- Research from 2022 indicates that mental ill health costs NI around £3.4bn per year. This is considered a conservative estimate, and the true cost could be higher.
- Northern Ireland allocates around 7% of its total spending on programmes of care to mental health.
- However, this is not necessarily the same thing as the overall health budget. A previous estimate calculated by the Audit Office suggested that mental health accounted for 5.7% spending of the total health budget in 2019-20.
- Different characterisations of the health budget (the NIAO’s is broader than the DoH) should not be directly compared. However, such a comparison was made by DoH in evidence presented to the Public Accounts Committee. This was misleading.
- While comparisons are not straightforward, there is evidence to suggest that NI spends a lower proportion of its health budget on mental health than England, Scotland or Wales – a point also made in a 2024 report from the Public Accounts Committee.
- There are indications that NI spends a HIGHER proportion of its health budget on mental health than RoI – although per capita spending on mental health is higher south of the border.
- A recent review from DoH indicated that 28 of the 35 actions (80% of the total) in the current mental health strategy have not been implemented due to a lack of resources.
In a 16 February debate in the Assembly around mental health data, Sinn Féin MLA Órlaithí Flynn claimed:
“Mental ill health costs our society £3.4 billion every year. Mental health receives around 7% of the Health budget, the lowest share across these islands. Around 80% of the [current NI mental health] strategy’s actions are paused due to funding constraints.”
There are several aspects to this article:
- Mental ill health costs NI £3.4bn every year.
- Mental health receives around 7% of the health budget, the lowest proportion across the UK and Ireland.
- Around 80% of the mental health strategy’s actions are currently paused due to a lack of funding.
The first aspect is supported by evidence. A Mental Health Foundation (MHF) report from 2022 identified an estimated annual cost of £3.4bn for mental ill health in NI, which has been cited again in research from both the NI Audit Office (NIAO) and the Public Accounts Committee (PAC).
This estimate is considered “conservative” and the actual annual cost of mental ill health to Northern Ireland could be significantly higher.
The second aspect to this check is complicated by different ways to frame the health budget and the challenges in finding directly comparable figures across different jurisdictions.
Northern Ireland spends about 7% of its total allocations on health programmes of care on mental health.
However, the overall health budget is wider than just programmes of care. Previous estimates that indicated NI spent 5.7% of its health budget on mental health use a different, broader measure for health spending so these two figures are not directly comparable.
It is misleading to say that the proportion of the health budget that goes towards mental health has risen from 5.7% in 2019-20 to 7% in 2023-24 because these two percentages rely on different characterisations of the overall health budget – although the Department of Health did present exactly this comparison in front of the Public Accounts Committee in April 2024.
Regarding comparisons with other parts of the UK and Ireland, there is evidence to suggest that NI spends a lower proportion of its health budget on mental health than England, Scotland or Wales. There are also indications that NI directs a higher proportion of its health budget to mental health than the Republic of Ireland (albeit RoI spends more on mental health per capita).
The final aspect is clearly supported by evidence. A report by the Department of Health (DoH) on the deliverability of its own mental health strategy highlighted huge funding shortfalls and indicated that, of the 35 actions initially laid out in the strategy, only seven (20%) are now set to be taken forward.
For more details, read on.
- Source
FactCheckNI contacted Ms Flynn about these claims. Her office responded by pointing us to several different sources of information, including a Public Accounts Committee (PAC) Report on Mental Health Services in Northern Ireland, a 2022 paper from UK charity Mental Health Foundation and an October 2025 review from the Department of Health into the deliverability of the current NI Mental Health Strategy.
- Figures
The first aspect of the check is about the estimated cost of mental ill health to Northern Irish society. Is that figure £3.4bn per year?
The 2022 Mental Health Foundation report mentioned above – the lead authors of which were academics at the London School of Economics noted – contains this calculation.
