Northern Ireland’s Mental Health Crisis 25 Years On from the Good Friday Agreement
Tommy Greene reports on the ongoing impact of the Troubles on communities in the era after the peace process
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A chasm is growing between affluent districts and communities at the sharp end of Northern Ireland’s deepening social crisis, say campaigners, with the Good Friday Agreement’s 25th anniversary overshadowed by a lack of devolved government in the region.
They say “the gap is widening” amid a sixth interruption of the power-sharing institutions established in 1998 through the landmark international peace accord.
Spiralling rates of antidepressant prescriptions and vanishing mental healthcare provision underline a less palatable legacy of the past 25 years in the region, according to campaigners.
They point to new statistics showing an overall decrease in the number of mental health care personnel available across the North, in comparison with the numbers recorded at an earlier stage of the pandemic.
Figures obtained by the charity PPR through Freedom of Information reveal a 4.5% drop in the number of mental health counsellors within Northern Ireland’s GP services between 2021 and 2022 – with a 17% decrease having been recorded for the healthcare trust serving Belfast.
The regional health service’s spend on antidepressants during the preceding year also rose by more than 50%, according to government statistics.
Meanwhile, rates of suicide, mental ill health and self-harm in working-class communities are double-to-triple the rate of that recorded in wealthier areas across the region.
The former areas, in many cases, bore the brunt of the violence and upheavals during the period known as ‘the Troubles’ between 1969 and 1998, which the Good Friday Agreement officially brought to an end.
The Spoils of Peace?
But, Sara Boyce of PPR, highlights that funding is still not being shifted in favour of those areas through existing mental health strategies and care frameworks, arguing that this should be happening if allocation was based on recorded levels of need.
She said new government figures simply “underline how the government continues to ignore the proven links between inequality and mental health”.
According to the figures, recently published by the devolved Department of Health, the suicide mortality rate is more than twice as high in Northern Ireland’s most deprived areas than it is in its most affluent – while prescription rates for mood and anxiety disorders were 66% higher between the two ends of the region’s socio-economic divide.
The statistics, she said, highlight that not all have seen the much-talked-about ‘dividend’ that was promised at the outset of the peace process.
Some commentators say a resulting sense of disenfranchisement within left-behind communities was evidenced on Easter Monday of the anniversary weekend, as a number of young people attacked police in the Creggan area of Derry – one of the region’s most deprived.
The extent of Northern Ireland’s deepening mental health crisis was brought into sharp focus in 2018 when an analysis revealed that more lives had been lost to suicide during the 20 years since the peace process began (4,500) than there were lives taken (between an estimated 3,500 and 3,800) during three decades of the Troubles.
Many communities that bore the brunt of the conflict have been disproportionately impacted by austerity and by the political vacuum that opened up as the peace process began to stall.
“Although the conflict is over, many people are still living with PTSD as a legacy of the Troubles,” says Margaret Gibney, a campaigner and women’s support services worker from the mainly-Protestant Shankill district of north-west Belfast.
While instances of sectarian attacks have fallen significantly within Gibney’s community, the historical heartland of Ulster loyalism, warring feuds between rival paramilitary gangs – mainly between branches of the Shankill UVF and UDA – have continued throughout the past 25 years. The area, like Creggan, consistently records some of the highest levels of health and educational deprivation across the UK and Ireland.
“Many people here are living with complex forms of trauma – often compounded by deprivation – which we’ve only started getting our heads around in the last few years,” she says. “But we still only have half the levels of investment in mental health that the wider UK does.”
Drug-related deaths, including deaths from alcohol abuse, were also the second-highest on record during the latest year, 2021, for which statistics are available. The rates of these deaths were more than five times higher in the region’s most deprived versus its least deprived areas.
Sara Boyce argues that the available statistics may be masking the full extent of mental health impacts across the region in a number of respects. The only figures published regularly by the devolved Department of Health are mental health in-patient numbers.
Northern Ireland’s power-sharing government collapsed in early 2022 due to an ongoing row over post-Brexit customs arrangements in the Irish Sea, meaning a statistical overhaul is unlikely in the short-term.
Turning the Page
Through its ‘New Script’ initiative, PPR is seeking to place trauma-informed human rights principles at the heart of approaches to mental healthcare in Northern Ireland.
Forms of therapy or treatment beyond medication alone are key to the “more holistic model” the organisation believes is required to adequately address mental health in a post-conflict society where almost all have been marked in some way by the Troubles.
Boyce added that, given the power-sharing institutions have been inactive for around 40% of the time since they were established in 1998, communities are increasingly looking to grassroots organisations to drive forward such initiatives amid the latest prolonged political vacuum.
“It’s exciting, 25 years post-Good Friday Agreement, to see communities across the North coming together, with a common vision for a better approach to mental health,” she says. “This in itself, is healing and transformative for communities.”