Wales Mental Health in Primary Care

Wales Mental Health in Primary Care

2011 Survey

Objectives

• To review changes from 2009 survey

• To seek opinion on certain topics

• To provide evidence to shape actions

Methodology

• Initial meeting in July to discuss survey

• Survey Monkey used to design and administer survey

• Pilot group of GPs used to test flow and length of survey

• Primary Care letters sent to practices with link to survey

• Results collated and survey closed October 11

Terms used

• HCPs – Health Care Professionals

• MH – Mental Health

• HBs – Welsh Health Boards

• PC – Primary Care

• SC – Secondary Care

Summary

• In total the survey attracted 202 respondents compared to 172 in 2009

Mental Health in Wales• Improvements are needed with the interface between primary and secondary

care, in terms of referrals and pathways• From the patient’s side, HCPs feel social issues including the support of family and

availability of employment, affect the ability to manage mental health. • On the medical practice side, HCPs consider that funding constraints and

infrastructure affect the management of mental health• Nearly two thirds of the HCPs feel able to deal with mental health and consult

with their primary care colleagues when appropriate.• More support is needed across the mental health pathway.• The two improvement areas considered to be of high importance are outreach

and community services and the referral/interface system to secondary care.

Summary

Wales Mental Health in Primary Care (WaMHinPC)•More people have heard of WaMHinPC compared with 2009•Information sheets appear to be received but few HCPs are reading or using them in practice•Dementia and CAMHS standard are the areas that HCPs think should be priority areas to focus on

Mental Health (Wales) Measure 2010•Just over a third of HCPs have heard of the Measure, with a range of awareness across the Health Boards•The low awareness and knowledge of the measure indicates that education is required. •Those that knew about Part 1 hoped to see more mental health trained workers from primary or secondary care working within practices

Summary

Dementia•Less than 20% of HCPs are aware of the National Dementia Vision for Wales•They feel extra support with behavioural disturbance in patients is the main improvement needed for managing dementia

Patients•Most of the HCPs with Welsh speaking patients feel their needs are being met as either patients switch to speaking English or the GP speaks Welsh•The majority of HCPs with BME patients consider their cultural background, however there aren’t many examples of specific services offered. •On average HCPs treat 1-3 patients with an eating disorder.

Summary

Respondents•More females completed the survey and there was an increase in respondents aged 40 and under•Compared with the 2009 survey the split between GPs and nurses is near enough identical•The mix of respondents across Health Boards has changed versus the 2009 survey.•Against the 2009 survey there has been a slight increase in the HCPs with a specific qualification in mental health but not an increase in those interested in mental health.

Mental Health

Q1. In your opinion how difficult is the area of mental health to manage at Primary Care level?

15

64

19

2

0

10

20

30

40

50

60

70

Very Difficult Quite Diffi cult/Difficult Manageable Not all Difficult

% o

f res

pond

ents

to

ques

tion

2011 (n=202)

Nearly 80% of HCPs feel that mental health within PC is difficult to very difficult

Q2 Setting aside issues of funding, resources or service quality, what factors contribute to making the management of mental health more challenging in primary care?

64.6%

51.9%

38.6% 37.8%35.1%

32.7%

24.0%

17.6%15.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Social issuesrelated to mental

health

Nature of thecondition makespatients harder

to reach / engagewith

Interactionbetween mental

and physicalhealth

Quality ofrelationships withother parts of the

mental healthservice

Social isolation Low publicawareness and

stigma

Pooridentification /

recognition of thesymptoms ofmental health

decline atprimary care level

Interaction between parents’

mental health and difficulties

for Children and young people.

Ageingpopulation

% o

f res

pond

ents

who

ran

ked

1st,

2nd

or

3rd

NB: In 2009 there were 7 options, in 2011 there were 9.

Social issues are considered to be the most important factor for HCPs, 65% ranked this 1st, 2nd or 3rd. Only 15% of HCPs ranked ageing population highly.

