Inspire has launched its manifesto for the 2024 general election. Entitled Inspire 20Four, the document focuses on four main policy goals and is informed by the insights of the individuals who use our services.

The 2024 general election represents an extremely important inflection point. It will decide the direction that the UK Government follows for the next five years and greatly influence the way in which our society works.

Mental health and wellbeing, perhaps more than ever before, remain highly relevant public health issues. They demand the attention of voters and those elected to represent them. Since the last general election, the world endured the Covid-19 pandemic, a once-in-a-century public health crisis that will affect communities everywhere for years to come.

In Northern Ireland, the lasting psychological impact of the Troubles and the ongoing harm caused by religious, political and racial divisions in our world are contributing to negative health outcomes for many, particularly the most vulnerable.

The new Westminster administration can, and must, take significant steps to address these problems and others if it is truly to improve the lives of people across Northern Ireland, as well as in every other corner of the United Kingdom.

The themes contained in this manifesto emerged from conversations with the people that we support.

As Inspire 20Four demonstrates, our service users are focused on local issues and international matters. It illustrates just how deeply they understand the intersection between holistic, high-level decision making and the goal of positive wellbeing for all.

You can access Inspire 20Four here.

We have also prepared more detailed information relating to the areas outlined in the manifesto. Check it out below.

Priority 1 – Funding Northern Ireland: a needs-based block grant

If the public sector in Northern Ireland is to excel, meet demand and support communities, it must be properly financed. The truth is that the Northern Ireland Executive can only do a certain amount if its funding is ultimately determined by UK Government.

From the perspective of mental health, a renewed fiscal framework is essential. The Executive commits far less to mental health services than any other administration in the United Kingdom, in spite of Northern Ireland’s high suicide rates, the legacy of the Troubles, inter-generational trauma, profound economic inequalities, and the social and health impacts of the Covid-19 pandemic. In fact, the prevalence of mental illness in Northern Ireland is reported to be around 25% higher than that in England.

The people who use our services continue to tell us about the things that will make their lives better: more in-patient beds, supported housing and community wellbeing programmes; progressive prevention and anti-stigma efforts; specialist interventions; and shorter waiting lists for psychiatric appointments.

And, yet, their priorities extend far beyond their personal challenges. We recently asked them to identify the everyday policies that they consider most important. They presented a range of important topics, from leisure facilities, skills and training to cheaper and more accessible public transport.

Inspire service users understand the bigger picture. They see the poor condition of Northern Ireland’s roads and many of its shared spaces. They recognise that the National Health Service is underfunded and understaffed. They know that social care and voluntary sector workers deserve better pay. They are now demanding a stronger, more equitable social safety net as a fundamental component of living well.

In our view, full funding for the Department of Health’s £1.2 billion Mental Health Strategy 2021-2031 also remains an overriding concern. So, too, are effectively delivered – and intersecting – substance use and suicide prevention strategies. We echo Mental Health Champion Professor Siobhán O’Neill’s appeal for a tenfold increase in Mental Health Strategy spending but recognise that such an uplift demands a new approach at Westminster.

For these goals, and others, to be realised, a larger block grant will allow Executive departments greater freedom in funding critical services. Going forward, however, the block grant should be calculated according to the real and various needs of the population in Northern Ireland.

Given the region’s particular history, a model that takes account of the issues faced by people living here, is a far more appropriate arrangement than the per-head method presently in operation. Indeed, while the UK Government has agreed to introduce a needs-related funding mechanism this year, current projections suggest that the effect of this will not be felt for a decade.

 

Priority 2 – Benefits and social security policy: a social security system that works for all

While the Department for Communities oversees and administers social security in Northern Ireland, the policies themselves are set and regulated by the Westminster government.

When we canvas the opinions of the people who use our services, the topics of poverty, income and social security are almost always referenced. We have heard about the impact of losing a job, moving to statutory sick pay, attending occupational health assessments and having to enter an unfamiliar and complex benefits system.

Poverty, deprivation and austerity bring with them significant consequences for a person’s mental health. Inspire staff have connected service users with foodbanks, so that they can eat. Our colleagues have located means of support to help pay for essential utilities, like a warm home, and regularly source mobile phones, so that people might stay connected to vital services.

The social security system is one of our greatest public service investments. However, changes made to that system by the UK Government in recent years have created genuine worry and anxiety. Almost without exception, those who have moved from Disability Living Allowances to Personal Independence Payments (PIP) reported feeling fearful about the transfer. Their experiences in the time since have not been positive. “We have to fight for everything,” says one person. “It’s got to the stage where you are dreading the postman,” says another.

A recent Inspire survey respondent labelled PIP assessments stressful and demeaning: “Benefit reviews for those with mental ill health need to be re-examined. I am made to feel like I am lying about my condition. I always feel sick around this time and my mental health deteriorates.” Service users routinely report a general absence of mental health awareness within the PIP assessment process, a process that does not seem to appreciate the nature of mental illness, which exists, for many, as a fluid state. Periods of good health are punctuated by debilitating spells of despair, depression, anxiety and worse.

The way in which PIP is evaluated requires a significant overhaul if it is to accommodate accurately and effectively those living with mental ill health. The UK Government must, of course, focus on better supporting people who can work when well enough to do so, while helping those who are not. Accessible, evidence-led, knowledge-based and compassionate assessments – underpinned by extensive mental health training and education – will spare people the ordeal of constantly having to prove themselves as qualifying for assistance.

