“Peace, what peace?” asks Thelma Abernethy, director of AddictionNI. There is, she says, a failure of political and civic leadership across Northern Ireland regarding mental health, and a failure to recognise it and drug and alcohol abuse as part of the legacy of the decades of conflict.

Demand for AddictionNI’s services is increasing while funding is being reduced due to austerity policies and the lack of a budget for Northern Ireland. Numbers on the waiting lists have increased in recent years from under 100 to around 400, meaning increased waiting times for services.

There has been a “tsunami” of addiction to prescription drugs, say Addiction NI programme managers Alex Bunting and Sam McCullough, and Northern Ireland is now a “world leader” in the use of drugs for pain relief and anti-depressants, such as Diazepam, codeine, and Tramadol. The increase, they believe, is directly related to the conflict. Evidence for this is anecdotal, says Abernethy. People may not immediately mention the Troubles when they first come for help, but it often emerges as a key feature when they tell the deeper story.

We have gone, says Bunting, from addicted individuals to addicted families, to addicted communities, particularly in the areas most affected by violence during the Troubles. Overstretched GPs have nothing else to offer patients who present with symptoms of anxiety, depression and stress, other than a place on a waiting list. Pills are passed from grandparents to children and grandchildren. There is a street trade in unused pills, and a black market in ‘duplicates’, drugs made in China and sold on the internet. McCullough quotes the Sunday Express’s description of the Royal Mail as an “unwitting drug mule.” Criminal gangs – sometimes called former paramilitaries – deal in the drugs themselves or take “taxes” from others, and in this way maintain their control over communities, while the police turn a blind eye within the enclosed and walled interface areas.

Furthermore, alcohol and drugs play a part in 60% of suicides. There have been over 4,500 suicides in the two decades since the signing of the peace agreement – a higher number of deaths than the 3,600 attributed directly to the conflict itself. This week a delegation from Northern Ireland, including David Babington, the CEO of Action Mental Health and Dr Iris Elliott of the Mental Health Foundation, met a cross-party group of MPs in Westminster to present figures on the epidemic of suicide in Northern Ireland – the highest rates of which are among men from those same interface areas.

AddictionNI has traditionally offered clients one-to-one counselling but in recent years has begun to modernise its approach. Recovery requires a more holistic response, involving “connectedness,” an addict’s relationships to people and community. They quote journalist Johann Hari, who says that “the opposite of addiction is not sobriety, it is human connection.” Counselling may help an addict deal with some causes of their dependency, but changing their lifestyle and the people they connect with is key to recovery. AddictionNI is also using Twitter and Facebook Messenger to raise its profile and spread messages about prevention. Last year a conference on ‘Celebrating Recovery’ brought together almost 200 service users.

Rob is chair of AddictionNI’s Strategic Advisory Group. His dependency on prescription drugs started within his family. Now 28, Rob embarked on a journey of recovery five years ago which began with writing his own narrative and uncovering the impact of the conflict on his family and relationships, even prior to his own birth. Having failed his 11+ and leaving school in North Belfast without qualifications, he is now due to complete studies for an LLB. He hopes to join AddictionNI in a peer support role and put his own direct experience to use. He would have “empathy and compassion” for those in the same position he was once in himself. Rob’s North Belfast back yard is a 20 foot peacewall and he sees the effects of deprivation and addiction in his own community every day. Some users, he says, “see script day as payday,” using side effects of drugs such as drowsiness to support their need for Disability Living Allowance.

In an interesting aside, the importance of “connectedness” has been well illustrated this week by another article in The Guardian. George Monbiot reports that in Frome, Somerset, hospital emergency admissions have fallen by 17% in contrast to a county-wide increase of 29%. The reasons for this dramatic fall have yet to be confirmed by solid scientific evidence, but the belief is that it is due to a local joined-up cross agency and community approach to medical and social care. In 2013, a local GP, Helen Kingston, set up the ‘Compassionate Frome’ project, linking agencies and employing ‘health connectors’ and voluntary ‘community connectors’ to help patients find the range of different supports they need, including various means to reduce social isolation.

Developing new and more connected approaches is difficult, however. Innovation may fail to win support from funders, who may be conservative, cautious or have their own agendas. Competition for funding in the voluntary sector inhibits agencies from working together. A comprehensive Drug and Alcohol Strategy for Northern Ireland would require political leadership. At Tuesday’s Westminster meeting, MPs were told that the worsening mental health crisis is being “exacerbated by Northern Ireland’s ongoing political dysfunction.”

The legacy of the Troubles is multi-faceted and requires a coordinated and systemic response, and that requires far-sighted, ambitious and courageous leadership – and a restored Assembly and Executive.

 

You can watch a BBC Community Life appeal on iPlayer featuring Addiction NI. You can donate online via bbc.co.uk/niappeals