Official Report (Hansard)
Date: 03 October 2007
HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
4 October 2007
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey
Mr Michael McGimpsey ) The Minister of Health, Social Services and Public Safety
Dr Miriam McCarthy ) Department of Health, Social Services and Public Safety
Dr Andrew McCormick )
Ms Patricia Osborne )
The Chairperson (Mrs I Robinson):
The Committee welcomes the Minister of Health, Social Services and Public Safety and his officials: Dr Andrew McCormick, who is the Department’s permanent secretary; Dr Miriam McCarthy, who is the director of secondary care; and Ms Patricia Osborne, who is from the health development directorate.
The evidence session will consist of two elements: we shall first discuss the inquiry into the prevention of suicide and self-harm in Northern Ireland, and that will be followed by a discussion on other issues. The Minister is not yet in a position to propose an urgent amendment to The Children (Northern Ireland) Order 1995, so that item of business has been left off the agenda.
Further to the Committee’s decision to conduct an urgent inquiry into the prevention of suicide and self-harm, the Minister has been requested to brief the Committee on the Department’s strategy, particularly on the work of the ministerial co-ordination group on suicide prevention. Members should note that the Assembly’s Research Service has prepared a paper on that strategy.
I invite the Minister to brief the Committee on the suicide-prevention strategy and the work of the ministerial co-ordination group.
The Minister of Health, Social Services and Public Safety (Mr McGimpsey):
Thank you. Before I start, and in response to remarks about carers and the Caring for Carers strategy, I must state that I am happy to discuss mutual interests with colleagues on the mainland. However, this is a devolved matter, so we are not bound by what is decided in England. We are taking our own strategic approach, which is based on a comprehensive consultation exercise; raising awareness of carers’ issues and addressing the deficit in information; introducing legislation, structures and procedures; developing monitoring arrangements to offer assurances that carers are being identified; and the necessity to expand and improve the range of services that are available to carers. That is a rough synopsis of the current situation.
The Assembly debated the Caring for Carers strategy on 25 June 2007. That matter is of interest to the Assembly and the wider public, and correspondence relating to it continually appears in my mailbag.
I am delighted to be here. This is the second time that I have attended a meeting of the Committee for Health, Social Services and Public Safety Committee in my capacity as Minister, and I look forward to a fruitful discussion.
I welcome the Committee’s inquiry. The background to this serious and tragic problem, which affects everyone in our society, is that the previous Administration developed a suicide-prevention strategy, and a suicide strategy implementation body (SSIB) was set up in September 2006 to deal with that. That approach must be constantly reassessed, and it is important to state that there is no quick fix. This is a challenging matter, which requires concerted cross-sector work. In 2006, there were 291 recorded instances of suicides. That stark figure that does not begin to reflect the individual tragedy that lies behind each death.
From the outset, I accept that mental-health services are not good enough. That is a big issue in Northern Ireland, where needs are 25% greater than in England, even though our spend is approximately 25% less pro rata.
The recently completed Bamford Review of Mental Health and Learning Disability (Northern Ireland) was a major exercise that was conducted over several years. It investigated Northern Ireland’s mental-health and learning-disability requirements, and contains more than 60 recommendations.
In 2007-08, £3 million was allocated to the suicide-prevention strategy, of which £1·8 million was invested to support communities. The suicide strategy implementation body includes key stakeholders, bereaved families and local communities. That body began with a series of actions: a self-harm mentoring scheme was established in the Western Health and Social Service Board area; a pilot suicide-prevention 24/7 telephone helpline was established in north and west Belfast; and research began into the effects of the Troubles on mental health and suicide rates. We are all aware of having come from a period of more than 25 years of conflict, which played a part in our figures and in suicide rates.
A GP depression-awareness training programme has been launched. To date, 161 GPs have received training, and approximately another 200 will have received training before December 2007. In addition, 71 practice managers and nurses have received related training. All GPs have received the related CD-ROM training package. There has been a joint North/South public information campaign, and we are working with the media to encourage responsible and sensitive reporting. Ireland-wide media guidelines are in place. We have been working with key website providers, with whom I have met. That meeting was facilitated by the Home Office, because it is primarily its responsibility. I anticipate that further meetings will take place because of Internet involvement in adolescent suicides.
In June 2007, I established the Mental Health and Learning Disability Board, which is chaired by Professor Roy McClelland. The board’s prime roles are to champion the Bamford Review’s recommendations and to challenge my Department and me on the implementation of those recommendations. Its first piece of work is to consider the underlying causes of suicide, and it is doing that in conjunction with the Queen’s University research and development department.
