‘Northern Slant Hosts’ is our new series of interviews with people in public life on key issues affecting Northern Ireland. In this episode, Roger Greer speaks with Professor Siobhán O’Neill. Siobhán is Professor of Mental Health Sciences at Ulster University, and was appointed as Northern Ireland’s Interim Mental Health Champion in June 2020.

Professor O’Neill has been championing better mental health in Northern Ireland for a few years now, and it came as little surprise when she was appointed NI’s first Mental Health Champion last year. 

We spoke about her appointment, and the role – including being appointed at a time where people’s lives were being turned upside down due to COVID-19 – and how we might begin to tackle Northern Ireland’s historically high prevalence of mental health. We also touched on what we can all do to look after ourselves, and look after each other.

You can watch our discussion here, or listen on Spotify if you’re on the go. I’ve also shared some highlights from the Q&A below.

I began by asking Siobhán about her new role and what it entailed.

There are three elements to the role. It’s about working with Government and advising, being a critical friend, supporting all of the different Government departments, and making sure that mental health is promoted within their policies.

I’m particularly there for the Department of Health when they were developing the Mental Health Strategy for the next ten years. So that was a really important programme of work.

I’m also working with the Department of Justice on different projects around mental health in the criminal justice system, on prisoners and staff. Also in the Department of Education – planning the mental health in schools framework, so that we improve mental health provision there. 

I also work with the public, sending out important messages about self-care and what they might expect from mental health services. 

It’s also about being a public advocate, collecting the views of people and their perspectives on mental health and how it’s being managed, and making sure that that is translated into action across the Government Departments. 

So it’s those two elements – working with the population and working with government. 

We do have real issues with mental ill health in Northern Ireland. You’ve written about the high prevalence of mental illness here, compared to the rest of the UK. In Ulster University’s Health, Equality and the Economy report you touch on transgenerational trauma as one of those issues. Is this one of the reasons why it remains so high in NI?

Yes, this is one of the reasons why our rates are higher than other places. We had a period of significant violence in the trauma in the population, but we also have effects of the legacy of the Troubles: poverty and deprivation. Money was being spent on other things and there wasn’t the investment that there should have been. So it’s important to really emphasise that inequality and poverty are key contributors to mental illness now as they were during the time of the Troubles. 

We have communities where families have been traumatised. All of the data internationally is showing that what happens to you in those early years and in childhood is really important for your mental health. If there are adversities and negative experiences there, it can influence how you manage stress across your life, and the likelihood that you’ll develop mental illness. This is about adversity in childhood particularly, and also about poverty and inequality. That’s the transgenerational transmission we are talking about. 

There is some evidence of biological transmission too, but if you get in there in the first few years and through primary school, you can make a huge difference to children’s risk of developing mental illness in adulthood. 

You started your role at a really challenging time, in the middle of the pandemic. Is there any indication yet on the impact of COVID-19 on mental health in Northern Ireland?

Yes – a lot of data has been collected. Right from the very start, scientists were collecting the data so we now have strong evidence of the very high rates of anxiety at the first lockdown, and that is completely normal because we are dealing with a deadly pandemic and so much uncertainty. 

Rates of anxiety went away up. Luckily for most people that was short-term effect. As we kind of got used to the situation and the Government put in mitigation measures to provide certainty on their income and the economic impact, then we saw those rates decline. But there is strong evidence that there were more long-lasting effects; effects that could influence the risk of mental illness among particular groups of the population.

We know that children and young people were adversely affected, particularly young people of primary school age. Their impacts were worse than secondary school children. Young people who lived in deprived areas where they didn’t have opportunities to get outside and exercise, where they didn’t have gardens, were more impacted. 

We saw a mental health impact where young people who didn’t have access to technology, who couldn’t talk to their friends, or participate in home schooling to the same extent as others: they were more adversely impacting. 

Disabled young people saw a really strong impact – decreases in levels of happiness in that group was so concerning. Children with special education needs were also more impacted. 

This is happening at critical developmental periods. For a couple of weeks or months at the start it might not be so bad, but now we are into this long-term COVID impact, where it has gone on maybe for more than a year. We need to make sure we apply interventions right now to reduce the long-term risk.

I am very hopeful. There is lots we can do for those groups; but we really need to start looking at that now. 

The Minister for Health has released a consultation on the Mental Health Strategy. Do you have any thoughts on that and how it is developing?

This was one of my first jobs, to oversee the Mental Health Strategy. There has been a lot of work undertaken with people with experience of mental health problems, as well as carers. It was really welcomed, particularly in the time of a pandemic. We had to do all this stuff online; but I am feeling really positive about the Strategy. I think it’s really strong.

We need people to respond to the consultation. When you look through it, it can sometimes feel like it is a bit of a wish list. It is aspirational. It is a collection of services. There are issues around the links between services: for example, between schools and mental health services, and the links between criminal justice and mental health services.

Prevention, early intervention – all of these things. We need to work out what this is going to look like. We are really calling on people out there, particularly people with experience of mental health problems, who have tried to use the services and maybe had negative experiences. We want them to comment on the Strategy and tell us what it needs to look like. How this should be delivered. How it should feel like for someone approaching their GP or somebody else with a mental health problem, looking for treatment. 

We need the roadmap. We need to know how to do it, and how to do it so we promote recovery, so that we do this in a really compassionate way. This is the ethos which is supposed to be running through it. So how do we do that? How do we deliver that? What have other countries done? 

This is a real opportunity and I want everyone to have a look at this, give us their thoughts and let me know what this should look like.

Moving from the societal to the personal ways in which we can mental health. If there are individuals who are feeling stressed or vulnerable, or if they think a family member or friends feeling this way, what can we do to try to help them?

It’s important to work out where you are on this continuum. On one hand we have “really well, doing ok,” then starting to get stressed. Stress in-and-of-itself isn’t a problem, but you need to be able to cope with the stress that you have. It’s about identifying “is this stress?” or how far along the continuum are you? 

Is this getting to the point where someone might be developing a mental health problem? If there are long-lasting symptoms of anxiety – really not being able to sleep or eat, constantly being on high-alert – and if that has been going on for a few weeks, it’s time to talk to a GP to try to get some treatment for that.

Whenever these symptoms start to happen, there is a lot you can do to look after yourself and take care of yourself. I would be promoting the five steps to wellbeing:

  1. Distract yourself – find something to do.
  2. Connect with other people. 
  3. Be grateful and take notice of the good things. 
  4. Physical activity and exercise is really important.
  5. Learn something. 

It’s all about emotional regulation, getting away from that stressed state and being able to physically function.

But if all of those things aren’t working or if you feel like you can’t control it, then doctors and the mental health providers want you to come to them and say that you’re struggling and need a bit of help. There are techniques that you can use. 

It’s important to ask for help. Don’t even assume that there is nothing there for you.

This interview is available as a podcast on Spotify.