislation. However, that should not be seen as a precedent; it should simply be seen as something that they happen to have done. Perhaps there has been a tendency so see that as setting a precedent for Northern Ireland. We want the Assembly to think things through from the root and branch of what Northern Ireland needs, without thinking that it has to follow Scotland, England and Wales.
There are jurisdictions around the world in which those issues are handled much more coherently. There is a real opportunity here for it to be done better. Complex political processes were involved, particularly in England and Wales. It was not necessarily that that was their preferred outcome; it was more how things happened to turn out, including the very politicised process that existed.
I do not know the reason that we are sticking to the two pieces of legislation, particularly when the Department accepts the idea of a single set of principles for both pieces of legislation, accepts the idea that they should be implemented at the same time, and accepts that there should be a single comprehensive framework, to use the phrase. Why is there a break in the last step? I do not know.
Ms Taylor:
As regards Mrs Hanna’s second question about the one thing that we could ask for, a huge area was covered in the Bamford Review and in the Executive’s response. However, my overwhelming feeling — and probably that of the Mental Health and Learning Disability Alliance — is that the Bamford Review created huge expectation of a long-term vision for change in mental-health services. There is no doubt that the Executive’s response is a step in the right direction. However, we have major concerns as to whether it will be a road map for the future, considering that they stopped short on many of the specific areas of the Bamford recommendations.
The Executive’s response goes so far, but they are not adopting the specific ethos of the Bamford Review. They have said that they accept the broad thrust of the Bamford Review, yet their response is very vague and ambiguous in places. We need clear and measurable targets in order to produce the change that we need and expect.
Mr Buchanan:
In point 5 of your submission, under the title “Promoting Mental Health & Tackling Stigma”, you recommend:
“The development of a programme to tackle discrimination and stigma”.
Can you elaborate on why you think that people who suffer from mental-health problems and learning disability are being discriminated against? What shape do you want to see that programme take in order to tackle discrimination? What key initiatives would you like to see included in it?
In point 6, you recommend:
“An increase in the number of respite packages proposed.”
By what percentage do you think that the number of respite packages should be increased in order to address the need that exists in the community?
Mr Spiers:
Regarding stigma and discrimination, I recently read comments on suicide that witnesses from various groups in Northern Ireland made in this Committee on 29 November 2007. One of the witnesses, who, I believe, lost her daughter to suicide, mentioned “traditional values”. I wish to start by addressing that phrase.
Although values and attitudes always change over time, those of us who work in the service, and who take an interest in what our clients, service users and carers say, are told that people with mental illness — I am talking only of mental illness, not learning disability — sense that, in the course of their week, others perceive them as being different. The message that I wish to put across to the Committee is that there are people who, by what they are thinking and how they behave, can at times appear to be different, and, indeed, they are different at that moment. It is understandable that attitudes to mentally ill people can sometimes be shaped by those examples.
When there is a tragedy, and the popular media — I am being generous in my terminology — highlight it on their front pages, they become the opinion leaders for significant parts of the population. To follow on from what Colin said, that is why there was a public-protection agenda to the new mental-health legislation in England. That agenda kept influencing everything that was going to happen. That is incredibly discriminating, because the reality is that the majority of mentally ill people, the majority of the time, is no more a threat to anyone else than anybody in the Senate Chamber is. It is difficult to get that message across when a real tragedy occurs, and the popular media are pushing a different agenda.
How do we cope with that? We have had some mental-health promotion in Northern Ireland. The Health Promotion Agency ran a short campaign through the media during 2007, which I regret that I have forgotten the name of for the moment. In Northern Ireland, those of us who are most involved would probably look to a campaign that has been running in Scotland. It is called the ‘See Me’ campaign, is funded by the Scottish Executive and led by five voluntary-sector organisations, including the Scottish Association for Mental Health (SAMH).
There have, at various times, been local campaigns running in England and Wales. One such campaign is ‘Time to Change’, which started in autumn 2008, and ran its first television campaign last week. If the Committee is interested, members can visit the ‘Time to Change’ website.