Q2 Which other factors contribute to making mental health more challenging in primary care?• The most common other factor mentioned by respondents is issues

surrounding CMHT and secondary care. • Examples included patients being ‘bounced’ between CMHTs and primary

care. Also those patients that need an urgent referral are not always able to be seen promptly

CMHT/Secondary care issues 5Knowledge and training of staff 4Patient fear of diagnosis 3Availability and quality of counselling 2Family/carers 2Substance and misuse problems/services 2Time 2Young people 2Patient wants secondary care 1Rural location of patients 1

CMHT/Secondary care issues 5Knowledge and training of staff 4Patient fear of diagnosis 3Availability and quality of counselling 2Family/carers 2Substance and misuse problems/services 2Time 2Young people 2Patient wants secondary care 1Rural location of patients 1

Q3. Which of the following do you feel affects the successful delivery of improvements to PC MH services in Wales?

70

6158

37

30

24

12

73

76

56

28

32

2321

0

10

20

30

40

50

60

70

80

90

Lack of infrastructure towork in synergy with

other parts of themental health service

Funding constraints Lack of clear referral /treatment protocols

Professional knowledgeof condition and

training limitations

Difficulty inimplementing

Government policy

Low level ofprofessional interest in

mental health inprimary care

Other

% o

f res

pond

ents

to

ques

tion

2011 (n=198) 2009 (n=169)

As with 2009, lack of infrastructure was chosen by most HCPs. Not as many respondents chose funding constraints compared with 2009. Professional knowledge and training is seen as more important than 2009.

Q3 What other factors do you feel affect the successful delivery of improvements to MH in PC?• The most common factor stated by respondents is the lack of support

from secondary care.• Examples included unable to contact services out of hours and

communication pathways being poor• HCPs also mentioned that there are long waiting lists in PC for counselling

and the need for staff to be trained on mental health

Lack of support from secondary care 12Lack of staff/time in primary care 6Lack of counselling services 3Patient's drug and alcohol issues 1Training needs in primary care 1

Lack of support from secondary care 12Lack of staff/time in primary care 6Lack of counselling services 3Patient's drug and alcohol issues 1Training needs in primary care 1

Q4. Do you feel there should be a greater or lesser level of investment in time and resources in mental healthcare in Wales, relative to other primary healthcare priorities in general?

31

58

9

21

32

58

10

0 10

10

20

30

40

50

60

70

Much greater Somewhat greater The current level of investmentis right

Somewhat less Much less

% o

f res

pond

ents

to

ques

tion

2011 (n=193) 2009 (n=169)

There is no changed compared with 2009. Nearly 90% of HCPs think there should be more investment in mental health compared to other primary health priorities.

Q4. Do you feel there should be a greater or lesser level of investment in time and resources in mental healthcare in Wales, relative to other primary healthcare priorities in general?

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Much greater Somewhat greater Current level of investment isright

Somewhat less Much less

% o

f res

pond

ents

National ABM n=15 Aneurin Bevan n=37 Betsi n=36 Cardiff n=15 Cwm Taf n=19 HD n=17

Most HBs follow the national trend indicating there is little variance between the organisations. ABM appears to be the HB that moves away from the national picture, with a spread of opinion.

Q5 How would you describe your own skill level to mental health treatment for people of all ages?

10%

49%

20%

10%

7%

4%

2011 (n=192)

I am very happy to deal with any and all mental healthproblems I see, as I have extensive knowledge in thisarea

I am happy to deal with most mental health problems Isee, although there are times when I consult withprimary care colleagues for advice

I am unsure about dealing with many mental healthproblems I see, and tend to discuss these cases withother healthcare professionals in both primary andsecondary care. I will, however, still treat in most cases

I am unsure about dealing with many mental healthproblems I see and tend to confer with primary orsecondary care colleagues.

I am not comfortable dealing with mental health problems, and tend to refer these cases for treatment –either to primary or secondary care colleagues

I don’t see any patients with mental health problems

The majority of HCPs (60%) are happy to deal with most mental health problems and 50% will consult with a primary care colleague. However this means that 40% of HCPs aren’t comfortable dealing with mental health

Q6: what proportion of your practice time is spent on mental health related work?