The economic case for investing in the prevention of mental health conditions in the UK estimated “the societal costs of living with mental health conditions in the UK in 2019” and compared these against the “cost-effectiveness of well-evidenced actions to prevent these mental health conditions.”
Overall it calculated that, across the entire UK, “these costs conservatively amount to £117.9 billion, approximately 5% of UK GDP in 2019” with £3.4bn in Northern Ireland. The local cost is broken down into:
- £420m spent on mental health care
- £65m on primary care
- £39m on social care
- £83m on education
- £1,152m on “informal care” (unpaid care undertaken by loved ones)
- £1,073m in lost productivity
- £576m in “intangible costs” (meaning extra costs “that are difficult to measure in monetary terms that reflect adverse impacts not only on quality of life, but also on issues such as social exclusion and discrimination in society” – see the full paper for more details)
The academics who prepared this paper said they consider the figures involved to conservatively undercount the total cost of mental ill health in the UK.
The same MHF/LSE £3.4bn figure was cited in a Northern Ireland Audit Office (NIAO) report from May 2023. Note that the NIAO report also noted significant limitations in mental health data in Northern Ireland.
In June 2024, the Public Accounts Committee published its own Report on Mental Health Services in Northern Ireland, which again cites the estimated cost of mental ill health in NI of around £3.4bn annually
Based on all this, it is fair to say that mental ill health costs an estimated £3.4bn annually in Northern Ireland – while also noting that this is a single-sourced conservative estimate, and the true total may be significantly higher.
- Budget proportions
Do local mental health services receive only 7% of the total health budget, and is that the lowest proportion across the UK and Ireland? According to the PAC report cited above:
“In 2023-24, the Department invested around £388 million in mental health services, amounting to around 7 per cent of the overall health budget and just over £200 per person in Northern Ireland. Within the £388 million, CAMHS accounted for approximately £30 million and around 8 per cent of the mental health budget. At this level, CAMHS funding continues to fall short of the 10 per cent share of the mental health budget advocated by the Department.
“Despite the worrying levels of mental health need in Northern Ireland, and growing complexity in presentations, there is a long history of underfunding in mental health in comparison with elsewhere. Evidence indicates that we spend significantly less per capita, and as a share of the overall health budget, on mental health than the rest of the United Kingdom.”
This seems straightforward enough. A Public Accounts Committee report states that around 7% of the total health budget goes on mental health and that this is the lowest such proportion across the UK (we will look at comparisons with Ireland later).
However, if 7% of your total budget is around £388m, that means the overall budget is somewhere in the region of £5.54bn – while the actual Department of Health budget in 2023-24 was £7.3bn, based on its initial allocation of non-ringfenced Departmental Expenditure Limits.
- Health budget (specific)
At the start of this month, FactCheckNI contacted the Department of Health, Public Accounts Committee and Northern Ireland Audit Office asking if they knew what was meant by “health budget” in this case.
The Public Accounts Committee responded quickly by stating:
“The figure of £388 million as 7% of the budget you refer to, was made in evidence to the Committee by Peter May as Department of Health Accounting Officer. I have attached the relevant Hansard report for your reference and highlighted the relevant statement.
“For any further clarification on the calculation of these figures, you should contact the Department of Health directly.”
The relevant submissions from then DoH Permanent Secretary Peter May came in a PAC meeting in April 2024. Mr May told the committee:
“The most recent figures that I have are that the spend is just over £200 per capita and that the proportion spent on mental health services is 7%. That is my understanding of the situation now, whereas the figures in the Audit Office report [see below] were accurate in 2019-2020.”
In response to a question from Alliance Party MLA David Honeyford, who noted that the 2023 Audit Office states that “overall [health] funding levels have increased in the past decade but mental health’s overall share of the health and social care budget has actually reduced”, Mr May said:
“The point I was trying to make is that we are increasing, both in real and proportionate terms, the amount that we spend on mental health. You referenced [the NIAO report], which shows funding in 2019-2020 of £298 million. The funding in 2023-24 was £388 million, which was 7% as opposed to 5·7%. That is a step in the right direction.”