I have also instructed that the pilot telephone helpline should go throughout Northern Ireland. The helpline has proved to be seriously oversubscribed, so it must be expanded throughout Northern Ireland, as must the self-harm mentoring scheme.
Alcohol and drugs misuse is a factor. In the United States, for example, one third of all adolescent suicide attempts involve intoxication. There is a clear relationship between suicide and alcohol and drugs, but we are not sure exactly what that is. We know that alcohol plays a role by removing inhibitions, and I am considering a way forward. Drugs are illegal, so their misuse is a law and order issue, but alcohol is licensed. We are looking at ways in which to make progress in that area through our drugs and alcohol task force. The impact that such substances have on young people in crisis is a significant factor in suicide attempts.
There is also cross-jurisdictional work. A five nations group that deals with suicide has been established that comprises England, Wales, Scotland, the Republic of Ireland and Northern Ireland. That group will continue to meet — its next meeting is on 12 November. An all-island action plan has been developed. I am meeting representatives from the Department of Health and Children in Dublin, including my counterpart Mary Harney, Dr Jimmy Devins and Pat the Cope Gallagher, to discuss ways in which to advance the all-island action plan.
The Executive have established a ministerial co-ordination group on suicide prevention, which I chair. It includes the Minister of Education and both junior Ministers. That was established in June 2007 to enhance cross-departmental co-ordination. It has met twice and is due to meet again on 16 October 2007.
The group has discussed a range of issues, including irresponsible reporting, bullying, evaluation, support in schools, drop-in centres, additional support for parents and the effect of the Internet. It is considering ways in which to take make progress on those matters, as well as on mental-health promotion and services, the implementation of the Bamford Review, and so on.
That is a quick résumé of work that the Department has done on suicide prevention. As I have said, I welcome the Committee’s inquiry into the prevention of suicide and self-harm, because suicide and self-harm can affect society right across Northern Ireland. Every single life that is lost to suicide is a precious one. The situation is made more poignant by the fact that the suicide rate has almost doubled during the past four years. The increase in the number of suicides has been among young people and adolescents. Therefore, suicide prevention is currently the burning mental-health issue.
Thank you, Minister, for that brief outline of the Department’s work. Before we kick-start discussions, I want to flag up a few issues. This morning, I took a tour of the psychiatric nursing unit (PNU) at Ards Hospital and saw the abysmal provision of services there. Conditions there are so bad that a patient who came to the unit with minor depression would be more depressed when he or she left.
Clinicians at the unit take short-term relief from the fact that they hope, in 18 months’ time, to move to the Ulster Hospital site. However, that will be only an interim move. They tell me that they need a purpose-built facility for the treatment of people with a variety of mental-health problems, particularly self-harmers and those who contemplate suicide.
The Committee has seen two excellent facilities. One is already up and running near to Altnagelvin Area Hospital, and the other is in the late stages of completion in the grounds of Craigavon Area Hospital. They are both excellent models. Therefore, I wonder why money is being wasted. I do not suggest that money should not be spent on the care of individuals who present with mental-health problems. However, various professionals, who were glad that the Minister would be in Committee to hear the point that I am about to make, told me this morning that it would be more cost-effective to provide a purpose-built facility and to bypass temporary solutions. I am aware that a business case is being made at present. Mental health comes under the third phase of that business case.
Does the group that is considering the roll-out of the Bamford Review include people who have suffered as a result of suicide tragedies? Has there been any professional input other than from those who were tied to the review?
Both the Chairperson and I visited the McKelvey building this morning.
You did not have to do that, Minister. The meeting was supposed to be private.
I am from Newtownards. I had my tonsils taken out in the McKelvey building 40 years ago.
As did I.
The building has not changed since then. I was shocked to see its condition. I agree with you on that, Chairperson. The necessary investment has not been made, and that is a matter of regret to me. It is, however, part of the plans to implement the Bamford Review’s recommendations.
The model at Craigavon Area Hospital, which I have visited, is an example of good practice in design and build.
However, consultant Jim Anderson said this morning that offering care in the community and supported living to individuals means that they do not become institutionalised. We must give people the support that they need in sheltered accommodation outside of institutions. That is Jim Anderson’s number-one priority. I have seen examples of the type of supported-living development that is required.
There will, of course, always be a need for acute beds, and there is a plan to move from the McKelvey building to a refurbished part of the Ulster Hospital. The consultant was at pains to say that he saw that as a temporary move, and we both agreed with him, Chairperson. A business case is due, and I will examine that. I am bound by the three-year comprehensive spending review (CSR), not simply on resources and revenue but on capital spend. Now that I have seen the need for care in the community, I will have no compunction in moving forward immediately if I have the resources, although investment is anticipated from the CSR bid, as well as capital spend.