The campaign is aimed at trying to change not only attitudes, because many people can change their attitude towards people, but, more importantly, behaviours. It is much more difficult for that to be seen to happen and for individuals to do. The ‘Time to Change’ campaign, for example, will cost £20 million over five years. It is being funded by the Big Lottery Fund and Comic Relief. We can provide the Committee with much more information on that campaign, because someone on the alliance is involved in it.
The ‘Time to Change’ campaign targets several areas, including the training of medical students and student teachers. After the TV campaign that went out last week, its website had 60,000 hits, which shows the power of advertising in the field of public health. Much evidence-based knowledge can be taken and used in Northern Ireland, and adapted to the local situation.
Ms Taylor:
From the point of view of the Mental Health and Learning Disability Alliance, the Department must be careful that it does not promote discrimination in its service delivery. In the area of mental-health services for children and adolescents, the news about the development of a specialist eating-disorder service is welcome. However, other specialist needs, about which the Bamford Review went into great detail, have been relegated to being addressed over time as resources permit.
Given the strict and limited budget, I cannot see those specialist needs being met in any way that matches what they should be. That is an issue for us, especially if early intervention in such matters is to be considered. Investment in the resources is needed now. The NDCS has experience of that in the area of sensory needs. Deaf children have an unmet need, but that is not receiving the same priority as other services. There is a certain amount of promotion of discrimination.
Mr Harper:
We have been promoting mental health and tackling stigma together, because the public do not primarily need protection from people with mental-health issues; they need protection of their mental health. Tackling the stigma is where the emphasis and focus is needed. That affects the broader challenges to face Northern Irish society to do with the vibrancy of the labour market and the high levels of mental-health issues.
Mental health is a public-health issue, and a proactive approach to promoting mental health and well-being in addressing some of the causes of mental-health issues must be taken. Mental health has a knock-on effect on the economic productivity of society, which is the foundation for so much. A public-health approach to mental health, in itself, helps to tackle discrimination and stigma. That approach takes the view that those issues can affect any of us. One in four people experiences mental-health difficulties in the course of his or her life. To illustrate that, one should look at the Assembly when it is packed and count every fourth person in the Chamber. It is a shame that people do not realise that statistic.
A good, strong, positive and proactive approach to mental-health issues that manage them at a population level, rather than focusing on the individual as the problem or the threat, is needed. That is why we see public health and mental health as going together.
Mr Gallagher:
Earlier, you mentioned that some individuals — I am sure that it is only a small number — are subject to intervention by the authorities and are hospitalised. You talked about the importance of safeguarding their rights. I note that the Department’s document proposes that an assessment take place 14 days after an intervention. Do you think that that is a reasonable period?
Given that the Department talks about hospitalisation, do you feel that hospital facilities are up to a good standard? What kind of provision is available for cases in which young people between the ages of 16 and 18 are hospitalised in such circumstances? What kind of provision is there for cases such as that, and are you satisfied with the level and standard of provision?
Ms Taylor:
In answer to your second question; the Executive are committed to providing additional inpatient beds by 2010. However, we have a major concern that that will in no way be enough to meet need. There has been a failure to recognise the importance of community services, so, I imagine that, by 2010, there will not be enough inpatient beds to reduce the pressure. The Executive have failed to implement the Bamford Review’s recommendation for developmentally appropriate settings for inpatient care. That recommendation is followed in England and Wales, where there is a statutory right to age-appropriate services. The Executive’s response, however, allows flexibility around how a child, or young person under the age of 18, is treated. That goes against United Nations Convention on the Rights of the Child (UNCRC) guidelines, which make it an obligation to treat a child in a developmentally appropriate setting. We have major concerns with that, and we will be asking the Committee to support us in asking the Minister — at all times — to treat children and young people in developmentally appropriate settings, with no room for flexibility.
