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

Access to treatment in Wales

March 28/29th 2015

• 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

Introduction

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

• Response to lobbying of Welsh Govt by Hafal/ voluntary organisations

• Specific Welsh legislation-implemented in 2012Intentions of measure1. To increase assessments + treatments within

primary care. Primary care services to, thus, be developed

2. To improve effectiveness and coordination of mental health services by creating statutory requirements for holistic care planning

Mental health Measure (2010)

Intentions3. 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)

Mental health Measure

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

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


Discharge from secondary servicesLimitations:• 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


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


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

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

Social Services and Wellbeing Act (Wales)

Wales’ first mental health and wellbeing strategyAims are:a. The mental health and well being of the population

is improvedb. 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

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


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


• First point of contact for individuals experiencing mental health issue

• If needs are acute GP may co-ordinate hospital admission

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)

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

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

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

Primary Care

• 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

Accessing assessments

• 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

Accessing support services

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

Voluntary sector

• 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

Secondary care

• 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

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

Crisis intervention

• 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

Conclusion

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

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