The mental health and learning disability board comprises four mental-health professionals and two people from learning-disability services. The board is a strategic oversight group that knows Bamford intimately, and it exists to challenge the Department on the implementation of the Bamford Review’s recommendations. As I have said, the board will act as champions for the sector and is led by Professor Roy McClelland.
Families who have been bereaved by suicide play a key part in the suicide strategy implementation body, which is chaired by Colm Donaghy. There are a number of key stakeholders, but the representatives of bereaved families and communities play a very important role, because they have intimate first-hand knowledge of the consequences of suicide — not just of the event but of living with it afterwards.
Thank you for that detailed response.
I am pleased with what you have outlined today, Minister, but there are a few issues on which I would like reassurance.
I am pleased that you will be working with the education sector. Can you assure me that there will be someone in each school who can identify possible mental-health problems early, and step in straight away? It is obvious that prevention is better than cure.
Can you advise me of what plans you have for prisoners in Northern Ireland? There seems to be very little that can be done if a prisoner with a mental-health issue does not consent to help, and, going on meetings that I have had recently, there seems to be a high level of mental-health problems in the prison population.
Can you assure me that you will consider educational programmes that will help GPs and doctors to identify mental-health problems, perhaps through a yearly one-day course? Although doctors receive training on mental-health issues when they go through medical school, a refresher course would draw their attention to the use of early prevention measures. People sometimes return time and again to accident and emergency (A&E) departments with the same problem, and that can be an indication that there is an underlying mental-health problem. If an A&E doctor could identify that problem, he could fill in the form that goes back to a GP after a hospital visit, and the GP could follow that up by ascertaining whether help is required.
The Minister of Education has taken steps to ensure that someone, who may not be a teacher, can take responsibility in each school. That is what is anticipated, as I understand it.
The mental health of prisoners is currently the Northern Ireland Office’s responsibility. That responsibility is due to pass to the Department of Health, Social Services and Public Safety in the near future. Paul Goggins and I have discussed that handover and the resources that are allocated to prisoners. Those resources will not begin to meet their physical- or mental-health needs, so that must be addressed.
Ms Patricia Osborne (Department of Health, Social Services and Public Safety):
My understanding is that a counsellor is present in all post-primary schools for half a day every week. The Department is working closely with the Department of Education to devise a mental-health first-aid training programme to enable teachers to deal with mental-health issues. That is my understanding. I cannot clarify that now, but I will find out more for the Committee.
The Prison Service was represented in the development of the suicide prevention strategy, and it is also represented on the implementation group. The Prison Service examined its suicide and self-harm policy, which was revised on foot of recommendations from a number of reports, including that of Professor McClelland in 2006. The suicide strategy implementation body is aware of that, and it is working with the Prison Service on that issue.
Do GPs receive any suicide-awareness training or yearly refresher courses?
There is ongoing GP awareness training, and some GPs, practice managers and practice nurses have participated in that. Such training is also being rolled out to A&E staff, because people who are troubled are likely to attend A&E departments. We are not entirely content that those who present at A&E receive the necessary sympathy. A CD-ROM has been produced that addresses that issue, and has been widely circulated throughout the profession. A refresher course is a useful suggestion, and I will take advice on that. We must keep this issue to the fore and on the agenda so that the professionals who work on the front line can facilitate a proper and fast response, ensuring early intervention.
The House of Commons Northern Ireland Affairs Committee is coming to speak to the Health Committee on 16 October about mental-health issues in the Prison Service.
Ms S Ramsey:
I welcome the Minister and his team, and I welcome his personal commitment to the prevention of suicide and self-harm. Alex mentioned GP awareness training, but families who have been bereaved through suicide are concerned about the take-up of such training. Minister, you said that 161 GPs have participated in that training, and 200 GPs are to receive it before Christmas. What is the shortfall? When the families who had been bereaved through suicide appeared before the Committee, they stated that that was one of their concerns.
I wish to raise some other issues, such as the whether a chill-out room — for want of a better term — should be provided in health centres and hospitals for those presenting with problems who may have drink or drugs in their systems.
Such people are sometimes not examined. A room should be made available in hospitals and health centres so that those people are not refused treatment or told to go away.
I turn to the subject of the availability of beds for children and adolescents. Answers to written questions that I have sent you indicate that there will be additional beds. However, we must deal with the current situation. We are investing for the future, but temporary solutions must be put in place to deal with the present.
There is also concern about the issue of under-18s using antidepressants. That matter arose during the investigation into the death of Danny McCartan. Many under-18s were continuously being prescribed antidepressants.
