Structure and administration

Northern Ireland is a province of some 1.8 million people comprising the six north-eastern counties of Ireland. It was formed in 1921 by remaining in the United Kingdom after the partition of the island created the Republic of Ireland. It remains part of the UK, although powers have been devolved. Following the 1998 Good Friday Agreement, the Northern Ireland Assembly was formed, with limited self-governing powers that include health and social services. The Assembly has been suspended on a number of occasions due to a lack of political agreement. During these times, government functions have been the responsibility of a Minister of State, who has control over a number of varied departments within the province and who reports to the Secretary of State for Northern Ireland (a UK cabinet minister). At present, the Northern Ireland political institutions are in operation and are responsible for legislation of transferred matters. These are matters that are not ‘reserved’ or ‘excepted’ – matters that remain under Westminster. Reserved matters are transferred to the Assembly based on competence.

Northern Ireland is the only part of the UK with a land border. It would appear reasonable for all Ireland mental health services to secure economies of scale and offer specialisms not readily available in a small population and to allow integrated care across the border. With few exceptions progress towards such rational provision has been faltering.

During periods of direct rule from Westminster, legislation affecting only the province is most often passed through an Order in Council and without a full debate in parliament. It is then called an Order rather than an Act. The current mental health legislation is the Mental Health (Northern Ireland) Order, 1986. A draft Mental Capacity Bill has been formulated. This work was a result of the Bamford review (Bamford, 2004). In 2002 the Northern Ireland government commissioned a review of ‘learning disability’ and mental health law, policy and services. This was the Bamford review. The review made ambitious recommendations for services in Northern Ireland. These included the development of mental health and capacity law.