The Audit Office paper in question contains the following table:
Figure 2 – source: NIAO
Compared with this, the stated increase in mental health spending in 2023-24 seems like a significant jump. However, the DoH budget for that year was £7.3bn, not £5.54bn. Where does the discrepancy come from?
The Audit Office was able to provide a possible answer.
In email correspondence between FactCheckNI and the NIAO, it was suggested that this 7% figure could be arrived at by focusing on overall spending on health programmes of care (PoC). Figures held by the NIAO (which we cannot link to, given this is based on an email exchange) indicate that the total health PoC budget in 2023-24 was £5.61bn while the mental health PoC budget for that year was £388m (the figure mentioned by the DoH Accounting Officer) – and £388m is 6.91% of £5.61bn.
In the second half of March, the Department of Health responded to our query about how it arrived at the 7% figure – and indeed said that this is mental health spending as a proportion of the total allocation to programmes of care and not the overall DoH budget.
According to DoH, the total figure it states as allocated to the Mental Health Programme of Care is taken from the Strategic Resources Framework (SRF). The SRF annually sets out the planned spend by Programme of Care for the Strategic Planning and Performance Group and the Public Health Agency.
The department noted that in addition to finances for programmes of care there is spending on management and administration, Family Health Services, direct Departmental spending and other Arm’s Length Bodies funding which make up the total departmental health budget. It also noted that, within this wider allocation, there may be spending relating to Mental Health that is not easily identifiable.
FactCheckNI also requested the total health budget and total amount spent on mental health in both 2023-24 and 2024-25 and received the following response:
“In 2025/26 a total of £428.7m has been allocated to mental health Programme of Care which is 7% of the overall budget allocated to programmes of care.”
To repeat the point, this percentage measures mental health spending as a proportion of the overall finances of programmes of care, with total programmes of care spending therefore around £6.124bn – whereas the total opening budget for DoH in 2025-26 was £8.388bn.
- A look at comparisons
Focusing on programmes of care means focusing on direct clinical costs and removes considerations of expenditure not explicitly focused on service delivery.
This is a reasonable approach to take when assessing mental health spending as a proportion of spending on health. For instance, DoH’s initial £7.3bn budget in 2023-24 will not just include bureaucratic costs but also funding for the Northern Ireland Fire and Rescue Service. Furthermore, according to DoH, the amount spent on mental health within the entire DoH budget might be higher due to additional spending that is not easily identifiable.
However, this approach does mean that direct comparisons with previous percentages, including the NIAO’s 5.7% figure, should not be made, given the NIAO confirmed to FactCheckNI that it used a different (and broader) characterisation of overall health budget.
In its evidence to the Public Accounts Committee, the Department made this direct comparison. This framing is misleading since these two percentages refer to different measures. While there are plausible arguments for various different measurements of mental health spending as a proportion of health spending, the framing should remain consistent when comparing such proportions over time.
NIAO comparisons look at mental health spending as a proportion of “the overall health and social care budget” – i.e. not just limited to the PoC, but removing NIFRS allocations and other allocations not directly relating to health – and its 2023 paper states:
“The increase in the mental health budget [in the 10 years to 2019-20], at 28 per cent, did not keep pace with increases in the overall health and social care budget, which increased by 43 per cent over the 10 years to 2019-20. As a result, the mental health share of the overall health care budget fell, from 6.4 per cent in 2010-11 to 5.7 per cent in 2019-20 …
“While planned expenditure also increased in Northern Ireland in 2020-21, to £323 million, and again in 2021-22 to £345 million, its share of the overall health and social care budget remained unchanged at 5.7 per cent.”
Once again, these percentages are not directly comparable to the 7% figure for 2023-24 mentioned in the PAC report.