Minister, despite the commitment to additional funding that you made during your presentation — £1·8 million in 2007-08 to go directly to communities — my colleagues and I have met a number of community groups that are concerned about the future of long-term funding. Some of that funding is piecemeal; some comes from DSD and some from your Department. However, community groups cannot plan ahead or become involved in proactive strategies because they are wasting much of their time trying to secure additional funding or to safeguard their own funding.
I welcome the ministerial co-ordination group on suicide prevention, which you said also involves the Minister of Education and the OFMDFM junior Ministers. As you stated — and as we are all aware — statistics show that the majority of people who take their own lives are young men. Therefore, I am concerned that there was no mention of the Department for Employment and Learning during your presentation. Should DEL not have a role in the ministerial group, given the connection between higher and further education, and the social demographic most likely to commit suicide?
It was mentioned that less money is spent on mental-health issues here than in England. Can you guarantee that that situation will change after the Budget and comprehensive spending review?
I have placed a three-year bid for funding as part of the CSR and I am arguing my case. It is for my Executive colleagues to accept or reject the case that I make for prioritising health. Health is an important issue for the general public: in a recent poll conducted for the ‘Belfast Telegraph’, 79% of respondents said that health should be one of the top three priorities for the Executive, which was a long way ahead of the next issue, which polled approximately 50%. I would be grateful for any help that you and your colleagues can give me in furthering that bid.
The suggestion that DEL become involved in the ministerial co-ordination group on suicide prevention is very useful. I shall discuss that matter with the ministerial group and with the Minister for Employment and Learning. That is a good suggestion, bearing in mind the link between suicide and young males, and DEL’s role in further and higher education — as well as the link between employment and self-esteem.
My Department is releasing funding at the rate of £3 million per annum, £1·8 million of which goes to local communities. Those resources are secure, because that is year-on-year funding. I welcome bids from local community groups, and I agree that continuity in funding is crucial to ensure that such groups do not spend half their time running around, making business cases and proposals for funding.
On the issue of available beds, Foster Green Hospital currently has 15 beds in its child-and-family centre, and eight beds in its adolescent unit — with an additional four beds being made available this month, with a further four to follow. The plan — the proposal is currently held up in planning — is for two new hospitals by 2009: an 18-bed adolescent unit and a 15-bed child-and-family unit.
I empathise with the remarks that you made about GPs and particularly with your remarks about the provision of space in A&E departments where a patient who is presenting in crisis can be taken. Perhaps one of my colleagues will deal with the issue of antidepressants and the under-18s.
Dr Miriam McCarthy (Department of Health, Social Services and Public Safety):
A formal course exists for updating GPs’ skills. GPs, in common with all doctors, have a professional responsibility to maintain their skills, expertise and knowledge. They will participate in a variety of courses as part of continuous professional development, a proportion of which is likely to be on the subject of mental health — even if it is not a particular, formal course. The course, which can be done online, can be quite challenging because it is largely interactive, and asks questions. That is a recognised form of continuous professional development. Therefore, there are a number of means whereby GPs and other professionals can gain further skills and experience.
Although you probably do not have the figures at present, I would appreciate it if you could provide us with them. Families who have been bereaved through suicide have told us that they have a concern about the uptake of courses. You told me that 361 people will have completed the course by December. Therefore, I would like to know what the shortfall is.
Was there not a recommendation, stemming from the Danny McCartan case, that there should be a review of the prescribing of antidepressants to under-18s?
The figure was 161 trained GPs. It is anticipated that, by Christmas 2007, 200 GPs will have undergone the training. I will return to you on that matter and, specifically, about the issue of prescribing antidepressants to under-18s.
It was the Committee’s view — after listening to the families and to Dr Paul Miller, who gave evidence to the Committee about suicide issues — that it would be helpful if there were a dedicated chill-out room where volunteers, such as the Samaritans, could calm the person down while waiting for the statutory agencies to take over responsibility.
I became aware of a constituency problem whereby a gentleman, who was in his 30s, was about to hang himself. His mother pulled him off the garage posts and managed to save him, just in time. He was about 30 years of age and was suffering from post-traumatic stress disorder, as a result of his service in Iraq. His mother went to Newtownards Hospital, and to many other places, but she could not get help anywhere. When he presented at an A&E department again, he was given a few tablets which would take four weeks to have an effect. Therefore, that mother will be watching over her son for the next four weeks until, hopefully, the drugs begin to calm him, and until he can get an appointment with a consultant. Therefore, the chill-out room is an important factor in controlling and dealing with those people who come in off the street, looking desperately for help.
