1 July 2016
Article by Stephen Boyce, National Assembly for Wales Research Service
Next Tuesday, 5 July, the Assembly will debate the Together for Mental Health – Delivery Plan 2016 – 2019. This is the Welsh Government’s second delivery plan for its 10 year mental health strategy, which was launched in 2012. The Delivery Plan was subject to consultation earlier this year and the final version had not yet been published at the time of writing; the information below therefore refers to the consultation document.
The Delivery Plan has 10 priority areas, covering mental health provision for people of all ages, and it covers a wide range of issues including dementia, eating disorders, suicide prevention, and needs of veterans. There are a number of actions and performance measures within each of the priority areas. This post focuses on three key issues: crisis care, access to psychological therapies and services for children and young people.
There has long been concern about the treatment of people experiencing mental health crisis and who are detained, for their own or others’ safety, by the police. Sections 135 and 136 of the Mental Health Act 1983 allow a police officer to remove a person who appears to be suffering from a mental disorder to a place of safety, which can mean police custody. Such powers should be used as a last resort but there is concern they are being overused, sometimes because of inadequate crisis care services.
A recently agreed multi-agency Crisis Care Mental Health Concordat for Wales aims to minimise the use of inappropriate places of safety, such as police cells, and to improve care for people who are detained under sections 135 or 136. The concordat was agreed between the NHS, social services, the police and emergency services, the voluntary sector and others. The Mental Health Delivery Plan states that by March 2017 all partners will ensure they are adhering to the principles of the concordat.
In the meantime though, the Policing and Crime Bill, which is currently before Parliament, is likely to revise the law affecting the provision of crisis care since it amends sections 135 and 136 of the Mental Health Act 1983. The amendments would, amongst other things, prohibit the use of police cells as a place of safety for people under 18 years and place new restrictions on the use of cells for adults.
Performance on improvements to crisis care achieved through the Delivery Plan will be measured by a reduction in the number of police transportations / increase in ambulance transportations of those in crisis or detained under Mental Health Act
Another significant issue to be addressed by the Mental Health Delivery Plan is access to psychological therapies. Third sector mental health organisations have been campaigning for wider availability and shorter waiting times for psychological therapies and less reliance on drug treatments.
Easier and quicker access to ‘talking therapies’ would go a long way to helping achieve one of the aims of the Mental Health (Wales) Measure 2010 which is to promote earlier treatment and support for people with mental health problems. The Measure introduced Local Primary Mental Health Support Services (LPMHSS), part of whose role is to improve access to psychological therapies.
The new Delivery Plan has a key action for Health Boards to improve access to evidence based psychological therapies for adults in line with the National Psychological Therapies Management Committee (NPTMC) Action Plan by March 2017. The NPTMC Action Plan includes measures to increase workforce capacity, reduce waiting times, develop information, and self-help resources, and develop national performance standards and improved data collection.
The Delivery Plan will require Health Boards to report on a 26 week referral to treatment target in specialist mental health services, 80% adherence to the 28 day LPMHSS waiting time, and measurement of waiting times for psychological interventions in LPMHSS.
Children and young people
In terms of the mental health of children and young people the Delivery Plan sets out a range of actions, many of which reflect those in Together for Children and Young People (T4CYP) programme. This is the Welsh Government’s three year programme to improve Child and Adolescent Mental Health Services (CAMHS) The programme emphasises a multi-agency approach to addressing the range of emotional and well-being needs of children and young people, with support to be provided in a variety of settings, as well specialist help from CAMHS.
The overhaul of mental health services for children and young people follows a number of critical reports in recent years, including by the Children and Young People Committee of the Fourth Assembly.
There are actions and performance measures in the Delivery Plan that relate to CAMHS provision:
- to address the needs of mothers at the pre and post-natal stages;
- for children in their early years and in educational settings;
- for children and young people with additional learning needs and those at extra risk of poor mental well-being; and
- to improve services for children and young people experiencing mental health problems.
The Welsh Government’s mental health strategy is an ambitious and wide ranging document which encompasses all age groups and emphases prevention and well-being and the contribution of public services beyond those concerned only with health and well-being. The Delivery Plan reflects that broad scope and its impact will be closely monitored both by people who experience mental health problems and those that support and represent them.