Northern Ireland’s mental health crisis is costing the region more than £3 billion a year but the demand for more and more help is spiralling, a report warns today.
An Audit Office investigation states that Northern Ireland suffers the worst mental health in the UK yet gets the lowest funding to tackle the issue.
The report found that one in five adults in Northern Ireland show signs of mental health problems, with an estimated one in eight young people experiencing anxiety and depression.
Read more: Northern Ireland health workers' pay rise at risk unless there's more funding, it is warned
In a 58 page report, published today, auditors paint a picture of a service creaking under the pressure of growing waiting lists and increasingly complex needs. That pressure has been growing for years, but the pandemic took its toll on staff and service users, the report found.
Vacancies among mental health nurses is another growing problem identified by the audit as is large numbers of targets on waiting times not being met.
On the impact of the pandemic, the Audit report states that “while mental health services were maintained throughout the pandemic, they did not function as normal”.
It adds: “In particular, staffing reallocation impacted on capacity, while service delivery was adapted towards telephone and virtual contact.”
And the report warns: “The full impact of the pandemic on mental health services, however, remains to be seen. The Department of Health estimates that, over the three years to 2023-24, demand for services will increase by around one third. As a result, the impact of the pandemic on mental health will add further pressure on services.”
On the scale of waiting lists, the reports states that by March 2022, just under 16,000 people were awaiting a first appointment”.
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.
The report adds: “Referrals data identifies a substantial increase in the level of demand for mental health services over the five years to March 2020, in the region of 50 per cent. Within this, there has also been an increase in the complexity of cases presenting to mental health services, particularly the co-presentation of drug and alcohol addiction alongside mental health issues.”
But despite that fact “Northern Ireland [is] reported to have the highest prevalence of mental health problems in the United Kingdom, around 25 per cent higher than in England” funding for services is lower.
The report states: “Mental Health funding in Northern Ireland represents around 6 per cent of the overall health and social care budget and, over time, has not kept pace with increases in the wider health budget.”
It adds that to bring “funding levels in Northern Ireland closer to that elsewhere in the United Kingdom would require substantial additional investment of £80 - £190 million per annum”.
The impact of increasing demand, the report adds, “was also reflected in a deterioration in performance against waiting time targets”. The auditors found that “maximum waiting time targets were not met regionally in any of the seven years included in our review (from 2015 to 2022)”.
Workforce issues “are also a key factor in the poor performance against waiting time standards”, auditors found. The report added: “Health and Social Care Trusts identified mental health nurses as a particular area of concern, with data at the end of March 2022 indicating a vacancy rate of around 11 per cent.”
The report also warns that the successful implementation of a 10-year mental health strategy for Northern Ireland is at risk without sustained investment.
Comptroller and Auditor General Dorinnia Carville’s report said the financial impact to Northern Ireland of mental health treatment and lost productivity is “conservatively estimated at £3.4 billion annually”.
The report said that in 2022-23, a total of £345 million has been allocated for mental health services, representing 5.7% of the overall health and social care budget.
The report welcomed 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 noted that funding for these reforms is not available from within existing departmental resources and will require additional funds to be secured through an Executive. Northern Ireland is currently without a functioning Assembly and Executive.
The report said the absence of additional, secured funding has meant that progress on delivering the 10-year strategy has been limited.
Ms 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 recommended 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”.
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