Rev Dr Robert Coulter:
I am pleased that so much activity is taking place in this field. Most of my concerns have been addressed already. However, there is one area that is of particular concern to me; namely the co-ordination of training with stakeholders in the community. I am thinking, in particular, of the various Churches. Churches are at the front line when it comes to dealing with the trauma associated with suicide. Has any thought been given to the co-ordination of training? We have talked about GPs and teachers. However, there has not been any talk about pastors, ministers and the Churches.
I entirely agree with you. Clergy played an important role in Craigavon, as they have in other areas. I shall ask Patricia to answer your question.
The suicide strategy highlights the need for training of GPs, teachers, youth workers, Churches and A&E staff, as front-line people. The suicide strategy implementation body is aware of that issue. At the moment, a variety of training is available. There is mental-health first-aid training, and the applied suicide skills intervention training programme. At present, the Health Promotion Agency is undertaking an audit of training; of the results of any evaluations of that training; and of what would be the most appropriate training for particular groups, be they GPs or A&E staff.
We have discussed training with the Churches, and we intend to meet them again.
Rev Dr Robert Coulter:
Have you been to the theological colleges to discuss such training with people on the ground?
I do not think so. My understanding is that the meetings were with the leaders of the five main Churches.
Were meetings held with individual members of clergy, on the ground?
That is another interesting suggestion — and I am open to all suggestions — that the Department will consider taking up. I will talk to you about that again, Ms Osborne.
It is encouraging to hear about some of the steps that are being taken. However, I am sure that everyone will agree that, given the scale of the problem, those are small steps, at this stage.
I want to examine how the misuse of alcohol and drugs is being addressed. It is good that that issue is being addressed in school, which is an obvious place to start. However, I noted that Patricia said that her understanding is that a counsellor works for half a day a week in all post-primary schools.
I accept that she described it thus, because I too have an understanding, but it does not match hers. My understanding is that there are not counsellors in all schools. In any case, I would question how there could be counsellors in all schools, given that they are so scarce on the ground?
I hear that teachers are being offered a couple of days’ training so that someone is available to offer counselling in schools. That has potential. However, the quality of the available counselling is important. I want the Department to examine that matter and to come back to the Committee with more information. Although some counsellors visit schools, I hear from the non-statutory organisations in the large towns of my constituency that their funding is being scaled down. Those organisations provide help and support for those who misuse drugs and alcohol. When they ask why their funding is being scaled back, they are told that support is already available in schools.
If it is decided to go down the road of diverting money for counselling to schools, we must have a clear understanding of why funding to groups that are available to offer help and support at the weekends — when vulnerable people often need it — is being scaled down. Is that the best road to take, and would that be money well spent?
We need answers to those questions, although I am sure that they cannot all be answered today.
Tommy, there is no single answer. The Department has no basic plan that I can assert will work. We are taking action in a number of areas, which everyone acknowledges is required. At a ministerial group meeting, counselling in schools was identified by the Minister of Education Caitríona Ruane, among others, as an important issue.
I must consult with her to get the detail that the Committee may need about the roll-out of that programme. That is important because the Department of Education works with schools and young people.
Drugs and alcohol were mentioned. Research over the past 20 years has shown that one-in-three adolescents who die by suicide are intoxicated at the time of death. Alcohol and substance abuse are important predictors of eventual suicide among young people. Young suicides have a high rate of alcohol and substance misuse and dependency. I do not say that that is universal, but it is a factor. The Department of Health in England states that:
“The implications for prevention and intervention are clear: focusing on drug and alcohol abuse would have a greater impact on adolescent suicide rates than any other primary prevention programme.”
Moreover, the percentage change in alcohol consumption has the single highest correlation with changes in the suicide rate among young people. There is a clear link. I do not say that if we deal with alcohol and substance abuse, everything will be fixed. However, it is an important factor.
I spoke of the situation of counselling in schools as “my understanding”, because I do not want to give misinformation. However, I think a relatively new counselling service has been put into post-primary schools and that a counsellor is available for one half day each week. I believe that to be separate from provision for drugs and alcohol counselling. I shall, however, seek clarification on that matter with officials from the Department of Education.
The Committee has advertised in the press its intention to take evidence, and it will call spokespersons from the Department of Education. The Royal College of Psychiatry will also give evidence.
I am delighted that the Chairperson is wearing a badge promoting the zero-tolerance campaign against attacks on healthcare staff. I am not wearing mine because I have nowhere to pin it on my jacket.
I have been involved in medicine for more than 20 years. Many matters have been covered, but the bigger picture should concern us all. It seems that the more affluent we become, the more prevalent suicide becomes. That seems to be the case in Japan and similar countries. As a GP, I agree with what has been said so far. A multi-disciplinary approach must be adopted, because many factors combine to cause suicide. It is not simply alcohol, although that is a major factor.
