28 November 2008

“Mental Health Services in Northern Ireland for Future Generations”

Ladies and gentlemen, distinguished guests – thank you very much for inviting me along to speak to you today. It is an honour to address you on the day of such a momentous announcement about going ‘independent’.

Come April 2009 I know that your status as a Northern Ireland charity will mean you will be able to deliver tailored services and campaigning specific to Northern Ireland.

As I have warned the Department of Health time and time again, there is no one size fits all when dealing with mental health. Through your courageous move you have taken a step to make sure what you do is on a Northern Ireland agenda, not a UK agenda.

Of course, my role applies to children and young people. 

Children and young people today face many challenges and pressures; in school, at home and in their peer groups - it is essential that they have adequate support to help them cope with these challenges and pressures.

No matter what each child’s background may be, he or she has a right to grow up being accepted for who they are, a right to an education in a safe, tolerant environment.

The theme of this conference is “mental health services in Northern Ireland for Future Generations” but I think we must not loose sight of the major challenges facing us in trying to deliver mental health services for those children and young people who need them today.

Our response to reforming mental health services needs to be two fold. Firstly, the delivery of a mental health service that can meet and respond to the needs of future generations. And secondly, responding to the current need and demands on service provision to ensure that all those with mental ill health have access to adequate support and interventions.

As Northern Ireland Commissioner for Children and Young People my job is described simply as:

Promoting and safeguarding the rights and best interests of children and young people to help them challenge and change the world in which they live. But most importantly - to give children and young people in Northern Ireland a voice.

And that’s all children and young people up to 18 in Northern Ireland. No exceptions. No exclusions.

I can also represent young people up to the age of 21 if they have been in care or have a disability.

When my office was first established in 2003 mental health was highlighted as one of the priority areas for our work. Over the past five years we have been involved in research, campaigning and case work relating to mental health issues.

In 2004 we brought together 100 young people with 100 adults, in a conference called HOPE. That conference saw young people tell the professionals directly about the issues affecting them and the services they need.

In late 2005 we launched a campaign entitled “Message to the Minister” whereby young people were invited to place messages on the NICCY website to be relayed to the Minister for Health, detailing views on how self harm and suicide could be dealt with. In February, 2006, a report of the findings was delivered to the then health Minister Shaun Woodward.

Some of the difficulties that the young people highlighted with regards to the current arrangements for self harm and suicide prevention included:

· Difficulties identifying appropriate sources of advice and support.

· Unacceptable delays in accessing services.

· Inappropriate placement of adolescents in adult mental health units.

· Inappropriate placements of young people with mental health needs.

· Insufficient needs-focused training and education amongst professionals.

· Inappropriate responses from professionals approached for help.

· Continued stigma/negative societal attitudes.

· Under-funding of services resulting in continued insufficient service provision across the fields of education, health and social services.

(I can see many of you nodding your heads as I read out that list - as professionals working in the field I am sure you have all faced these barriers and issues over the years)

My legal and casework department has supported many young people under 18 years who have been inappropriately placed on adult psychiatric wards, managed by staff with minimal or no training in pediatrics or child and adolescent mental health.

I have met with and spoken to children and young people who are inappropriately placed in an adult mental health facility at Muckamore Abbey. Some of the young people had been forced to live there for over eight years because there is nowhere else for them to access the care that they need.

The Government is failing these young people and contravening their rights. I am currently working with our Minister for Health to ensure a positive outcome in this situation.

We have intervened and acted on behalf of young people who need urgent treatment for eating disorders and other mental health difficulties only to be told that treatment is not available. Fortunately we ensured that they were admitted to inpatient facilities and given appropriate treatment. As a parent I can just imagine the stress, worry and heart ache of having to fight and argue in order to have your child treated for a life threatening illness and in some cases having to stand back and watch your child being sent to another jurisdiction for treatment because they cannot be treated in Northern Ireland.

Seamus mentioned in his address a service to young people affected by Asperger’s Syndrome. That is extremely commendable. Last year I published a report called ‘Try Living in Our World’. In that report we found there were pockets of good practice, but they were few and far between.

I wish your project good luck and hope that it will provide support for those affected by this little understood syndrome.

