Over twenty years ago I was involved in a World Mental Health Survey Initiative study which found that the rate of Post Traumatic Stress Disorder in NI at 5.1%, was the highest of all the participating countries.
Our history of violence accounted for the excess, with rates higher in the 39% of the population who had a conflict related traumatic event. Since then, myself and others have been highlighting the risk of transgenerational trauma due to adverse childhood experiences in the offspring of adults exposed to violence and trauma, and the need to provide evidence based treatments and reduce the suffering of the next generation.
Sadly, a recent study found that the situation now is actually worse, with 6.1% of the population reporting PTSD or complex PTSD. Now 17.6% report having four or more Adverse Childhood Experiences (ACEs), compared with 7.2% in 2005. ACEs carry an elevated risk of almost every negative, physical and mental health condition, and are associated with much poorer outcomes in education and employment. The evidence shows how the impact of the conflict continues to be felt; in the 2023 NI Life and Times study 29.9% reported that the conflict impacted their mental health. Similarly, 30% reported a traumatic conflict–specific event in the 2024 study of trauma and childhood adversities, and almost half the population had witnessed conflict related violence (47.5%).
In response to increased awareness of the extent of poor mental health in NI, and commitments to improve services in the New Decade New Approach and the Stormont House Agreements, Minister Swann launched The Mental Health Strategy in June 2021. The Strategy comprises 35 actions to transform mental health services, and create a Regional Structure to deliver care. To date the Strategy has resulted in several Reviews and a series of more detailed plans. It included a Workforce Review for the Statutory sector, which indicated the need for a 45% uplift in staff, and plans for a joined–up Regional Crisis Intervention Service including responsive interventions via the C&V Sector.
The Strategy’s successes to date include the establishment of the structure of the Regional Mental Health Service, which joins up the C&V sector, statutory sector and primary care to deliver a regionally consistent service. The Regional Collaborative Board that will oversee the delivery of the service has also been established. There are also promising developments in relation to early intervention and prevention services including the establishment of a public mental health learning network. Trusts and C&V sector organisations have also undertaken initiatives to expand and improve services.
Important and necessary as these developments are, progress falls short of what stakeholders might have expected, given that we are more than a third of the way through the Strategy’s implementation period. There now needs to be a dramatic uplift in investment in order to translate into meaningful change that can be felt by the general population. The funding deficit is stark, the Funding Plan stated that in 2023–2024 we needed over £40 million for implementation, the Department of Health allocated around £5.1 million in this year. In 2025–2026 we need over £60 million and it looks likely that the money available may remain similar to what was invested last year.
The situation on the ground remains concerning. Mental ill–health costs the economy at least £3.4 billion annually. Only 55% of those who access mental health services received an effective response within the recommended nine weeks.
Whilst the Programme for Government refers to trauma–informed approaches and systems, the Mental Health Strategy only receives a passing mention. The Programme states that the Executive will “Redouble efforts to improve physical and mental wellbeing and reduce inequalities “through continued implementation of, for example, the Mental Health Strategy 2021–2031”, and this is extremely disappointing. Trauma informed practice includes recognising pathways to recovery; accessible treatments and services are fundamental.
The Mental Health Strategy was presented as the roadmap for mental health reform. At a third of the way through, and with only a 12th of the money available this year, it can no longer be stated that the Strategy is being implemented. In fact, if there is no progress on funding for delivery it is possible that some of the plans and Reviews produced in years one and two will be defunct and out of date.
Professor Siobhan O’Neill, Mental Health Champion for NI and Professor of Mental Health Sciences, Ulster University