In my professional life, I have, unfortunately, been called to three suicides. The last one was over a year ago, when a young man hanged himself. Suicide is devastating for everyone. Many of those who take their own lives suffer from mental illness. Many have serious mental conditions, such as depression, psychotic diseases or schizophrenia. Cases in which no mental illness has been diagnosed are particularly frustrating for health professionals. The cases that shock health professionals are those in which there have been no signs whatsoever, when, out of the blue, a person takes their own life. That was the situation in two of the cases to which I was called. No one was aware that the subjects were mentally ill. They had not visited a GP, or any health professional.
It seems to me, and I have been in my job for 27 years, that suicide is a societal problem. Young people are becoming more affluent and are better provided for, and they have no hardships and difficulties in their lives. As a result, their coping strategies are not the same as those of previous generations.
Health professionals must step up to the mark. We must be there to pick up the signs of depression, and treat it. Do you agree, Minister, and do you know what is happening in Scotland?
Bob mentioned our Churches and clergy. We must tell our young people that life is precious and wonderful. I have seen young mothers left to bring up young children. I dealt with a family that lost an only son. All those people say that, if their loved ones had only known what devastation they would cause by taking their own lives, perhaps they would not have done it.
We need to get that message across to young people. Are the clergy and educators going to be involved in not only mopping up the aftermath of suicide and dealing with the resultant devastation through counselling, but in trying to get the message across that life is precious and the greatest gift that we have all been given? Young people need to know that, if things are not going well for them — for example, if a relationship breaks down — they cannot simply choose to take their own lives, because they will destroy the people that they leave behind.
Lastly — perhaps the Committee will find out more when it visits Scotland — from a medical point of view, Minister, there is an absolute dearth of mental-health facilities for children and adolescents. That must be addressed.
You made the link between affluence and suicide, which is one possible link among the many that I have mentioned. However, suicide can strike youngsters from the most deprived and disadvantaged backgrounds, as well as those from affluent homes. Some of the families that I have talked to showed no signs of affluence.
However, resilience and coping strategies are important, and we must imbue our young people with the ability to cope with life’s knocks. We must help them to understand that that is all part of life, and that life is precious, and that things will always change, no matter how black they might seem.
As for signs that might raise concern, I have often met families and communities who told me that there was no sign of what was to happen. Perhaps there were signs, and that is where GP and A&E awareness training is important. I do not have the exact figures, but, in several cases, a person had visited his or her GP in the previous 12 or six months, and showed no detectable signs of depression. The other part of the problem is the way that suicide strikes without warning.
Perhaps Patricia would like to add some comments. Scotland and New Zealand have strategies that appear to be models that we might follow. As part of the Department’s work through the five nations group, we are sharing experiences with the Irish Republic, Scotland, Wales and England. Although the incidence of suicide is not as great in England and Wales, there appear to be peaks in Scotland. Scotland appears — touch wood — to be getting over that peak, so we are looking at practice there. The same is true for the Irish Republic.
The task force on suicide visited Scotland, and the approach that was taken there was fully considered in the development of the Northern Ireland suicide strategy. The Department feels that the suicide strategy should not be looked at in isolation, because there are several factors that must be taken into consideration, as the Committee knows.
The Department sees all the strategies — on physical activity; sexual-health promotion; the promotion of good diet; drugs and alcohol awareness; teenage pregnancy; and the promotion of mental health — feeding into the work on suicide, so that it is not seen in isolation. Most of those strategies — for example, the teenage pregnancy, mental-health promotion and sexual-health strategies — promote coping skills, personal-development programmes and parenting skills. All those measures will help to ensure that young people are fit to cope with the world and with today’s society. Therefore, we do not view the suicide strategy in isolation; we see all those other strategies feeding into it.
Ms Ní Chuilín:
You are all very welcome today.
We met with a group of nurses and midwives, and they raised their growing concerns about treating pregnant women with mental-health difficulties. Some of those women may have self-harmed or given staff sufficient cause for alarm that additional nursing staff have been allocated to them while they are in hospital. Members of that group told us that that has been their experience across all the trusts, not just those in Belfast. They suggested that there should be better provision in hospitals for pregnant women with mental-health problems, and that there should be particular supervision for them, more space, specialised support and better staff-to-patient ratios.
