Now that the 10-year mental health strategy has been published, we all have the opportunity to see what it is and what it is not.
It is, in the Health Minister’s own words ‘a blueprint for reform of mental health services'. Designed to bring about service improvements and the development of new structures over the next ten years.
What it’s not, is what one of the leading global human rights experts in mental health, Professor Dainius Puras, has called on governments everywhere to provide - ‘a vaccine for the protection of good mental health, through the use of human rights-based approaches in all policies’.
Policies underpinned by human rights principles of availability, accessibility, acceptability and quality. Coupled with a determination by governments to eradicate inequality, poverty and discrimination, in order to improve mental health
Since taking up office in January 2020, the Health Minister Robin Swann has repeatedly stated that mental health is a personal and professional priority for him. Heartening to hear, but requires careful unpacking. The Minister’s various statements give a good insight into the paradigm which both he and his civil servants operate within, when it comes to mental health:
‘I am determined to reduce the number of people across all sections of our society who wake up every morning and struggle with their own mental health challenges’
The primary focus of this Strategy is on the individual and their own personal struggles, decoupled from any social or political context to the drivers of their distress.
In other words, the symptoms, rather than the cause. Or, in the words of the distinguished sociologist C Wright Mills, failing to make the necessary connection between ‘private troubles’ and ‘public issues’.
It was abundantly clear to seasoned mental health campaigners, having responded to the consultation, that this strategy was not going to deliver the paradigm shift in relation to mental health that was already so desperately needed pre-Covid.
A shift from the response to somebody in distress being ‘How can we fix you?’ to 'How can we fix the systems and processes that caused you to experience distress?'
A shift from what 123GP campaigners have dubbed ‘the sideways tilt of the head’ by duty bearers, whose body language exudes sympapthy but zero responsbility, to respecting, protecting and fulfilling people’s right to mental health.
A shift away from an individualised and medicalised approach to emotional distress and trauma, to one which recognises and addressed the socio-economic drivers of this pain.
Socio-economic drivers like poverty, unemployment, homelessness, discrimination. All massive stressors and causes of distress for people. None of which simply drop from the sky like the rain. All of which are the result of conscious political decisions and policy choices by duty bearers, including the NI Executive.
Just one recent, particularly disturbing example of such policy decisions by the Executive, has been to extend Capita’s contract to carry out assessments for Personal Independence Payment . This decision was made in the full knowledge of the impact of the assessment process on the mental health of vulnerable claimants; described by one claimant as ‘distressing and terrifying’.
While the Strategy acknowledges the social determinants of health, it effectively kicks them into touch. Indeed, the two relevant actions that are included, transfer responsibility for addressing those social determinants to ‘individuals, families and communities to address the social factors that impact on their mental health’.
Individuals wrestling with mental ill health may well have a thing or two to say about discrimination. Families struggling to support their loved ones' mental health may know all about the impacts of poverty, and disadvantaged communities are encyclopaedias of inequality, for anyone paying attention. But these are social ills, and responsibility for tackling them lies squarely with the state.
The Strategy lists the establishment of the Executive Working Group on Mental Wellbeing, Resilience and Suicide Prevention as evidence of the government’s commitment to addressing mental health in the wider context.
This group, made up of Ministers from all Departments, has meet four or five times since its establishment in March 2020. No evidence has been published to indicate that it is actively addressing the underlying determinants of emotional distress and trauma.
It should be said that nowhere does the Strategy actually make explicit its underpinning paradigm, but it’s far from difficult to discern. One table in particular illuminates the NI Executive’s priorities for tackling the enduring mental health crisis in this society.
The funding plan that accompanies the Strategy indicates that almost twice the amount of funding is to be invested in hugely costly bricks and mortar as opposed to lower cost, non-medicalised therapeutic responses. The Strategy highlights the existing £57 million on new mental health units and outlines plans to spend a further £170m.
The Strategy’s failure to address the sky-rocketing rates of prescribing of anti-depressants -- with the bill jumping by £7 million in 2020 -- is also deeply concerning, particularly given what the BMA has described as a ‘tsunami’ of mental health problems expected to be caused by the wider impacts of the pandemic.
All of this runs directly counter to the rights-based direction of travel globally - away from investment in in-patient mental health facilities that are wedded to the biomedical model of understanding, and towards a community-based and rights-based model that prioritises therapeutic and relation based approaches.
The opportunity existed, with the development of the Strategy, to ensure that counselling, one valuable therapeutic response to distress, was made available through GP practices to everyone who needs it.
Despite cross-party support and the weight of consultation responses, the Department of Health omitted GP practice-based counselling entirely from its future programmes, with no explanation.
Instead, plans outlined in the Strategy will see resources and staff increasingly moved within the ambit of the GP Federations, independent companies that lack any obvious or transparent public accountability mechanisms.
In conclusion, the development of a ten-year Mental Health strategy offered a unique opportunity for much needed new thinking and a paradigm shift, on how as a society we understand and respond to emotional distress and pain.
Regrettably the Executive has opted for more of the same - re-configuration of services within the existing, outdated paradigm, with the onus for any failure to address wider societal factors contributing to poor mental health on the sufferers themselves.
123GP campaigners know they must look to each other and to elsewhere for more progressive approaches to understanding and responding to emotional distress and trauma. Thankfully they have found plenty.
Two exciting initiatives they are currently involved with are The Rest of the Story -- community-based, trauma-informed storytelling -- and Open Dialogue, developed in Western Lapland and now being adopted worldwide. It is a philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks, coupled with a system of care. More on these in future blogs.
Sara Boyce works as an organiser with the #123GP mental health rights campaign. She has worked with PPR since 2016, both as an organiser and also as a policy worker across a range of campaigns supported by PPR. Prior to joining PPR Sara worked on both sides of the Irish border with a range of community and human rights organisations, including with Traveller groups and children and young people’s organisations.
She also worked for over a decade from the mid 1980s to the late 1990s as a Speech and Language Therapist, before undertaking a Masters in Equality Studies in UCD in 2006. Sara is passionate about promoting the power of poetry and other forms of creativity in challenging oppression and inequality at all levels.
‘Poetry is the lifeblood of rebellion, revolution and raising consciousness.’ (Alice Walker)