Law Centre (NI) Briefing
December 2006

1.  Introduction

This briefing paper outlines some of the main issues relating to mental health policy in Northern Ireland as identified by Law Centre (NI).

2.  Summary of Main Issues in Mental Health in Northern Ireland

• One in six people in Northern Ireland will suffer from a medically identified mental illness at any one time and research indicates that the history of sectarian violence in Northern Ireland continues to have a serious impact on the mental health of individuals;
• Mental health services in Northern Ireland are drastically under funded.  The Bamford Review of Mental Health and Learning Disability (Northern Ireland) (the Bamford Review) has recommended doubling the amount spent on services over the next 20 years;
• Mental health services in Northern Ireland lag significantly behind those in the rest of the United Kingdom and this needs to change;
• Patients detained in Northern Ireland because of mental health problems are often unaware of their rights and have insufficient access to advocacy services;
• Child and Adolescent Mental Health Services are inadequate and inappropriate.  Children are often treated or detained on adult psychiatric wards or transported to facilities in England or Scotland for treatment;
• People diagnosed with personality disorders often struggle to access mental health and social care services in Northern Ireland.  This is of particular concern within the criminal justice system;
• People diagnosed with mental health problems face a high level of stigma and discrimination.  Public assumptions about mental health need to be challenged in a process of re-education.

Further statistics regarding these main issues can be found in the annex to this paper.

3.  About Law Centre (NI)

Law Centre (NI) works to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland .  It provides a specialist legal service (advice, representation, training, information and policy comment) in five areas of law: mental health, immigration, social security, community care and employment.  The mental health legal representation service offers legal representation for issues around admission to hospital for assessment, capacity, treatment, discharge delay, community services and other mental health related legal issues.

Law Centre services are provided to almost 500 member agencies.  Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations.

Law Centre is particularly focused on proposals relating to mental health legislative reform and we outline these and other recommendations below.

4.  Background to Mental Health Law Reform

As part of the Bamford Review a Legal Issues Working Committee was established.  Part of the Committee’s brief was to review the Mental Health (Northern Ireland) Order 1986 and make recommendations for new legislation to update or replace the existing Order.  The need to ensure compatibility with more recent human rights and equality legislation was seen as one of the principal drivers for change in legislation.  Recent changes to legislation in Great Britain, in particular the introduction of capacity legislation has guided the work of the Committee to some degree.  A report by the Committee is due for consultation release in January 2007.

5.  Law Centre (NI) Recommendations on Legislative Reform

5.1 Law Centre (NI) would welcome a change in current legislation and proposes that consideration be given to the following:

• The benefit of one piece of legislation to deal with care, treatment, detention and capacity issues for those with mental health problems;
• The development of capacity provisions to bring Northern Ireland in line with the rest of the UK;
• Equal access to services and treatment for those diagnosed with a personality disorder;
• Access to advocacy services and legal aid for legal representation at Tribunals;
• The use of other medical and social professionals in assessment of diagnosis and capacity;
• Automatic right of review for detention and capacity assessments;
• Automatic right to request and receive a second medical opinion;
• Holistic treatment to include medication and other therapies, namely talking therapies;
• Inclusion of positive and proactive rehabilitation in treatment plans.

7.  Access to Justice

7.1  1,379 people in Northern Ireland were recommended for compulsory admission to psychiatric hospitals for assessment last year.  Of these a total of 763 were detained.

7.2 It is clear that a high proportion of people with mental health problems continue to suffer in silence as they feel unable to access the support they require or remain unaware of their rights.{footnote}Jim Campbell & Debra Wilson, Unmet Need, Law Centre (NI) 2004{/footnote}  The lack of sufficient advocacy services in Northern Ireland and the fact that legal aid for mental health patients is means tested greatly affects the access to justice for people with mental health problems.

Advocacy

7.3 There should be a statutory right to independent advocacy support to ensure that mental health patients who are detained, have a protected right of participation and access to justice.  Many mental health patients are unaware of their rights and feel they can be branded as troublemakers if they raise legal or service issues.{footnote}Northern Ireland Human Rights Commission, Connecting Mental Health & Human Rights, December 2003{/footnote}  Legislating for the right to an advocate will go some way to increase the awareness and acceptance of having an advocate, which will greatly benefit many detained patients.

Legal Representation

7.4 A patient, irrespective of his or her income or savings, should also have an entitlement to expert legal representation at an independent Tribunal.  Experienced lawyers with expertise in mental health and compulsory detention should provide this representation.  Full access to legal aid should be extended to ensure that the cost of attending Tribunals does not preclude mental health patients from taking cases further.  As we are dealing with issues relating to a person’s liberty there is a vital need for greater access to legal aid to ensure that those eligible are able to challenge detention decisions.

8.  Mental Health Promotion

8.1 Good mental health promotion depends on expertise, resources and partnership across all sectors and disciplines.  It is relevant to the implementation of a wide range of policy initiatives, the equality agenda, neighbourhood regeneration and community development.