I ask the Minister to elaborate on another issue. Not so long ago, we visited the home-treatment base at the Mater Hospital site in Belfast, and it is very impressive. Issues such as funding and the community link are important there. Sue Ramsey mentioned those issues, and you acknowledged them, too. However, funding and resources for the future cropped up time and again. Is it a pilot scheme or a one-off scheme, or will it be part of an integrated strategy that deals with suicide prevention and mental-health provision? It is widely accepted that A&E departments are not for people with mental-health problems, yet, even so, when someone in crisis goes to A&E, nobody is on call to help them. That is not the case in all hospitals, with Craigavon Area Hospital being an exception. However, at the Mater Hospital, for example, no one is on 24-hour call. The home-treatment teams that provide care and support at home, and the after-hours and on-call services, are invaluable.
Sue and Iris mentioned chill-out rooms. Without linking both matters and without sounding as if I am contradicting myself, I suggest that there is a definite need for a dedicated space for someone under the influence of drugs or alcohol who has asked for help. At the same time, staff, particularly A&E staff, who provide a very valuable service, definitely must be protected.
Can consideration be given to midwives’ queries about maternity care for women with mental-health difficulties? Can you also elaborate on the home-treatment side of mental-health provision? If you cannot do that now, will you do so at a later stage?
I will take back to the Department the queries from nurses and midwives about self-harm. The Department can speak to the nursing profession and examine the suicide-prevention strategy to see what it can do.
When I talked about the other strategies earlier, I should have mentioned healthy workplaces and health-promoting hospitals. We see that as very much in line with work in the whole area of health improvement, and mental health would obviously fall within that. I will take back to the Department the points that you have raised. The Department will consider them and discuss them with the implementation body.
Ms Ní Chuilín:
If it has not already happened, will you consider talking to the Royal College of Midwives and the Royal College of Nursing? They represent the staff who deal with those matters almost daily, so they will provide some valuable insight into what is needed.
The Department is looking at the idea of chill-out rooms in A&E departments. The matter has been raised before.
Dr M McCarthy:
In addition to what Pat has said, the Department is aware of the likelihood of mental-health issues coming to the fore during pregnancy. It is a stressful time. It can be particularly stressful for a single parent or a teenage parent. There is, of course, well-documented evidence that post-natal depression affects a significant proportion of new mothers. The community midwives who visit women at home after they have given birth are very conscious of all the emotional and mental-health issues.
Following an audit, a group is considering some aspects of maternity services. It is chaired by the Chief Nursing Officer, and I am happy to bring to his attention what you have asked. His group is considering correct staffing and the right balance among midwives, assistants and nursing staff. If we have any further information, I will be happy to provide you with it.
Dr Andrew McCormick (Department of Health, Social Services and Public Safety):
As the Minister has said, now is a critical time in the funding cycle. A debate is taking place about the allocation of resources, and about mental health in general. Suicide issues, in particular, are at the forefront of what we are seeking in improvement of services and provision. We must ensure that that fact is highlighted. Although a great deal of responsibility lies with the Department of Health, Social Services and Public Safety, other Departments can contribute, and that may benefit the economy. The effects of the difficulties that we face on mental health are significant for sick absence and employment, not to mention for Dr Deeny’s point about the value of life and the contribution that people can make. We must make a serious difference, and the challenge to do so is immense. Earlier, the Minister gave figures that our pro rata need for spending on mental health is 25% greater than that of England, yet we have 25% less pro rata funding. The Appleby Review recognised that a large reason for those funding differentials is the fact that we are so far behind in our approach to mental health and learning difficulties. That is at the heart of the issue. It is important that our Department, as well as other Departments, keep suicide issues at the forefront.
I thank the Minister for his attendance. It is encouraging to hear about some of the strategies that are being rolled out. Robert Coulter talked about rolling out the suicide awareness strategy to Churches and Church leaders. In sparse rural areas, community groups should be involved in the strategy.
The Minister also said that funding had been secured for the next few years and that he would stress to his Executive colleagues the need for extra finances. Does the Minister accept that, in order to meet the demand and the increasing costs of providing services, the Department must consider modernising its methods, with more innovations and incentives to improve performance? I ask that because I have been informed that five people in Omagh were trained recently to work in the mental-health sector, at a cost of £178,000. I am told that, when that training had been completed, the Western Health and Social Care Trust decided that those posts were no longer required. That is an example of financial wastage in the Health Service. Issues such as those must be addressed. Although the Minister can appeal to his Executive colleagues for more funding, wastage in his own Department must also be identified. If that wastage is cleared up, more funding will be available for front-line services, such as those that are being discussed today. Can the Minister elaborate on that issue?
There is a clear need for efficiencies. Thus far, under the Gershon efficiencies, £140 million has been contributed, and we are signed up to the 3% CSR efficiencies, which is a further £340 million. That amounts to almost £500 million in efficiencies, and that is big money. I will pass over to Andrew for him to talk further on that.