Mr Spiers:
From the early 1990s until quite recently, I worked in one of the trusts. During that time, I witnessed a significant improvement in the physical surroundings in which the majority of patients were cared for, and an increase in staffing levels, proportionate to the number of patients. At the same time, the number of patients being treated in hospital was reducing. However, we must move forward, not just on general care and the environment in which patients are cared for but on the range of interventions and treatments that are offered to patients in hospitals, and to their families, whether they be voluntary patients or detained patients.
Mr Gallagher:
What about the 14-day review?
Mr Spiers:
Under current legislation, there is an initial review period of 14 days. This month, the Government have proposed to increase that period to 28 days, as it is in Scotland. I am not being coy or trying to evade the question — we have, as an alliance, put that out for consultation, so we have not yet formed a full opinion. I assure the Committee that that opinion will be informed by a range of expertise.
Ms Shea:
I think that we glossed over the second part of Mr Buchanan’s question regarding respite.
Mr Buchanan:
Yes, I am waiting for that to be answered.
Ms Shea:
The trusts are in the process of changing the terminology, and all new documents refer to “short-break care” instead of “respite”, so I may interchange the terms. I cannot be precise on the exact number of respite packages that are required. What is needed, however, is a variety of options so that a family can chose the short-break provision that best suits them. Everyone needs some service to give him or her the necessary respite.
Short-break care can take different forms: it can take place in a hospital-type setting — I do not want to use the word “institution” — with a bed in a room; a large group of patients choose home care, in which they are individually supervised in a home; patients can opt for family care, in which they stay with another family. Those options can all take different forms: a few hours after school for a child; a few hours a day for an adult; at the weekend; or overnight.
It depends on the individual needs and availability, and the type of care that the family arranges. The most recent statistic that I have seen is that approximately 8% of the children and young adults with disabilities who are known to services receive any form of short-break care, which takes the form of either day care or overnight stays with an approved carer. Some may stay with an aunt for a night, for example, but those figures are not recorded. Approximately 8% receive the standard forms of care; that figure does not provide the exact number, but it gives the Committee a rough idea.
Dr Deeny:
You are most welcome, ladies and gentlemen.
The entire Committee is extremely interested in mental health, and, as a GP, it is of particular interest to me. Northern Ireland’s major challenge, but also wonderful opportunity, is to examine attitudes to mental-health issues, and how, as we move through the twenty-first century, they can be tackled differently to the way in which they were dealt with in the past. I could not agree more that a single piece of legislation, rather than several, should cover people with learning disabilities.
As a GP for more than 20 years, I regard health as one package that contains three elements: emotional; mental; and physical. I know people who have never had mental-health issues but who were emotionally unwell, unhappy and discontent, and they did not feel that their life was worth living. I am sure that you know that about a third of GP consultations are associated with mental health. GPs deal with about 90% of mental-health issues rather than referring patients to psychiatrists. However, we are called general, rather than mental-health, practitioners.
Colin, you talked about treating mental health as one part of overall health, rather than our having such a strong focus on it as a separate entity, and we must face that challenge. When I tell patients that they are suffering from stress, occupational stress, or whatever, and that it is a mental-health issue, they nearly jump down my throat, because they do not want to be labelled as having a mental-health problem. We must take on board the stigma that is attached to mental-health problems.
In future, most people with mental-health problems will not be dealt with as they were in the old days, by being admitted to the ancient, dark, dull and depressing buildings that were psychiatric hospitals. I hope that they will be treated in modern health centres and similar facilities.
GPs have insufficient access to talking therapies. I agree with Rebecca and Victoria that children and adolescents simply cannot be seen quickly enough. I will go further than that and say that mothers who have had psychiatric problems both before, and particularly after, the birth of a child, should not be dealt with in psychiatric hospitals. There should be a transition from child to adult care, but, at the same time, children should not be treated in the same environment as adults.
The subject interests me because I recognise the wonderful opportunity to create an environment in which people can talk, rather than whisper, about mental-health issues. This week, I held a few surgeries, at which several people presented with mental-health problems, including, unfortunately, one lady whose son had committed suicide recently. I acknowledge that GPs are dealing with mental-health issues, but we should treat it as one element of a patient’s overall health.
