In a small office nestled next to supermarket on the Antrim Road in north Belfast, the crisis in Northern Ireland’s public services is acutely visible. One young man is sitting in a chair in the waiting room nervously shaking his leg, the motion causing a slow and repetitive tremor to reverberate through the floor that gives the room its own anxious pulse. Another man paces up and down, both keen to avoid eye contact.

The charity Public Initiative for the Prevention of Suicide, known locally as PIPS, provides urgent support for people living with thoughts of suicide and self-harm. Staff member Martina McIlkenny welcomes me into her office. She explains that Northern Ireland has always had a mental health crisis: it has higher suicide rates than the rest of the UK or Ireland, suggested to be linked to residual trauma from the Troubles and higher levels of poverty. But the absence of a government at Stormont has exacerbated the crisis even further.

Northern Ireland has been without a government since January 2017, when the power-sharing agreement at Stormont collapsed after Sinn Féin pulled out of government with the DUP, citing concerns about a financial scandal that the party was linked to. Under the unique rules of the region’s post-conflict political structures, one party cannot govern alone. Instead, both must co-govern through consensus. The two parties have entered into countless rounds of negotiations – to no avail. Last summer, the region took on the unenviable world record previously held by Belgium for being a democracy without a government.

It’s not the first time Northern Ireland has been without a functioning government. During the Troubles and in the embryonic days of power-sharing after the peace process, Westminster intervened directly when agreements broke down. But on this occasion, Britain has deferred time and time again – perhaps due to concerns of impartiality now the Conservatives have a confidence-and-supply arrangement with the DUP, or simply due to the distractions of Brexit.

In the meantime, Northern Ireland is governed day-to-day by civil servants. They have been tasked by Secretary of State Karen Bradley with making decisions that are minor and/or non-controversial, as well as those which broadly seem in line with what the last government to sit Stormont would have probably done. The vague instructions have been the subject of several legal challenges already. Day-to-day, many major decisions are left gathering dust in the in-trays of government departments who have no ministers to sign off on new laws. Earlier this year, the head of the civil service in Northern Ireland warned of a “slow decay” to public services in the region.

This lack of government is becoming an issue of life or death for the people McIlkenny sees every day. Despite having some of the highest rates of suicide and mental ill health, Northern Ireland is the only part of the UK or Ireland not to have a specific mental health policy agenda. A draft strategy was due to be finally rectified, but languishes with no government minister to sign it off or release the funding.

This absence has very real consequences, McIlkenny explains. “We had a young lady come in here this morning. She is suicidal and needed to go in to the hospital. She went down to the hospital this morning at 9 o’clock and won’t be seen until about 4 or 5 o’clock this afternoon because there’s only so many members of the mental health team to be assessors. So she’ll have to wait all day for that.

“If she does wait, that’ll be great because then something will happen with her but if she doesn’t wait, then she may just go home and God knows what could happen.” Had the mental health strategy been approved, she adds, more mental health assessors would be available in hospitals – reducing torturous waiting times.

She gestures around the office, a small space in which the paintwork and furnishings have seen better days: “We were awarded money [by Stormont] in 2012 for a new premise and it’s taken up until now to get that. It should have been given to us two years ago but because of the breakdown of Stormont it was put back.”

Health isn’t the only area where decisions have been left in limbo. Schools have seen a real term budget decrease of 9 per cent since 2012. Graham Gault, headteacher of a primary school in County Antrim, appeared before a committee of MPs last October to plead for more resources, telling them: “I've actually found myself in the humiliating position of begging my parents to support the wellbeing of their children by providing Pritt Stick, reading books, tissues and soap. I actually have parents – and this isn’t a joke – who are donating toilet roll to my school. It feels Victorian – It's a disgrace.”

A number of laws have been introduced in the rest of the UK that cannot apply to Northern Ireland due to the stalemate at Stormont. Many, including legislation to protect against coercive control, affect women’s rights, but the lack of government ministers at Stormont means those working for women’s charities have nobody to lobby or hold to account for policy decisions.

“The issues that rise to the fore time and time again are the frustrations women feel that they do not have a voice on Brexit, Welfare Reform and the bedroom tax, abortion rights as well as a host of other issues. The whole country is being held to ransom on a variety of issues”, Catherine Cooke, co-ordinator of Foyle Women's Information Network says.

Tara-Grace Connolly is a student based in Belfast and campaigner for a second referendum on Brexit with the group Our Future Our Choice. “It is deeply worrying for my generation to see this broken form of politics persist in Northern Ireland. We have grown up without the backdrop of the Troubles and have only known peace and power sharing, which has been crucial for progress and the healing of divisions. The political situation in Northern Ireland is far from ‘normal’, and young people who are becoming accustomed to the lack of government in the region are victims in a dispute that was supposed to have been being resolved since 1998.”

A fresh round of negotiations was called amid growing public concern about the stability of the peace process following the murder of 29-year-old journalist Lyra McKee in Derry in April. The talks began in May but have rolled on to June without any sign of progress. A bitter dispute about the role of the Irish language continues to aggrieve the two parties. Sinn Féin says it will not go back into government without legislation to protect and promote the language, while the DUP says it will not go back into government if any such legislation is introduced. Barring a major U-turn from either side, a breakthrough is unlikely to occur, and with Westminster distracted by Brexit and dependant on the DUP, the prospect of direct rule also feels distant.

In the meantime, Northern Ireland continues to float on adrift without decision makers at the helm.

As McIlkenny puts it: “People in Westminster just aren’t interested. We’re set aside. We’re across the sea. We’re not really important. We’re left on our own.”