Debate contribution: Autism Mental Health Services

Debate contribution by Mr Mike Nesbitt on 20 January 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

20 January 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Autism Mental Health Services

Assembly identifier

Official Report component 4744972

Read the official Assembly record

Text

Thank you very much, Mr Deputy Speaker, and thanks to all Members who have contributed to this important debate. First, I recognise the passion and commitment of every Member who has spoken. Autism is not a stranger to my family, so I believe that I have some grasp of the challenges, concerns and needs. I absolutely agree that we need to ensure that all those seeking mental health support, including those with autism, have access to the right services at the right time. It is an issue, not least in waiting lists. As Robbie Butler said, I have campaigned on mental health issues since I was elected here in 2011. One of the main reasons for that is that I came here from the Commission for Victims and Survivors, where you could not but be deeply moved by the level of poor mental health as a really toxic legacy of the 30 years of our violence. When I came here, however, I did not see anything like the same level of recognition. Some people seemed to be reluctant even to consider it a thing or certainly not a thing that was worthy of attention.

Indeed, one day, one MLA scoffed at me because I was campaigning on mental health. That was how disassociated they were from it. Awareness in 2025 is very high, but I hear the call from Members that it is not about awareness any more; it is about action. When Robin Swann became Health Minister, I was delighted, because I knew that he would focus on mental health. He appointed the mental health champion and commissioned the 10-year strategy, which has 35 action points in it. I want to dwell on and put on the official record the three themes that underline those action points. The first is:

"Promoting mental wellbeing, resilience and good mental health across society".

That is key to addressing the ongoing issue of the stigma that gets attached to people with mental health problems, which we will debate tomorrow. The second theme is:

"Providing the right support at the right time".

That covers a range of person-centred service improvements, such as, for example, improvements in child and adolescent mental health services; community mental health services, which are absolutely key; and inpatient and specialist services. The third theme is "New ways of working". That sets out the changes that will support improvements across the system, including a single mental health service, workforce planning and research. Overarching that, we have, as many Members mentioned, the appointment of the autism reviewer, Ema Cubitt. She will be and is an independent voice. Any Member who heard her first public comments will have been reassured that she will indeed be an independent reviewer and a strong voice for the community that all the Members who have spoken today wish to serve. Autism, as has been made clear, is a lifelong condition, but better education for and understanding from all of us can help people to lead fuller and healthier lives and enjoy the same benefits and freedoms as the rest of us. I am aware of significant delays in accessing autism assessments. That is partly what drives people to seek a private diagnosis. Today, I can say that, in the past financial year, trusts have carried out more assessments than in previous years. There remains a demand/capacity gap, and, consequently, the waiting lists still exist, but work is under way to standardise the diagnostic pathway across trusts while better meeting the needs at an early pre-diagnosis stage. That comes back to my theme of how we should find where the best practice exists and roll it out so that it is common practice across the five geographic trusts. I want to make it clear that an autism assessment should not be required to access mental health services. At this stage, I commend Autism NI for raising awareness of the mental health inequalities that are experienced by autistic people. I am aware that over 25,000 people signed the petition that was mentioned and that there were over 400 comments from people and families on the mental health challenges that they have faced and the need for better provision. Whilst autism is not a mental health issue, it is common for autistic people to experience poorer mental health outcomes, and that can be partly attributed to a lack of access to mental health services. We must also be cognisant that three in 10 people with learning disabilities will have a co-occurring diagnosis of autism, and that was mentioned earlier. Those people can present with an exceptional level of need, and they are typically over-represented in our mental health inpatient services. As referenced, seven out of 10 people with autism have co-occurring conditions such as anxiety, depression, ADHD or obsessive compulsive disorder. The mental health strategy recognises the need for services that can cater for those with disabilities, including physical and sensory disabilities, ASD and learning disabilities. That must also include help and support for parents and families. While it is vital that such individuals have good and equitable access to mental health services and that those services are able to deliver on their specific needs, the Department does not consider it appropriate to develop dedicated mental health services designated to treat those individuals. Doing so would mean that people are treated primarily according to their underlying disability or circumstance rather than receiving the most appropriate intervention that they need for their mental ill health, which is different for everyone. Instead, the strategy aims to put in place a person-centred service that is focused on the presenting mental health needs of the individual with consideration of how best to meet those needs, given their underlying disabilities and/or circumstances.

