Making Sense of Recent Reports on Mental Health in Wales

This year’s World Mental Health Day (Monday 10th October) saw the publication of a number of significant documents. Some looked at the state of mental health services in Wales today; others looked to the future of those services. Here we introduce them:

1. Raising the Standard: The Revised Adult Mental Health National Service Framework and an Action Plan For Wales

What it’s about: Launched by Dr Brian Gibbons, Minister for Health and Social Services, this Assembly Government document presents a revised National Service Framework (NSF) that supplants the NSF published in April 2002 (Dr Gibbons also announced that mental health services will receive an extra £5 million in funding). As well as presenting eight key standards and 44 key actions intended to improve mental health services in Wales, the Framework also sets out a revised timetable and action plan for delivering those services.

The aim of the NSF is “to set standards for services in Wales, drive up quality and reduce unacceptable variations in health and social care provision”. Many of the ideas and aims remain similar to those presented in the 2002 NSF, but the document takes into account changes in the commissioning, performance management and inspectorate arrangements.

Why it’s important: This document sets out the Assembly Government’s plans for mental health services across Wales for the coming years. It will shape the modernisation of services and sets out the targets that must be met.

What people said about it:

Dr Brian Gibbons, Health and Social Services Minister, stated: “I am determined to see mental health services improve. With the extra funding announced today and by setting out a clear timetable in the Action Plan I am confident that improvements will be made across Wales.”

Bill Walden-Jones, Chief Executive of Hafal, said: “It is up to us as an organisation to ensure that the Assembly Government delivers on its promises this time. Hafal is a client-led organisation and our Members – having gone through the current system – are committed to holding the Assembly accountable and seeing that services are properly improved.”

MIND Cymru “welcomes the publication of these key documents, and hopes that their contents and recommendations will be influential in raising the profile of mental health service provision in Wales on the Assembly’s agenda. However, we have reservations about the context in which they are published, this being that there has been very little evidence of effective progress on implementation of the NSF standards since publication of the NSF in 2002.”

Available at: The NHS Wales Website

2. Adult mental health services in Wales: A baseline review of service provision

What it’s about: The report, published by the Wales Audit Office, contains the findings from a whole system review of adult mental health services in Wales.
The conclusion is that there are significant gaps in key elements of service delivery that are currently preventing full implementation of the NSF.

Findings include the following:
• There is scope for greater integration and co-ordination of adult mental health services across different agencies and care sectors.
• The approach to empowering and engaging service users and carers varies considerably.
• Current planning and commissioning arrangements do not fully support the development of whole system models of care.

However, examples of good practice are identified. These included several from Hafal, including the Work Preparation and Carer Support Service in Bridgend, the education initiatives in Cardiff, and the all-Wales Empowerment Programme. A pilot discharge support scheme in Pembrokeshire run by Mind in conjunction with the local NHS Trust is also commended.

Why it’s important: The report provides a detailed insight into the state of mental health services in Wales, highlighting problems with the way services are currently planned, organised and monitored – which are jeopardising the success of the Assembly Government’s new NSF.

What people said about it:
Auditor General for Wales, Jeremy Colman said: “Services for adults with mental health needs have a long way to go. The Welsh Assembly Government should use the findings of this report, and other external reviews, to develop a clearer approach for the future to make sure people with mental health problems in Wales receive the quality of care they deserve.”
Liz Griffiths-Hughes, Empowerment Coordinator at Hafal, said: “The report confirms what many of our clients have told us about their experiences of mental health services. Continuously we hear about the unacceptable delays service users endure before seeing a psychiatrist. Unfortunately many people become so ill during this time that they have to be hospitalised. Some have even been arrested because of the impact the illness has on their behaviour. Every such case is an unnecessary tragedy, because if people receive timely treatment they have an excellent chance of managing their illness before it becomes acute.”

Available at: The NHS Wales Website

3. Report of a Review of Adult Mental Health Medium Secure Units in Wales

What it’s about: This review of medium secure units in Wales was undertaken jointly by the Healthcare Inspectorate Wales (HIW) and Health Commission Wales (HCW). Issues raised by the report include:

• The differences between the estate, management structures and clinical governance arrangements of the two NHS and the two private sector medium secure units reviewed.
• The weaknesses in discharge planning arrangements.
• The problems with the identification of risk factors and relapse indicators.

Why it’s important: The report provides an important consideration of the adequacy of discharge planning arrangements for patients with mental illnesses for the four medium secure units in Wales, as well as reviewing the quality of services and patient care within the units.

What people said about it:
Dr Peter Higson, HIW Chief Executive, said: “There is clearly a need for stronger arrangements within Wales to ensure continuity of high standards of care and treatment for patients with mental health problems following discharge.”

4. Under Pressure: Report of the Risk & Quality Review of NHS Mental Health Services

What it’s about: Commissioned by the Welsh Assembly Government and produced by the Wales Collaboration for Mental Health (WCMH), the aim of this review of priority areas in mental health is to show the current state of services and make recommendations for improvements so that service users can be assured of a minimum standard of care. 24 recommendations to reduce risk and improve service quality are made in the report, which identifies changes to the structure of service commissioning bodies as being crucial to delivering improvements to service users in Wales.

Why it’s important: Presents an independent insight into the state of mental health services in Wales: the whole review process was subject to scrutiny by a user/carer reference group.

What people said about it:

Gareth Morgan of the University of Wales Bangor, Project Manager for the research, said: “It is pleasing to note that since “Under Pressure” was submitted to the Welsh Assembly Government a few months ago, several new and relevant initiatives have been announced.”

5. CPA: A User’s Guide

What it’s about: Produced by Welsh mental health charity Hafal, the Care Programme Approach (CPA) Guide – launched by Dr Brian Gibbons on World Mental Health Day – was written by service users for service users. It aims to promote the use of CPA, which has yet to be fully implemented across Wales, and to show service users how to get the most out of the CPA process.

Why it’s important: CPA is a process designed to ensure that people with a mental health problem have all their care needs assessed, and receive a coordinated care package. However, CPA has yet to be fully implemented across Wales, and many service users have yet to receive a fully-integrated package of care as they should.
The Guide is designed to change this. It lets service know about CPA, when they should ask for it, and how they can get the most out of it.

What people said about it:

Richard Timm, a Hafal client at Swansea, said: “We’re really pleased with the CPA Guide. We wanted to produce something that showed people exactly what they should expect to get from CPA. Everyone who has seen the Guide is impressed with it, and they say it really works.”

Dr Brian Gibbons, Minister for Health and Social Services at the Assembly, commented: “Through continuing to develop good partnerships, especially across the NHS, public health, local government, the voluntary sector and with service users themselves and their carers, we can ensure that a holistic and integrated programme of care is provided to people who use mental health services.”

Les Sharpe, Chair of the CPA Association for Wales and England, stated: “We’ve been delighted to work closely with Hafal as they produced this service user’s guide. It’s important that service users across Wales understand the process of the Care Programme Approach and how they can contribute to their care planning so that staff and service users can work collaboratively to promote recovery. This Guide will help to achieve that.”

Available at: Hafal’s Website

For more on the latest news on the latest mental health publications in Wales, check out the Mental Health Wales website every week.