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Mrs. Iris Robinson (Strangford) (DUP): I shall touch on three issues. First, I will take the opportunity to discuss mental health in Northern Ireland, and specifically the promotion of good mental health. I shall also mention child and adolescent services later, if time permits.

The mental health review, chaired by Professor David Bamford, is continuing in the Province. One of its working groups has suggested the formation of a mental health promotion directorate to oversee and co-ordinate the entire area of this work. In Scotland, £24 million has been allocated over three years to establish the mental health improvement and well-being directorate. The resourcing of mental health promotion in Northern Ireland should reflect the cost of mental ill health and   the potential savings from achieving an improvement in the mental well-being of individuals, families, organisations and communities. Undoubtedly, several millions of pounds would be required. That seems like a lot of money for something that will not be deemed as acute care. However, given annual costs, it represents good value for money in the longer term.

There is a growing body of research on the effectiveness of mental health promotion, with a robust evidence base on specific interventions. The focus of much mental health research is on mental illness as opposed to good mental health. The promotion of positive mental health is necessary at all life stages. Early   intervention for children and adolescents has been proven to improve resilience. Older people—an ever-growing population group—have their own specific needs. There is strong evidence to show that mental health can be promoted in a range of settings, such as schools and the workplace. Further education colleges and rural areas are also crucial.
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The effective delivery of mental health promotion in all sectors and settings in Northern Ireland will depend on building knowledge, expertise and capacity. This should include training, information and guidance, and research.

In Northern Ireland we have an extra dimension to the causes of mental ill health. The fabric of many communities has been destroyed by the legacy of more than three decades of terrorism. Communities need to grow and to develop, enhancing levels of trust, a sense of belonging and potential for participation to promote emotional well-being. Although some progress has been made towards this vision, much still needs to be done.

Spending on mental health services has mushroomed in recent years. For instance, in 2003, £150.8 million was spent by trusts in Northern Ireland, an increase of more than 31.3 per cent. on four years previously. It comprised £85.6 million for hospital services, £25.4 million on community health services and £39.8 million for personal social services. It does not include £34.1 million for GP consultations on mental health or £44 million for psychiatric drugs last year. Furthermore, the cost to our economy of lost output and the quality-of-life impact on individuals cannot be underestimated. The Northern Ireland Association for Mental Health, in "Counting the Cost", attempted to calculate a monetary figure to reflect the impact of mental illness across all sectors of our society. Costs not generally considered include formal care from family and friends, loss of earnings through sickness absence, non-employment and premature mortality as well as mental health care provision by the private sector or voluntary and charitable organisations. The sum that the study reached represents the savings that would be made in Northern Ireland if there were no mental illness. Its final estimate of the total cost of mental illness to society in Northern Ireland in 2002–03 was £3 billion—a figure greater than total spending on health and social care in the Province for all health conditions. That £3 billion is, of course, an artificial figure, as the eradication of mental illness is not possible, but it highlights the extent of benefits that could be achieved by limiting the prevalence and severity of psychiatric illness.

The cost of mental health affects everyone, as escalating increases in Government spending impact on taxes and access to public services. In a response to a recent parliamentary question, I was informed that spending on mental health promotion in the Province has increased from £50 million to £600 million in the past four years. Those totals have raised eyebrows among mental health professionals, and I have submitted further questions to seek a detailed breakdown of the way in which the totals were arrived at.

In reviewing progress on mental health promotion in the Province, a number of initiatives have emerged as crucial to the achievement of effective delivery, including the prioritising of key at-risk groups, and cross-sector co-ordination and co-operation. To achieve strategic, co-ordinated, cross-sectoral and multi-agency action on mental health promotion in Northern Ireland a regional mental health promotion directorate should be established. It should be part of the Department of Health, Social Services and Public Safety, and should have responsibility for mental health and disability
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rather than become part of an overall health promotion structure. Another option, given that good mental health crosses many sectors, would be to include the directorate in the Office of the First Minister and Deputy First Minister.

