The Belfast Mental Health Rights Group have expressed their concern that the Card Before You Leave Scheme could be at risk. The scheme launched in 2011 by Minister for Health Michael McGimpsey (pictured) has been positively evaluated by the Health and Social Care Board, and has resulted in the number of mental health patients who do not attend their follow up appointments falling by almost half, yet indications have been made that it is 'under review'.

The best practice appointment system was lobbied for by the Belfast Mental Health Rights Group (BMHRG), a group of mental health service users, families bereaved by suicide and carers.  They are now calling for the Minister to intervene and give assurances about the ‘Card Before You Leave’ scheme and maintain what is widely acknowledged as a ‘lifeline’ to those in distress.

The ‘Card Before You Leave’ scheme is intended to ensure that any patient with mental health issues who is considered safe enough to go home, is given a written appointment for a full psychiatric  assessment within 24 hours.  The ‘Card Before You Leave’ system aims to ensure people remain tied into services when they are particularly at risk.

Since 2009 BMHRG has worked with the Health and Social Care Board to implement the system and push for necessary improvements from the perspective of mental health service users. This work has taken place against the backdrop of the ever increasing problem of suicide in Northern Ireland.  Last year alone, suicide claimed 313 lives in Northern Ireland. 

Bobby Duffin a BMHRG member who lost his daughter to suicide shared his concerns:

“The ‘Card Before You Leave’ is a lifeline for vulnerable people. We campaigned long and hard for this so that things would change and I really hope that the HSC Board and the Minister start showing that they take this problem seriously. We went to them in good faith and worked alongside them to produce positive results. They need to keep that going.”

BMHRG has been instrumental in securing improvements to the roll out of the ‘Card Before You Leave’ scheme.  They lobbied to ensure patients received an actual appointment rather than the promise of a follow up phonecall, which was the approach that was being adopted in areas such as Belfast. The BMHRG also insisted that a robust evaluation, with full disclosure and consideration of how the appointment system was working, or was not working, across all Trust areas was conducted. This resulted in an evaluation report in November 2012 which stated:

“...there are good grounds for believing that this scheme and similar schemes elsewhere offer real potential in helping to reduce further incidences of deliberate self-harm/suicidal ideation through the provision of appropriate contacts and information on how to access services.”

Ministerial body set up to implement CBYL dissolved

At the end of November last year, the Belfast Mental Health Rights Group was dismayed to be informed that two months earlier in September, recommendations were made to scrap the forum through which they had made improvements to the CBYL, and they were informed that the CBYL was now subject to review. These recommendations were signed off by Health and Social Care Board officials without service-user knowledge.

Despite meetings having taken place between the HSC Board and Belfast Mental Health Rights Group in the period between September and November, the decision to dissolve the Board was never disclosed.

Kathy Gilliland, a mental health service user and member of the Belfast Mental Health Rights Group explains:

‘It isn’t just about being respectful of what we have been through, it’s about recognising that it makes good sense to listen to people who have been through the system and know what works and what doesn’t. Our experience can make things better and save money - throwing it away in times of cutbacks makes no sense.’

Responsibility for progressing the ‘Card Before You Leave’ scheme will now be transferred to another body with a broader function. It is unclear how this new group will operate and if people with direct experience of using mental health services will be included. Stephanie Green from Participation and the Practice of Rights adds:

“The need on the ground is there; the evidence that this scheme works is there. Involving people who have experience is not only the right and respectful thing to do, but it also makes sense. The conduct of the Health and Social Care Board is concerning. The experience of the Belfast Mental Health Rights Groups work with the ‘Card Before You Leave Board’ was starting to show lessons about how we can work differently to achieve better care for people with mental health problems.  Indeed these lessons were being developed into HSC policies on participation. This latest development is worrying not just for the BMHRG, or for people who need the ‘Card Before You Leave’ but also for groups in the future who try to improve services.  The Minister needs to intervene to support the BMHRG, service users, carers and their families and schemes which work like the ‘Card Before You Leave‘.”