- The lowest proportion in the UK and Ireland?
Figure 2, above, indicates that NI spent a lower proportion of its health budget (by that configuration) on mental health than anywhere else in the UK and Ireland in 2019-20.
In October last year, DoH published a review of the deliverability of its own mental health strategy. It identified a “funding gap” of £64.7m, stating:
“The identified funding gap of £64.6 million exacerbates Northern Ireland’s position as having the most poorly funded mental health system in the UK and Ireland … Northern Ireland has the lowest absolute spend and the lowest per capita spending.”
A per capita spending comparison between NI and the other constituent nations of the UK is laid out in the table below, which appeared in that DoH review.
Figure 1 – source: DoH
By considering each of these figures for mental health spending alongside the total health budgets in the different nations – and ensuring these figures are as comparable as possible – we can put together a comparison of the proportion of health spending each jurisdiction allocates to mental health.
In Northern Ireland, the £403m in the 2024-25 health budget represented a just 5.19% share of the initially agreed health budget of £7.76bn that year (based on non-ringfenced DEL, so this figure is not comparable with the 7% figure in the PAC report or the figures calculated by the Audit Office) – although this figure may have changed as in-year allocations are taken into account.
However, not all other parts of the UK and Ireland include fire and rescue services within their health departments. Removing the £98.6m initially allocated to the NI Fire and Rescue Service from that budget, we calculate NI’s total health spending as £6.77bn, indicating that 5.95% of the local health budget was spent on mental health that year.
What about elsewhere (using comparable figures to the NI calculation above, i.e. using total departmental spending on health and social care but not fire and rescue services)?
- England’s initial Department for Health and Social Care budget (fire services are supported by the Ministry of Housing, Communities and Local Government) in 2024-25 was £190bn. This means the £12.1bn spent on mental health was 6.36% of total health spending.
- Scotland’s total fiscal allocation for health that year was £18.2bn. Mental health spending – from the table above – was £1.3bn, representing 7.14% of total health spending (note that the Scottish Fire Service is under the auspices of Justice and Home Affairs).
- Wales total health budget was £11bn (fire services are largely funded by local authorities), so mental health spending of £820m represents 7.45% of the total.
- Ireland’s budgets operate on calendar year cycles, rather than the financial year, and the mental health spend of £1.272bn above covers 2025 and is converted from a figure of €1.48bn using an exchange rate of €1 = £0.86. Ireland’s initial health budget was €25.76bn (fire services are not under this department), meaning mental health spending was 5.74% of the total – slightly under the proportion spent here – albeit spending per capita was higher south of the border.
Note that, by a different configuration, the proportion of Ireland’s health budget spent on mental health in 2025 was 6.17%, according to Minister of State at the Department of Health Mary Butler TD, but these observations made during a debate in the Dáil may have used some different delineation of health spending (see above, and note once more that by one measure NI spends almost 7% of its health budget on mental health).
The comparisons calculated by FactCheckNI have tried to use figures that are comparable across all five jurisdictions in question, but even this comes with several notes for caution. For instance, social care funding may be structured in significantly different ways in each nation, Ireland’s budgetary periods do not align with those in the UK.
Based on all the above – with all the contextual information about the many ways to define “overall health budget” taken into account – there is solid evidence to support the second aspect of this claim. An exception is found in comparisons with Ireland, where there is evidence to suggest spending as a proportion of the overall health budget is lower than here – although spending per capita is higher.
- Has 80% of the mental health strategy not been implemented?
Yes.
The final aspect of this check is supported by evidence.
DoH’s review of the deliverability of its mental health strategy found that, by the end of 2024-25, only 16% of the funding planned to that date had been allocated.
The strategy itself identified 35 actions. Of those, “20 have commenced with partial funding” but ultimately the review concluded that only seven “priority” actions should be taken forward from this point.
That means 28 of the initial 35 actions have been set aside, at least for now, which is 80% of the total.