Every five years Northern Ireland along with the UK and devolved administrations is examined by the committee on the rights of the child to assess if they are meeting their obligations under the UN Convention on the Rights of the Child.

As part of my role as Commissioner I supply the committee with evidence regarding the implementation of children’s rights. This year I facilitated a visit from Professor Lucy Smith, a member of the committee, to show her first hand how children’s rights in Northern Ireland are being violated. Mental health was one issue I kept high on the agenda.

When Northern Ireland was examined in 2002 the committee on the rights of the child recommended that they:

“Take all necessary measures to strengthen its mental health and counselling services, ensuring that they are accessible and sensitive to adolescents, and undertake studies on the causes and backgrounds of suicides”

In September of this year I was in Geneva at the latest state party examination. It’s no surprise to many of you that the committee naturally expressed its concern that the situation relating to mental health has not improved over the last five years.

The committee recommended that:

 “ additional resources and improved capacities are employed to meet the needs of children with mental health problems throughout the country, with particular attention to those at greater risk”

It really seems to any sensible person a disgrace that the Government has ignored the recommendations from an international committee on Human Rights - it raises the question if we can have confidence in a Government which continues to ignore children’s rights and deny children from services that they so urgently require.

As we have seen too few improvements in services for children with mental health difficulties, my office continue to make mental health and wellbeing a priority area of work for the next three years. We are currently planning a piece of work on promoting emotional health and wellbeing in schools - focusing on tier one counselling services.

When the Government announced the Bamford Review, many of us saw this as the catalyst for change in our mental health service.

I hoped that Bamford would put forward proposals to improve current service provision and address the gaps that currently exist.

While Bamford did an excellent job of highlighting and recommending the improvements that are needed, the Government response was less than satisfactory.

Rather than take the recommendations from Bamford and develop them into a time bound action plan, the Government made vague statements of intent and repackaged work from departments that is already underway and in some cases pre dates the Bamford Review.

I want DHSSPS to radically change their response and develop it so that it actually deals directly with the issues highlighted in Bamford and provides a vehicle for the implementation of the recommendations made in it.

Bamford clearly highlighted the problems with the legislation that governs our mental health services; however, in the government response relating to the introduction of new legislation it did not recognise that the needs of children and young people differ from those of adults, therefore safeguards and child specific legislative provisions are essential to afford them greater protection. New legislation must provide children and young people with a vehicle to challenge flaws in mental health services.

The Bamford Review made 51 recommendations on children and adolescent’s mental health services. Dedicated timeframes, budgets and clear accountability for delivering these must be put in place.

This, accompanied with the positive aspects of the response from government, such as developing standards and frameworks and adopting an approach of early intervention in tier one services, will positively reform our child and adolescent mental health.

If you take one message away from today let it be the importance of the Government response to the Bamford Review. If this response is not clear, comprehensive and does not directly deal with the issues in Bamford, then we will not see the necessary improvements to our mental health services. The way forward to developing “mental health services for future generations” is the full implementation of the recommendations from the Bamford Review.

While I criticise Government I must also commend the steps they have taken. This month Health Minister Michael McGimpsey cut the first sod for a new adolescent mental health facility at Forster Green. This is a welcome, if overdue step. Other service developments have also taken place. They are, unfortunately, too few. 

But, as Bamford did, I really want Government to take a real step to listen to those that will use the service – in other words, directly ask and listen to children and young people, both those with a mental health problem, and those without one.

I began this speech by saying that there is no one service that fits all needs. By Government engaging with Rethink, and by hearing the voice of children and young people directly, we have a unique chance to shape a service fit for purpose, fit for the needs of our children and young people and fit for future generations.

I pledge to you today that I will continue to be a vocal advocate for the services that are needed. I pledge that you will find an open door at my office to hear your concerns, act on your behalf, and help individuals where services let them down.

Congratulations on this conference and your courage in becoming independent.

I leave you with this message.

We often hear statistics about how many people can be affected by a mental illness.

American doctor William Menninger said:

“Mental health problems do not affect three or four out of every five persons but one out of one.”

There should, there must be services that are right for each and every child and young person that needs support.

Thank you again.