It is fair to say that autistic people could be better served by our mental health system. However, that does not sufficiently make the case, in my view, for a specialist mental health service. The evidential, professional and policy position, as indicated in the mental health strategy, remains that most autistic people are best supported in a mainstream service that is autism-aware and with reasonable adjustments. At times, they will need to access specialist services such as those for eating disorders, substance abuse and forensic learning disability. Again, the evidence and the professional position remain that those services should be reasonably adjusted to provide access and treatments and should be adapted for autistic people. Training is key to ensuring that appropriate adjustments are made for each autistic person and that our mental health service is person-centred, adapting treatment and care at every point throughout a person's journey. Health and Social Care staff have access to a range of autism training modules. Work is under way with the Middletown Centre for Autism to develop new modules to be launched in the spring. It is my expectation that that training will be mandatory for mental health professionals and that it will form the foundation of additional training to be developed in the future. For autistic people with a co-occurring learning disability, specialist services are provided and continue to reflect a strong evidential and professional basis. That is not to say that it is a perfect system. I am aware that specialist learning disability and mental health inpatient services are significantly stretched and that there is an urgent need to develop a more robust community mental health system to prevent hospital admissions. In collaboration with the HSC Leadership Centre, my officials are in the process of finalising a review of the autistic population with a co-occurring learning disability who are known to services. That work will inform the implementation of the learning disability service model and the development of a delivery plan for the final three years of the autism strategy from 2023-28. It is important to recognise that wider factors can impact on a person's mental health and well-being. The autism strategy recognises that the challenges faced by autistic people are cross-cutting and require action through a collaborative, cross-departmental and multi-agency lens. The strategy aims to meet the requirements of our unique autism legislation, setting Northern Ireland apart and, indeed, ahead of many countries, to ensure that public services understand the needs of autistic people and provide the right level and type of services. At this stage, I pay tribute to colleagues on the all-party group on autism for their work in progressing both pieces of autism legislation in the past 15 years. As many of you will be aware, the autism strategy was developed and is being taken forward in a period of exceptionally constrained financial circumstances for all Departments, public bodies and Health and Social Care services. Whilst there is continued commitment to the implementation of the actions, that has necessitated a creative and innovative approach. The autism strategy sets out to deliver actions across health, education, housing and public services generally, including the Civil Service. The first monitoring report on year 1 progress is due with me imminently, and it will then be presented to the Assembly. While work is being progressed to make mental health services more accessible to those with co-occurring diagnoses such as autism, it is worth noting that the delivery of many of the actions in the mental health strategy will, once fully implemented, help improve access to mental health services for all service users. I will highlight a number of those actions. Actions 1 and 2 of the strategy focus on promotion and prevention and are being progressed through a Public Health Agency-led early intervention and prevention action plan, with year-on-year actions covering a lifespan approach from infancy to older age. Importantly, the action plan will:

"consider groups disproportionately affected by mental ill health who often struggle to access early intervention services and seek to reduce stigma associated with mental ill health."

A new regional mental health service as part of action 31 will, once fully established, help ensure access to high-quality regionally consistent and locally based mental health services in local communities. To date, significant work has been progressed, such as the appointment of a number of key roles and the establishment of the collaborative board, which has its inaugural meeting scheduled for later this month. A review of the mental health workforce and response to action 32 was published in July 2023, and that set out 18 recommendations to ensure that we have a workforce that is fit for the future. An implementation plan for the delivery of the workforce review is being finalised. It will set out priority actions that are to be progressed, subject to budget availability. A comprehensive review of the scope, scale and capacity of the community and voluntary sector, as part of action 17, was commissioned last month, the findings from which will inform how best our community and voluntary sector can be true partners in the planning, development and delivery of mental health services, which should ensure improved outcomes for our population. Lastly, a regional specialist CAMHS ID model is being developed to address the mental health needs of children with complex needs, who are typically those with a co-occurring diagnosis of learning disability and autism. On the subject of children, it is also important to recognise that mental health pressures can be reflective of gaps in social care. Members will be aware that I accelerated our work on respite, residential care and family support with additional recurrent funding of up to £13 million that was announced in October last year. It will take time to ensure that that funding is fully utilised, but I expect there to be measurable improvements to the lives of autistic children and their families. While considerable progress has already been made to advance those key actions in the mental health strategy, alongside the delivery of a range of other actions, they are being progressed with minimal budget. I have repeatedly highlighted that to Executive colleagues since taking up post. The funding plan that was published alongside the mental health strategy in June 2021 identified a requirement of an additional £1·2 billion over the life of the strategy to fully deliver those 35 actions. This year, £5·9 million has been allocated towards the delivery of the mental health strategy actions for 2024-25, but that is against an estimated requirement of some £42 million for this year. That is £5·9 million versus £42 million. If we genuinely want to realise vital improvements in our mental health services to meet the needs of those with an autism diagnosis and, indeed, of the whole population, mental health services need real and sustained additional funding to ensure the full delivery of the strategy. In closing, many Members have asked me for certain actions, including those to, for example, fulfil commitments that were made under section 2 of the Autism (Amendment) Act 2022 and that would deliver Mr McHugh's utopian vision. There is a reason why the three-year plan that I published recently for the rest of the mandate talks about stabilisation before reform and delivery. There is no magic bullet, and decisive action can come only when there is a budget. When we have £5·9 million against £42 million, we have a big problem.

2,196 words. Text as published by the Northern Ireland Assembly.

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