Policy makers can’t ignore the links between poverty, addiction and mental ill health, writes Alex Bunting, Inspire’s Group Director of Care & Support for Mental Health and Addiction Services

Statistics released by the Northern Ireland Statistics and Research Agency (NISRA) earlier this year paint a starkly illuminating picture of the obstacles we at Inspire encounter in supporting those impacted by substance use and mental ill health

According to NISRA, 218 people were lost to alcohol and other drugs in 2020, a significant increase on 2019. These were all preventable deaths and they force us to reflect on how best to reach people living with addiction issues.

Behind the headline figures lie significant repercussions for families, communities and region-wide physical and mental health. The social cost of substance use is thought to be around £1 billion per year, further demonstrating the urgent need for a new approach focusing on harm reduction and recovery.

Granted, progress has been made in some quarters. Crucial policies now working their way through the Department of Health, including the Mental Health Strategy 2021-2031 and the equally vital Substance Use Strategy, provide opportunities to reduce the scale of substance use and addiction in Northern Ireland. These contain distinct proposals, of course, but, given the undeniable crossovers between mental ill health, addiction and substance use, they are equally important and interdependent.

If these strategies are to be successful, ministers must commit significant time and effort to their full implementation. They should be adequately resourced, in order to effect the various objectives and bring about positive change. That is no small consideration, obviously. To deliver all of the actions in the Mental Health Strategy, for example, a 34% increase in funding for services is required. 

Elsewhere, even as the Department consults on the putative introduction of minimum unit pricing for alcohol, we must remember that these kinds of measures serve as complements to reform; they are not silver bullets. There must be wider strategic thinking around what influences substance use and, thus, it is essential that we look to prevention as a fundamental part of any solution. Key Executive initiatives must be bound together and operate according to the factors that fuel mental ill health and addiction.

One such framework still outstanding is the cross-departmental anti-poverty strategy, one of a long list of pledges in the New Decade, New Approach accord of January 2020.

As remote as those pre-pandemic days now seem, the promises made have never been more relevant than they are today. The strain of poverty has undoubtedly expanded to myriad households throughout Northern Ireland, with deprivation constituting a significant driver of mental ill health, substance use and addiction. Widening health inequalities further underline the necessity of joined-up thinking and resourcing that remove barriers to help and support.

The Health Survey (NI), published in December, found that a third of those in the most deprived areas had experienced mental ill health, compared with just under a quarter of their peers in the least deprived neighbourhoods. The numbers in both categories are up in comparison to the previous year but the imbalance remains clear.

Changes to the social security system have also created genuine fear and anxiety. Many Inspire service users have admitted to feeling worried about the transfer from disability living allowances to personal independence payments.

As people face the ongoing challenges of austerity, a cost-of-living crisis is now compounding their difficulties. Fuel, energy, gas and food prices are forcing families to make increasingly difficult choices. As thousands are falling below the poverty line, incidences of mental ill health and addiction will inevitably rise.

Mental health and personal finances intersect in two main ways: changing circumstances when a person becomes unwell and the impact a mental health condition can have on a person’s ability to make sound financial decisions. This mix of uncertainty and precariousness combines to produce unwelcome outcomes, pushing people towards alcohol and other drugs. Indeed, in Northern Ireland, high levels of mental ill health are tracked by our UK-leading anti-depressant prescription rates.

While addiction can touch on the lives of people across the socio-economic spectrum, we cannot neglect the significant links with deprivation. In short, poverty is a threat to public health and government must act, without delay, to tackle it.

This article was first published in the most recent edition of NI Healthcare Review