Briefing note on mental health ICESCR examination

Briefing by the Mental Health Rights Campaign on the Northern Ireland Executive’s compliance with Article 12: Right to the highest attainable standard of health

Participation and the Practice of Rights (PPR) 6A Albert Street Belfast BT12 4HQ Tel: 02890313315 Email: sara@pprproject.org www.pprproject.org

Human Rights Concerns Article 12.2 (d) provides for the right to health facilities, goods and services. This includes equal and timely access. A number of serious issues exist in respect of the provision of adequate mental health services at emergency hospital departments for people in mental health crisis.

Suggested Questions The Committee may wish to ask the NI Executive what procedures are followed to ensure that adequate and timely follow up arrangements are in place for people who attend emergency departments in mental health crisis.

The Committee may wish to ask the NI Executive how it intends to address the issues around delays in sectioning so as to ensure that the rights of people who present at emergency hospital departments to timely and appropriate health care are fulfilled.

Context The Mental Health Rights Group is a group of people whose members have personal or family experience of mental health issues and suicide/self –harm and who have been campaigning for human rights compliant mental health services in Northern Ireland since 2006. The group is supported by PPR in its work.

The legacy of over 30 years of violent conflict continues to be felt in Northern Ireland ( NI). Rates of mental ill health and suicide are higher than in other jurisdictions of the UK, with the Department for Health estimating that the prevalence figures for mental health in NI are 25% higher than in England. In 2014 the rate of suicide in Northern Ireland was 16.5 per 100,000 compared to 9.2 per 100,000 in England. Since the 1998 Good Friday/Belfast Agreement more people have taken their own lives in Northern Ireland than were killed in the conflict. Despite this, investment in mental health services in NI is between 10-30% lower than per capita spend in England.

Those areas most impacted upon by the conflict continue to experience higher levels of inequality and social deprivation, including in relation to the provision of mental services. Rates of suicide in the most deprived areas are over three times (29.9 per 100,000) those for the least deprived areas (9.3 per 100,000).

Card Before You Leave In 2010 a new appointments system for those attending emergency hospital departments in mental health crisis was introduced across the five Health and Social Care Trusts in Northern Ireland. The ‘Card Before You Leave’ appointments system provides people in mental health crisis, at the point of discharge from emergency departments, with an appointment card with the date and time of their follow up appointment. This system was successfully campaigned for by the Mental Health Rights Campaign and was based on their own experiences combined with international human rights standards and best practice standards.

However, in a survey of 104 mental health service users carried out by the Mental Health Rights Campaign in 2015, less than half (40%) of those who attended emergency departments in mental health crisis and in need of follow up were provided with a Card Before You Leave on discharge.

Delays in Sectioning Delays in carrying out sectioning1 of seriously mentally ill people who have presented at emergency hospital departments constitute a breach of patients safety and can also constitute a potential breach Sectioning refers to the process of detaining people under the Mental Health ( NI) Order 1986 for mental health assessment.

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of their right to life. In January 2011 a young man, Jonathan Magee, presented in the emergency department of City Hospital, Belfast after self-harming. Mr. Magee left the emergency department after waiting for over seven hours for psychiatric assessment; the following day he took his own life. A Serious Adverse Incident Review conducted by the Health Trust following Mr. Magee’s death highlighted delays in the sectioning process related to the delays in attendance of out of hours GPs. A subsequent inquest heard in May 2016 also highlighted a number of failings in the police investigation.

In response to the Serious Adverse Incident Review the Belfast Trust agreed a process to address issues around GP attendance at emergency departments for sectioning procedures.

However, monitoring visits of emergency hospital departments conducted by the Mental Health Rights Campaign alongside the Public Health Agency in 2015 revealed that delays in sectioning were still ongoing in the three Health Trusts visited; similar issues in the Belfast Health Trust were confirmed by a senior health official in May 2016.