Mental Health should be at the heart of Northern Ireland’s Programme for Government

21 July 2016

The public consultation on Northern Ireland’s Programme for Government Framework closes this Friday, 22 July. I have submitted the Mental Health Foundation’s response, and am sharing my thoughts on how the proposed Programme for Government could be enhanced to achieve significant progress in mental health over the next five years. 

The response took considerably longer to complete than the optimistic 20 minutes advised by the consultation team; but this is because mental health is relevant to the success of every aspect of Programme for Government. The new Government will need to take promoting good mental health into account as it improves the economy, education, housing and transport. It also reduces poverty and inequality. 

As the recent Assembly debate on a Mental Health Champion for Northern Ireland made clear, mental health is not the sole concern – or responsibility – of the Department of Health. Mental health is an asset to every minister in leading their department and of interest to party spokespersons and committee members across all policy briefs.

Equality

The evidence is clear: equality is fundamental to a successful economy and society. However, before the Programme for Government Framework was published, the government departments were reduced in number and their responsibilities reconfigured. Equality policy was relocated from the Office of the First and Deputy First Minister to the newly created Communities Department. I have used the Equality Impact Assessment section of the consultation to express my serious concern about this decision, which was outside the scope of the public consultation.

The Programme for Government's potential impact on equality is fundamentally undermined by this marginalisation of equality from the heart of government and its framing as 'something that communities do.'

In the Foundation's consultation response, I have proposed the following. 

  • Equality policy: return equality policy to the executive department. 
  • Strategic outcomes language: reference peace, equity, human rights, inclusion and fairness.
  • Strategic outcomes life course: include later life as well as children, young people, and working age. The unintended consequence of leaving out later life is that older people will not be prioritised and could be neglected. 
  • Mental health indicator: include measures for people who experience mental health problems as well as a general population measure.
  • Measures: integrate mental health within measures across Programme for Government (up to 3 measures per indicator rather than one, prioritising measures to promote public mental health).
  • People with disabilities: remove 'quality of life' as the disability indicator and 'life satisfaction' as the sole measure, and replace with an indicator and three measures that will realise Northern Ireland’s human rights obligations under the Northern Ireland Act, the Human Rights Act and the UN Convention on the Rights of Persons with Disabilities. 

Why public mental health?

Increasing the number of measures and integrating mental health across the whole framework is a significant change. Below I illustrate why a public mental health approach should be adopted for the Programme for Government Framework.

Indicator 2. Reduce Health Inequality: people with mental health problems experience particular inequities in their physical health status and in access to public services including health services (in part due to stigma). People living in poverty have higher levels of mental health problems; and people with mental health problems are more likely to experience poverty. 

Indicator 4. Reduce Preventable Deaths: People with serious mental health problems die between 15-25 years earlier than the general population from preventable conditions including cardio-vascular disease, diabetes, stroke and cancer. 

Indicator 7. Improve Health in Pregnancy: The sole measure proposed is birth weight. To realise the Government’s commitment to prioritise maternal mental health there needs to be at least one mental health measure. 

Indicator 18: Increase the Proportion of People Working in Good Jobs: good jobs are positive for the working population’s mental health and wellbeing and are more likely to support people with mental health problems to remain in employment and progress in their career (reducing economic inactivity and under-employment, and the related risk of poverty). 

The consultation recognises that the success of Programme for Government is reliant on collaborative working with organisations across the public, voluntary, community and private sectors. We at the Mental Health Foundation are keen to contribute to its success.