Access to treatment in Wales March 28/29 th 2015

1. Access to treatment in Wales March 28/29th 2015

2. Introduction • Significant and sustained improvement to mental health services in Wales in last 10-15 years • Positive change to ethos and principle behind both services and their commissioning • Vast majority of services are provided in the community; hospital admission is avoided where possible-always seen as the last resort • All services (inc psychotherapy) are free • Almost all support is based on empowerment and is recovery focussed • Significant reduction in stigma-Time to Change (UK wide)-high profile of mental illness in the media

3. Holistic approach-The Whole Person Approach Nine areas of recovery • Medical (inc medication) • Physical health • Financial • Accommodation • Training and education • Employment and occupation • Social • Other therapies (e.g. psychotherapy) • Parenting or caring relationships

4. Mental health Measure (2010) • Response to lobbying of Welsh Govt by Hafal/ voluntary organisations • Specific Welsh legislation-implemented in 2012 Intentions of measure • To increase assessments + treatments within primary care. Primary care services to, thus, be developed • To improve effectiveness and coordination of mental health services by creating statutory requirements for holistic care planning

5. Mental health Measure Intentions 3. Provisions to be in place so that individuals, if discharged from secondary care, are able to directly refer themselves back (within a year) 4. To extend provision for Independent Mental Health Advocate (IMHA)

6. Mental Health Measure-Current Picture Care and Treatment Planning (CTP) • Most individuals now have an agreed and recorded CTP-holistic-legal requirement to cover at least 5 areas of the Whole Person • Majority of clients report they feel more involved in the process and that CTPs are making improvements to their lives

7. Mental Health Measure-Current Picture Care and Treatment Planning (CTP) Limitations: • CTPs not always focused on recovery aims and objectives • Non-pharmacological interventions are still not receiving enough priority

8. Mental Health Measure-Current Picture Discharge from secondary services Limitations: • Client feedback: poor communication and lack of adequate advice upon discharge • Too often clients will be in crisis before they are able to re-access services

9. Mental Health Measure-Current Picture Provision of IMHA • LHBs report that IMHAs are widely available across Wales, but:- • Variations in access. Some clients will have access to IMHA 7 days a week; some for just few hours • Also, individual LHBs develop own strategy so is limited national coherence

10. Social Services and Wellbeing Act (Wales) Intentions: • To improve access to and the provision of services across Wales • To increase the consistency of services • To give individuals a greater voice and stronger control over services • To improve collaboration and partnership working between health and social care agencies

11. Social Services and Wellbeing Act (Wales) Limitations: • No all Wales system that measures overall recovery and to what extent individuals are achieving better outcomes • Reported long delays in accessing treatment to secondary care-resulting in deterioration in individual’s condition between referral and assessment • The act does not allow for a single assessment process if an individual requires both mental health and social care services

12. Together for Mental HealthMental Health and Wellbeing Strategy for Wales Wales’ first mental health and wellbeing strategy Aims are: • The mental health and well being of the population is improved • The impact of mental health problems and/or mental illness of all ages, their families and carers, communities and the economy generally, is better recognised and reduced

13. Together for Mental HealthMental Health and Wellbeing Strategy for Wales c. Inequalities, stigma and discrimination suffered by people experiencing mental health problems and mental illness are reduced d. Individuals have a better experience of the support and treatment they receive and have an increased feeling of input and control over related decisions

14. Together for Mental HealthMental Health and Wellbeing Strategy for Wales e. Access to, and the quality of preventative measures, early intervention and treatment services are improved and more people recover as a result f. The values, attitudes and skills of those treating or supporting individuals of all ages with mental health problems or mental illness are improved

15. Primary Care • First point of contact for individuals experiencing mental health issue • If needs are acute GP may co-ordinate hospital admission

16. Primary Care • Depending on complexity of need may refer on into secondary care (inc Crisis Resolution Teams) or • Refer to other agencies (e.g. counseling, drop-in centres etc) or • Provide treatment within primary care setting (in non-complex cases)

17. Primary Care • Reported increase in the numbers of individuals being offered non-pharmacological interventions (inc. CBT, psychotherapy and counseling) • Also reported increase in the numbers of individuals being referred to voluntary agencies re education, occupational etc support • Overall view, though, is that primary care professionals remain reliant on prescribing medication

18. Primary Care • Efficacy of GPs/primary care professionals in assessment of need viewed as being erratic • Some reports indicate improvement in empathic skills of GPs since introduction of the Measure and Together for Mental Health Strategy • Also reports that accessing appropriate treatment can be dependent on the empathic ability of the primary care professional

19. Primary Care • Client view: GP not always best placed to recognise or acknowledge is significant problem • Potential communication problems • Lack of specific training in MH issues • No legal requirement to measure and report on client experience • CMHT view-similar to above-e.g. only small % of referrals made from Primary Care will be accepted

20. Accessing assessments • Waiting times for assessments vary from between 2 weeks to up to 6 months • There has been some reduction in waiting times since the implementation of the Mental Health Measure • National target is that 80% receive assessment within 28 days • Figures indicate that majority of individuals receive assessment within 28 days

21. Accessing support services • Welsh govt. target is that 90% of individuals should receive support intervention within 56 days of assessment • LHB figures report that they are largely achieving this • Client feedback reports that there are still quite lengthy waiting times particularly for counseling/CBT services. Substantial amounts report they have to wait for over 6 months

22. Voluntary sector Comprehensive range of services available to clients including: • Supported Housing • Employment Projects • Physical health (e.g. health and wellbeing groups, smoking cessation; physical activity) • Early intervention programmes • Resource centres/drop ins

23. Secondary care • Significant improvements to the quality of care planning have been witnessed since the introduction of the Mental Health Measure • Legal right to a CTP with which the client is fully involved and which is holistic • Individual’s care coordinator writes the CTP with the full involvement of the client • The CMHT are able to provide, or signpost to, a comprehensive range of services inc. crisis intervention, medication, talking therapy, housing, finance, social, occupation, leisure

24. Crisis intervention • Since MH measure significant improvements appeared to have been made to interagency working • Also appeared to be significant improvements to providing access to crisis intervention • High quality preemptive interventions • Crisis Teams in operation 24 hours per day • Many hospital admissions were being avoided as a result of the above

25. Crisis intervention Impact of recession/cuts • Greater pressure on services leading to poorer quality communication between services and thereby impacting on joined up working • Crisis intervention being delayed and leading to more/longer hospital admissions • Alongside limited bed availability-clients waiting for beds to become available plus having to travel significant distances

26. Conclusion • Significant, if slow, improvements made to Welsh mental health systems • Sustained cooperation between agencies • The client, and their recovery, is increasingly placed at the centre of treatment • Vital importance that such gains should not be lost to cost efficiencies