8.2 Stigma and discrimination against people with mental health problems is rife through all areas of society and its impact is far reaching and goes beyond just the impact on an individual to society as a whole.  63 per cent of people surveyed in Northern Ireland underestimated the proportion of people who might have a mental health problem at some point in their lives while over half said that if they were experiencing mental health problems they wouldn’t want people knowing about it.

8.3 The need for more positive views of mental health is increasingly obvious in the workplace, 63 per cent of employers said they wouldn’t employ anyone who ever has time off work because of mental illness.  The workplace has a powerful effect on an individual’s health.  Discrimination within the workplace is having a significant impact on people with mental health problems, their rights are being breached and their health is being placed in jeopardy.

8.4 Mental health is also having a significant impact on our workplace economy an estimated 80 million workdays are lost each year to stress, depression and anxiety.  Not addressing mental health problems in the workplace cost business and the public sector an estimated £9 billion each year.

8.5 These issues need to be addressed and the reduction of the stigma associated with mental health and the enforcement of the illegality of discrimination against those with mental health problems will provide for a more healthy and prosperous society.

9.  Equality of Access

9.1 People with mental health problems should have equal access to support and services regardless of their health status.  However, this is often not the case in Northern Ireland.

9.2 As already mentioned people with mental health problems face significant disadvantages within the workplace.  They also face disadvantage in accessing social services, including housing and benefits and even other health services.  Research has found that people with mental health problems are less likely than the general population to receive physical health advice and support.{footnote}Disability Rights Commission, Equal Treatment: Closing the Gap A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems, 2006{/footnote}

9.3 Although 1 in 10 children in the UK are known to suffer from a mental health problem, Child and Adolescent Mental Health Services (CAMHS) in Northern Ireland are drastically under funded and under resourced.  There are not enough CAMHS staff or facilities available to provide adequate mental health services for children and young people.  Waiting times in Northern Ireland for treatment for non-emergency referrals by CAMHS professionals range from 25-72 weeks.

9.4 This results in children being inappropriately detained on adult psychiatric wards, putting them at physical risk and at risk of a negative impact on their treatment.  In other cases children have to travel to England or Scotland to receive treatment, separating them from their family and support services.

10.  Where To Next

10.1 Law Centre (NI) aims to track and monitor the implementation of the recommendations made within the Bamford Review and its work will be informed and shaped by cases brought to our mental health legal service.  This provides a unique and exciting opportunity for campaigning and lobbying on policy issues to be directly informed by people with mental health issues, their carers or family members.

10.2  There is a clear need in Northern Ireland to ensure that those with mental health problems are aware of their rights and have access to appropriate advice and support.  It is vital that service providers and government bodies are held accountable for the services and support provided to people with mental health problems in communities across the country.

11.  Annex

Key Statistics

• One in six people in Northern Ireland will suffer from a medically identified mental illness at any one time{footnote}Northern Ireland Department of Health, Social Services and Public Safety, “Effectiveness Evaluation: Health and Social Care”, 2003, chapter 7{/footnote}
• 1 in 10 children in the UK suffer from a mental health problem;{footnote}Child and Adolescent Mental Health: Special Report at www.communitycare.co.uk/Articles{/footnote}
• An estimated 80 million workdays are lost each year to stress, depression and anxiety;{footnote}Future Foundation, Mental Health: the last workplace taboo, for Shaw Trust June 2006{/footnote}
• Not addressing mental health problems in the workplace cost business and the public sector an estimated £9 billion each year;{footnote}Department of Health, National Service Framework for Mental Health, 1999{/footnote}
• 63 per cent of employers said they wouldn’t employ anyone who ever has time off work because of mental illness;{footnote}Scope, Tackling Stigma and Discrimination in Mental Health, November 2006 at pg. 14{/footnote}
• 63 per cent of people surveyed in Northern Ireland underestimated the proportion of people who might have a mental health problem at some point in their lives;{footnote}Health Promotion Agency, Research into Public Attitudes to Mental Health, at www.healthpromotionagency.org.uk{/footnote}
• 1,379 people in Northern Ireland were recommended for compulsory admission to psychiatric hospitals for assessment last year.  Of these a total of 763 were detained;{footnote}Mental Health Commission{/footnote}
• Up to 90 per cent of Northern Ireland prisoners have mental health or other personality disorders;{footnote}NI Prison Service, Promoting Healthy Prisons – speech by Director of NI Prison Service, at www.niprisonservice.gov.uk{/footnote}
• Over 70 per cent of people involved with mental health services in Northern Ireland have been in contact with services for at least one year;{footnote}Supra point 10{/footnote}
• Over 51 per cent of CAMHS users have been on the case load for at least one year;{footnote}Ibid{/footnote}
• Waiting times in Northern Ireland for treatment for non-emergency referrals by CAMHS professionals range from 25-72 weeks.{footnote}Department of Health , Social Services & Public Safety, Mental Health Services Follow Up: Regional Summary, June 2004{/footnote}