As a member of the Cliff Edge Coalition, Inspire has, since 2018, been campaigning to sustain and strengthen key welfare reform mitigations, enacted by the Northern Ireland Executive, to protect families and communities from poverty. However, they continue to struggle under the weight of policies that cannot be fully curbed and harsh new welfare challenges have been steadily exacerbated by the ongoing cost-of-living crisis. Tellingly, according to research that we conducted in 2022, 79% of adults here said that their mental health and wellbeing was adversely impacted by higher inflation.

The next UK Government can take immediate action to ease the burden on people by removing the universal credit limit on support for more than two children per household.

Furthermore, the UK Government must expedite the resolution of the five-week wait between the initial claim for universal credit and the first payment. This should be done either by shortening the waiting period, or dissolving it altogether, and better resourcing the arrangements that exist for interim payments.

Priority 3 – Immigration and asylum: migrant and refugee mental health

Northern Ireland plays its part in the international community by offering protection and safety to those leaving behind terrible, life-threatening situations. More broadly, immigration has, for decades, enriched our society and supported our economy.

It is important to remember that people fleeing their homelands have lost their livelihoods, communities and property; they have been separated from their loved ones. Some have witnessed unimaginable violence. They have been tortured, seen friends and relatives killed, and made perilous journeys in search of new lives.

A proportion of them then reach the United Kingdom, where the complexities of the asylum system can cause anxiety, distress and depression. Concerns around family life, housing, finances, education, access to legal advice and, perhaps more than anything else, the future all take their toll.

In addition, many coming here from other parts of the world may continue to live in fear – fear of deportation, homelessness and rising animosity towards ethnic minorities, refugees and asylum seekers.

The World Health Organisation (WHO) states that ‘Migrants and refugees can be exposed to various stress factors which affect their mental health and wellbeing before and during their migration journey and during their settlement and integration. The prevalence of common mental disorders such as depression, anxiety, and post-traumatic stress disorder tends to be higher among migrants exposed to adversity and refugees than among host populations.’

The WHO recommends that ‘the mental health needs of migrants and refugees … be addressed by organising inclusive and accessible promotion and prevention programmes; strengthening mental health as part of general health services; and ensuring timely diagnosis, treatment, and rehabilitation’. In spite of this, those coming to Northern Ireland in search of asylum do not receive mental health assessments.

In 2017, The Executive Office and The Mitchell Institute at Queen’s University Belfast published research on the everyday experiences of refugees in the region. The report, entitled Asylum Seekers and Refugees’ Experiences of Life in Northern Ireland, identified common problems, including an absence of support for mental health issues and the impact of torture, along with a general requirement for more information on health services.

A comprehensive, compassionate and multi-disciplinary approach is essential if we are to address the physical and emotional wellbeing of migrants, asylum seekers and refugees. The UK Government – and, in particular, the Home Office and its agencies – should implement the recommendations of the WHO by rolling out and resourcing a wide-ranging mental health strategy for these groups.

Such a strategy must focus on: addressing and supporting migrants’, asylum seekers’ and refugees’ myriad needs, particularly with respect to their past and current experiences; providing immediate care; breaking down barriers to accessing services; and facilitating the engagement of multiple sectors (e.g. criminal justice, child protection, immigration, social services and education) in order to integrate support.

Priority 4 – UK Government and MPs: tackling stigma through language

The people we support face a host of obstacles every day. Stigma is one of them. As a provider of services to individuals living with mental ill health, addictions, intellectual disabilities and autism, Inspire is committed to, and campaigns for, a world in which they can lead dignified lives.

Earlier this year, alongside our partners in the Anti-Stigma Alliance, we took part in the If It’s Okay campaign, which ran across England, Northern Ireland, Scotland and Wales. The aim of this campaign was to give a voice to everyone experiencing mental illness, as well as countering the ongoing impact of discrimination and shame.

We carried out polling to better understand the issues and found that well over six in 10 (64%) of people with a history of mental ill health had felt shamed because of it. A majority of the population (54%) believed that there is still a great deal or fair amount of shame associated with the subject and 70% felt that society should be more sensitive when talking about mental health, so as to avoid upsetting others. Significant numbers of respondents held inaccurate beliefs about mental illness and employed stigmatising words, unthinkingly, in everyday language.

These are complex topics and discussing them in everyday terms can prove difficult. The things we hear from influential figures really matter. They can shape popular opinion in ways good and bad. When stories are told accurately, with compassion and sensitivity, they can be very powerful, raising awareness, informing debates and driving positive change.

Conversely, sensationalism, misinformation and recklessness in reporting can do real damage. The link between violence and mental health, for example, still tends to be exaggerated and the use of derogatory terminology perpetuates stereotypes and otherises those enduring often debilitating personal challenges.

Using the right words can have a real impact on people living with these conditions, just as negative terminology – which is very often employed subconsciously and without malice – can wound and stigmatise. Following on from the If It’s Okay campaign, we are calling on all elected representatives to lead in this important area and help reshape societal attitudes.

We believe that the UK Government can set an example by promoting positive language in its public statements and talking about these matters in sensitive ways. Ministers, and members of parliament more broadly, should act as ambassadors, tackling mental health stigma and establishing high standards for vital popular, political and media discourse.

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