As I have said several times in Committee and elsewhere, it is imperative that any funding released from the hospital sector be invested in the community sector. People who have problems with either their physical or mental health are being discharged from hospitals sooner than before. In the past, more people were admitted to the old-style mental hospitals.
I fear that the community sector will be overwhelmed by the problems that it will be asked to address. We mentioned that to the Minister, and we keep receiving reassurances from him. It is imperative that the community sector receive that money. Should that be written into legislation? You mentioned moneys being ring-fenced and protected from efficiency savings — I could not agree more. Can that be written into legislation?
You mentioned involving the service user in their care — I take that to mean patient involvement, which is good to hear. You also mentioned tackling discrimination and stigma, and drawing from the experiences of the Scottish Executive and the Westminster Government — what do they do that we can learn from?
Ms Taylor:
I appreciate your comments. As an alliance, we agree with you. The Bamford Review envisaged an expansion of community services and an increase in the number of primary healthcare workers, with the purpose and focus being on early intervention and reducing the need for inpatient care. The problem is that we see precious little detail on those reforms in the response from the Northern Ireland Executive. Instead of embracing fully the Bamford Review recommendation to expand the role of community and primary healthcare, we feel that the Executive will adopt it as part of a long-term plan. However, as you know from your experience on the ground, action is required now.
The alliance agrees and recognises that there are excessive waiting periods for children and adolescents, because there is no access to the community services. That section of the community requires those services the most — children should, preferably, be treated by primary healthcare workers and have access to community services.
Mrs McGill:
Are you content that the Health and Social Care (Reform) Act 2009 will address issues that you and others in your field raised?
Representatives from the Western Health and Social Care Trust will also give evidence to the Committee this afternoon. That trust has earmarked £3·1 million of efficiency savings in adult mental-health and disability services over the three-year period. Will delivery of those services, which are intended to go to the community, be possible with that level of efficiency savings?
Mr Harper:
As we are giving evidence on behalf of the alliance, we must represent a large number of organisations. Although we share the concerns that your questions raised, we must be cautious about providing detailed answers that will not necessarily be the agreed view of the whole alliance.
Mrs McGill:
I was simply asking about the Health and Social Care (Reform) Act.
Mr Harper:
There is no formally agreed alliance position on the Act. Therefore, we must be cautious about expressing opinions on issues on which we cannot speak for the whole alliance.
Ms Taylor:
If Mrs McGill is happy for us to do so, we can return to the Committee with an answer.
Mrs McGill:
I am not asking for the witnesses to respond on issues that are not in their remit.
Will the Western Trust be able to deliver adult mental-health and disability services if it makes £3·1 million of efficiency savings?
Ms Taylor:
The alliance wants mental-health services across Northern Ireland to be protected from the 3% efficiency savings. We have been lobbying for that, and we appreciate support. Given the systemic underfunding in mental-health services, that is a proposal that we would ask the Minister to consider.
Mr Spiers:
I will briefly respond to Dr Kieran Deeny’s comment about mental health and emotional health. Last week, you heard evidence from witnesses from the Northern Ireland Association for Mental Health (NIAMH). I will not speak about its document in any detail, because it is not my place to do so. However, the document includes reference to the concept of “flourishing” mental health, a concept of which I am aware from studies that have been conducted in Scotland. The modern thinking is that the absence of diagnosed mental illnesses in a person does not, inevitably, lead to good mental health, and that it is only the most severely mentally ill who use the second- and tertiary-level services. The modern thinking is also that the majority of the people who are “unhappy” are patients of GPs and avail themselves of other front-line services. It is a challenge for any society to try to advance the whole agenda when that position is adopted, but we can point the Committee to any documentation and evidence-based research, if it so wishes.
The Deputy Chairperson:
Thank you for that, Mr Spiers. I thank you all for attending this afternoon’s meeting. The Committee wants to be able to work with groups, such as yourselves, who represent people with mental-health problems and learning disabilities. We want to be able to make a meaningful difference, and the Committee is here to do all that it can to work in closer relationship with you. I am sure that we will talk again.