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Thank you for inviting us to come and talk to you today about the #123GP campaign, which is a campaign to equip GPs with mental health expertise. The specific focus of this campaign to date has been on improving access to counselling in primary care which is what we are going to talk about.

We would like to start by sharing three quotes with you

 “It’s good to talk – I just wish it was much easier to access talking therapies”  Paula Matthews, #123GP                

 ‘The awful reality is that some people will be dead before they get the counselling help they need’  Christine Rocks, SAM88

“I have concerns about the way that some GP practices engage and use counsellors, in particular counsellors in training. Also issues about payment to counsellors, a number of counsellors are doing it for little or nothing. We also need to address the inequity of services where a number of practices offer no services to their patients. The overall service in NI is poor, underfunded, inequitable, of variable quality and not joined up”    Dr Richard Orr, Medical Advisor to the HSCB in an email to Public Health Agency 2014

#123GP Campaign

A region-wide network of mental health activists who have personal or family experience of mental health problems as well as families bereaved by suicide who are campaigning to ensure that all GP practices provide timely access to quality counselling (talking therapies).

Here’s the reason why people feel that this is vitally important and needs to be urgently addressed

  • GPs are the first port of call for people concerned about their mental health
  • Between 30-40% of GP appointments concern mental health
  • Too often however medication is the only treatment option offered to patients
  • We know we have one of the world’s highest prescription rates for anti-depressants
  • Counselling is known to be an effective, low-costs form of treatment.
  • We have an escalating suicide crisis. We know that counselling can be an effective intervention for people at risk of suicide.
  • We also know that it can be an effective intervention for families who have lost loved ones to suicide, who are themselves three times more at risk of taking their own lives.
  • So, in the words of Paula Matthews, #123GP campaigner, why is counselling so hard to access?

GP referral options for counselling provision

The 330 GP practices across Northern Ireland have two referral options for patients requiring counselling, either to Primary Care Talking Therapy Well-being Hubs run by the 5 Health Trusts,  or to an in-house counselling service funded through the Local Enhanced Service (LES) element of the GP contract.  

LES Counselling Provision

This is funded by the GP’s contractor, the Health and Social Care Board (HSCB).  Only around two thirds of GP practices provide this service and no data is available from the HSCB on waiting times or number of sessions provided. No statutory waiting time target exists. The level of provision varies greatly across the 5 Trusts, from 48% of GP practices in the Southern Trust providing access, to 86% in the Northern Trust.

Funding for LES Counselling Provision

In 2016/17 HSCB expenditure on LES practice-based counselling was £1,571,140 and in 2017/18 it was £1,665,235. Year on year the allocated budget is overspent; in 2016/17 the overspend amounted to just under £116,000. However, the current allocation does not in any way reflect the level of demand. #123GP has calculated that the funding provided for counselling would average out at roughly £2.29 per patient if all those patients who could potentially benefit from practice-based provision were provided with this service.

We are extremely concerned at what seems to be a widespread use of unpaid trainee counsellors by practices while drawing down HSCB funding, something alluded to by Dr Richard Orr in 2014.   From anecdotal evidence and information, we have received from counsellors this practice appears to be fairly widespread and is common knowledge among GPs, counsellors and counselling organisations, community and voluntary organisations as well as the educational institutions the trainees undertake their training in.

Allowing trainee counsellors to see clients within GP practices, without a qualified, paid counsellor on site to supervise and manage the trainees, is putting both vulnerable clients and trainee counsellors at risk. It also presents for the GP practice itself should anything go wrong.

HSCB Activity Expenditure for year 2017/18

(Source: Freedom of Information request submitted by PPR to the Health and Social Care Board)

Primary Care Talking Therapy Hubs

Data obtained through Freedom of Information on the PCTT Hubs or ‘mental health hubs’ are they are known, demonstrates that waiting times are unacceptably long, patients are only offered an average of 6 sessions, geographical access is inequitable and there is little monitoring or oversight of the service in general.

(Source: Freedom of Information requests submitted by PPR to the five Trusts).

Here’s one example of what these variations across Trusts means for people in local communities trying to access counselling, where their GP practice may not provide an in-house counsellor.

In the Northern Trust, a breakdown of the three geographical localities serviced and numbers of people accessing counselling in those areas has revealed that out of a total of over 2000 referrals accepted for counselling only five were in the Magherafelt/Cookstown locality.

Numbers seen in the other three localities ranged from 417 (Antrim/Ballymena) to almost 1000 in the Larne/Carrickfergus/Newtownabbey area. Out of the 19 organisations contracted to deliver counselling, only 2 were identified as being able to cover all three localities which would include the Magherafelt/Cookstown area.

Response from those in power 

The response to date can be sadly characterised as a mixture of arrogance and indifference. Here’s how both the Department of Health and the Health and Social Care Board have responded.

Richard Pengelly Permanent Secretary Dept Health April 2019

You’ll recall that members of this APPG wrote to Mr. Pengelly following our event in the Long Gallery event in Jan 2019. The standard response received by MLAs as well as by #123GP can be summarised thus: it talked about everything and anything to do with mental health bar the issues raised in the letter around access to counselling and solutions needed! Mr. Pengelly’s letter mentioned the Regional Mental Health Care Pathway, talking therapy hubs, local enhanced service provision, counselling provision under Protect Life 2, roll out of Multi-Disciplinary Teams but singularly failed to address in any shape or form the issues raised by #123GP or yourselves, in relation to lack of access to counselling!

 HSCB

It took #123GP campaigners at least 6 months to get a meeting with the Health and Social Care Board. They met with officials in Sept 2018 and with the Board in Dec 2018. Campaigners presented all of the evidence outlined above, which is based mainly on Trust and Board data.

This was the Board’s response:

it is at a practice’s discretion, as independent contractors, as to whether they provide counselling. However, Trusts hold a range of contracts with accredited community and voluntary organisations to provide counselling for people with mild and moderate mental health conditions, and manage access through Primary Care Talking Therapy Hubs. This means that counselling is available to people whose practice does not provide it in-house” (letter to #123GP Sept 2018)

“we feel that #123GP have been very clear in articulating a range of concerns and, as such we do not feel a further Board discussion will add anything substantive at this stage. We can of course review this in the future, particularly if there are any specific proposals to discuss” Email from Dr Ian Clements, Chair HSCB to #123GP 9 April 2019

 

Solutions

Two weeks ago, on World Mental Health Day, the UN Special Rapporteur on the Right to Health Professor Dainius Puras gave the keynote address at a Mental Health Congress organised by PPR and #123GP and held in the Spectrum Centre on the Shankill Road. In his address Professor Puras underlined the need to recognise psychosocial interventions, including talking therapies as essential components of a rights-based mental health system, not a luxury.

#123GP has identified some clear and concrete actions that the Department of Health, Health and Social Care Board and the Trusts could implement without delay to ensure that nobody is denied their right to timely access to talking therapies:

  1. Ensure that all GP practices provide access to an in-house counsellor
  2. Introduce a target waiting time for counselling of 28 days maximum

Today people in all of your constituencies are sitting on waiting lists for counselling while their mental health deteriorates. As Christine Rocks #123GP campaigner has said, the sad reality is that some of these people will become suicidal and some will take their own lives.

Counsellors have told us that if the current budget of approx. £1.6m were doubled they could clear their waiting lists.

All parties on this APPG already support this campaign. So, we are asking you today as the APPG to call on the Health and Social Care Board as a first step in addressing this crisis to double the funding for in-house counselling, from £1.6m to £3.2m.