The Department is developing a whole range of different responses to the challenge of improving efficiency. Much depends on how the people are used. Most of the budget is spent on people; therefore, investing in training and in the workforce is exactly what is required, and we need to ensure that that is aligned with the Health Service’s needs. That is a complicated task, but it is one that we must improve on and ensure that we deliver.
The efficiency programme that the Minister mentioned includes many elements that are aimed at securing continued and sustained improvements in efficiency and productivity. Those improvements will depend on the professionals taking responsibility and showing leadership. We want to secure their involvement and commitment.
One reason for some of the changes that are currently taking place is to ensure that all the professions are fully involved and engaged in sharing the responsibility. That will ensure that the training is well used, and that we can get a stable and strong plan to allocate resources, staffing time and staffing attention to those critical needs, rather that continually chopping and changing.
As has been said, it is vital that we do that in partnership with other sectors. I am not sure whether Pat can add anything on the involvement of the voluntary and community sectors, but there are definitely areas that they can reach that we cannot.
Professor John Appleby has pointed out in his report that the Health Service here is more inefficient than that in England — a clear price tag can be put to that. The gap between here and England is growing all the time. We are working hard to get more money. The proposition that there is enough in the budget to close that gap — if only we were more efficient — is incorrect.
An important factor that must be considered when making comparisons between Northern Ireland and England is that professionals and staff in the Health Service benefit from national pay deals. I am a supporter of that. However, we do not have any control over those pay deals — we are unable to negotiate them, yet we are obliged to implement the outcomes. Therefore, Health Service employees here get paid the same as those in England, but we do not receive as much funding. That must be considered, and although there are areas in which we can be more efficient, a huge gap still exists between here and England. Patricia will talk about the voluntary and community groups.
The Department is aware of the difficulties in rural areas, particularly their isolation. We have been working with the Department of Agriculture and Rural Development since the last outbreak of foot-and-mouth disease, and both Departments provide support to the rural support network. That support has continued since that last outbreak.
The rural support network was involved in the development of the suicide-prevention strategy, and it is also represented on the implementation body. Both Departments meet with that organisation at least twice a year. Therefore, we are aware of all the difficulties, particularly those that the farming community are experiencing.
I have given everyone an opportunity to pose questions to the Minister. This discussion highlights the fact that the Committee is concerned about mental-health provision.
Have you had any contact with the media and Internet providers, Minister? We know only too well that, sadly, people have been able to use the Internet to encourage others to take their lives. An example of that was that dreadful incident some time ago when two strangers met up and took their own lives — it later turned out that they had been influenced by a website.
The media have been accused of sensationalising suicide. However, it is hard to make a distinction when three young people from the same school, in quick succession, take their own lives in copycat fashion. Have you had any dealings with the media? Are you taking any findings?
Both the print and broadcast media have been very responsible. I recently met with editors of newspapers and television — not to point out deficiencies but to see how we can help them and how they can work with us. They have a duty to report, and we must look at how we give them the information to allow them to do that.
My dealings with individuals and organisations in Northern Ireland have, by and large, been good. I met with Internet providers, and I will have more meetings with them. The Internet is facilitated by the Home Office — it is responsible for regulating the Internet. The response from the Internet providers was positive, but more can be done. We are teasing out what they can do and encouraging them to do it.
The incident to which you referred was disturbing, but it is by no means the only example. Some of the messages and chatroom conversations that I have seen, and that were reported to me, are equally disturbing.
In closing, I wish to highlight an issue that greatly annoys me morally. The Westminster Government have extended drinking hours in pubs. They permit the morning-after pill, which I believe is encouraging sexual activity from an early age and putting pressure on young people to conform, to be prescribed without telling those young people that it is right to say no to sexual activity. The Government are not encouraging young people to say no.
The Government have also introduced online gambling. Are you looking at any of those issues, because drugs, alcohol, and so on, fall under your responsibility?
There is a clear correlation between drugs and alcohol. The gambling issue is a reserved matter, although I have my own views on online gambling. The prescription of the morning-after pill is the responsibility of GPs and doctors. It is not for me to try to tell them what they should or should not be allowed to do.
My reason for raising the issue of the morning-after pill is that if young girls do get caught and become pregnant, that can lead to the breakdown in the social fabric of their family unit and can cause them to contemplate the easy way out, as they see it, which is to end their lives. That is not the answer.
Dr Paul Miller made the point in Committee on 5 July 2007 that suicide is a permanent solution to a temporary problem. All that we can do is to encourage you, Minister, to ensure that mental-health services receive the appropriate level of attention, and that any moneys directed to those services are ring-fenced and cannot be used or abused because of shortfalls in other areas of delivery.