A fully resourced directorate would increase awareness of mental health promotion, facilitate the achievement of existing targets, and set new targets in future. It would provide greater permanence, leadership and sustainability to drive mental health promotion in the Province. It would assume ownership of mental health promotion across all sectors and relevant agencies. On a related matter, a suicide prevention strategy, separate from any mental health directorate and based on United Nations and World Health Organisation guidelines, should be properly resourced and developed in the Province with an identified action plan, target dates and responsibilities. There is a great deal of concern about the large number of suicides in Northern Ireland, particularly among young men. After heart disease and cancer, suicide is the third largest contributor to life-years lost in the Province. To highlight the personal cost of mental illness, I should like to raise the case of a constituent whose family recently approached me. Their 39-year-old son suffers from obsessive-compulsive disorder. He has undergone cognitive therapy but, unfortunately, to little or no effect, and he remains on a high dose of a drug with significant side effects. He sits in his flat all day in torment, unable to go out, to mix with people and to lead a normal life. He is a qualified dietician, and he knows and understands only too well the details of his condition.

Provision for OCD is limited, and the family have pinned their hopes on his being taken by one of a couple of units in London. OCD sufferers face agonising torment, and they struggle alone in silence. That man's mother is concerned that he will eventually commit suicide, because of the hopelessness of his condition. His story highlights the impact of mental ill health on an individual and on their livelihood, lifestyle and family. It is essential that we do everything that we can to provide the best services and work to promote mental well-being. Greater community and voluntary sector involvement is required, more resources need to be invested and extra training should be provided for professionals. Better co-operation between schools, youth organisations and health bodies would be useful, too.

With the increasing popularity of television and the internet, people are living more solitary lifestyles. The sense of community has been diluted, and individuals have less contact with their families and neighbours, which means that they have fewer people in whom to confide. Bereaved families say that little help is available in the aftermath of suicides, which is a crucial deficiency that must be addressed. Families often feel personally guilty following a suicide within the family unit. Much more needs to be done to tackle the stigma of mental illness and to increase public awareness of mental ill health and the risk of suicide, and that will require substantial funding.

The increasing prevalence of suicide among young men is not confined to Northern Ireland. The same pattern is reported across the rest of the United Kingdom and in many other countries. There are
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numerous pre-disposing factors for suicide, which is more common among impulsive and aggressive personalities. A large majority of those who commit suicide have mental disorders at the time of death. Chronic ill health can contribute, and many individuals have a history of alcohol or drug misuse. Binge drinking is increasingly common across our society, and suicide can also result from the transient mood swings associated with alcohol consumption.

We must also consider the role of the media. Hawton et al showed in 1999 that suicide rates increase after television programmes about suicide, and Eisenberg in 1986 and Gould et al in 1990 showed that the means and timing of suicides are influenced by earlier suicides that attract attention within local communities or receive media publicity.

Mental health crisis response and assertive outreach teams have proved successful, and their introduction across the Province should be encouraged. Despite a high number of suicides among teenagers, children and young people in the Province can wait for up to four years for an initial psychiatry out-patient assessment. There are huge disparities between the duration of waits across different trusts, but even the shortest wait is several months.

Social and cultural factors have led to more young people requiring assessment, and drugs, sexual abuse and difficult domestic environments also contribute. Many more behavioural conditions and autistic spectrum disorders are being diagnosed than previously, and the totals will continue to grow. Planning for future resources must take into consideration the changing demands of the specialist field. We need to invest in more child and adolescent psychiatry staff, including not only consultants but junior medical staff, nurses, social workers, occupational therapists, psychologists and psychotherapists, because existing resources are overstretched.

I want to raise a second issue—I know that I shall not get to my third issue. In March 2004, the Prime Minister's strategy unit published, "Net Benefits: A Sustainable and Profitable Future for UK Fishing", yet little has been seen in the fishing villages of County Down to lead anyone to believe that anything positive is   being done to assist the industry after years of EU-promoted decline. Year after year, the fleets of Portavogie, Ardglass and Kilkeel are subjected to increasingly repressive directives that have now begun to affect the processing industry, with the recent loss of Middleton Seafoods in Portavogie.

It appears that this groundhog day is to be repeated in 2006, as information coming through from the EU Fisheries Council in Brussels today indicates that the Northern Ireland fishing industry is once again to pay the greatest price. As a result of the yearly attack on the Irish sea's white fish stocks, prawns now represent the most important catch for Northern Ireland fishermen. News from Brussels today indicates that the prawn total allowable catch for the North sea is to increase by 39 per cent., while there will be a 31 per cent. increase in the west of Scotland. The Irish sea is to have its nephrops TAC reduced by 12 per cent.

While all this has been going on, English and Scottish fishermen have been represented at the Fisheries Council by their respective Government officials, but
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Northern Ireland has been cut adrift by its Minister with responsibility for fisheries. If that Minister could not be available despite the fact that this date was known for months in advance, he should not be in office and I would ask that he resign.

4.56 pm

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