14.8

16.4

25.9

24.3

11.10

7.40 8.3

17.3

28.227.6

16.70

1.90

0

5

10

15

20

25

30

<5% 5-10% 11-20% 21-30% 31-50% >50%

% o

f res

pond

ents

to q

uesti

on

2011 (n=189) 2009 (n=156)

There has been an increase in HCPs spending less time on mental health and an increase in those spending more time compared to 2009. In 2009 90% of doctors spent 5 to 50% of their time on MH now it is 77%, indicating some HCPs might be taking the lead and taking workload off colleagues

Q6: what proportion of your practice time is spent on mental health related work? Split by HB

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

5% 5-10% 11-20% 21-30% 31-50% >50%

% o

f res

pond

ents


There is a wide range of mental health workload across the LHBs and within in the LHBs. For example in Cardiff nearly 35% of HCPs spend less than 5% on MH and 45% spend over 50%. Cwm Taf and Aneurin Bevan have a higher workload than the national average

Q9 How confident is your practice overall in dealing with each of the following steps in the patient’s pathway?

63.7%

67.6%

59.1%

48.1%

58.5%

55.6%

36.4%

21.4%

69.9%67.9%

62.0% 61.1% 60.8%

45.5%

37.1%

18.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Assessment and diagnosisof mental health issues

Treatment and referraldecisions

Follow up andreassessment

Early / proactivedetection of signs ofmental health issues

Managing patients withco-morbidity of mentaland physical ill-health

Patient support andengagement

Understanding andsignposting for the socialfactors related to mental

well-being

Promotion of mentalhealth and well being inthe patient community

including social andeconomic interventions

% o

f res

pond

ents

who

rate

d 4

or 5

2011 (n=167) 2009 (n=154)

A greater proportion of HCPs feel more confident with the early and proactive detection of signs of MH issues compared to 2009. Promotion of MH and wellbeing is the pathway step that they feel the least confident in

Q9 & 10 How competent/confident is your practice overall in dealing with each of the following steps in the patient’s pathway?

67.5%

63.6%

48.1%

59.1% 58.4%55.6%

36.4%

21.4%

67.9%69.9%

61.1% 62.0%60.8%

45.5%

37.1%

18.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


Assessment anddiagnosis of mental

health issues





Understanding andsignposting for the

social factors related tomental well-being


% o

f res

pond

ents

who

rat

ed 4

or

5

Confidence 2011 (n=167) Competence 2011 (n=167)

Confidence and competence levels are similar.

Q11 How much support do you feel your practice has overall in dealing with each of the following?

25%23%

22%

18% 18%16%

13%12%

33% 33%

40%

28%

36%

22%

19%

31%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Assessment anddiagnosis of mental

health issues





Understanding andsignposting for the

social factors related tomental well-being


including social andeconomic interventions


% o

f res

pond

ents

who

fee

l the

re is

a le

vel o

f sup

port

2011 (n=-137) 2009 (n=145)

NB: Respondents who answer 4 or 5

HCPs consider themselves confident and competent in MH areas but feel there is not a high level of support. Also the respondents to the 2011 survey consider there is less support compared with 2009

Q12 If you were responsible for improving the overall mental health provision in your area, which aspects of care would you addresses as a priority?

79%

70%

52%

40%35% 35% 34%

29% 28%

21% 21% 19%

11%

3%

56%

43%

21%

13% 13% 13%

8% 8% 6% 6% 6%3% 2%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Outreachand

communitymentalhealth

services

Referral system –primary / secondary

care interface

Improvedsocial

supportincludinghousing

especially fordeprived or

at risk groups

Timemanagement/ allowance

to assesspatients

Improvedfitness,

exercise anddiet among

localpopulation

Staffinglevels

Reducingbarriers /increasingaccess to

services forhard to reach

groups

Choice ofservices

accessible tousers

Professionaltraining

Healthpromotion

Improveddetection ofproblems ininfancy and

earlychildhood

andimproved

service

Clinicalprotocols

Patient andcarer

engagementand

consultation

Researchopportunities

% o

f res

pond

ents

2011 (n=141) % in top 5 % of respondents who rated option 1st or 2nd

Nearly 80% of respondents felt outreach and community MH services would be the area to focus on, closely followed by referral system. This is supported by verbatim in Q3 where respondents felt lack of support from secondary care affected MH in primary care

NB: Respondents could choose up to 5

Q12 Which other areas would you address as a priority?• There were 13 additional suggestions for priority areas.• The top two were access to counselling and increased levels of staff in

Primary Care• Access to and availability of counselling has been mentioned in other

questions, in that there are long waiting times for the service.• The small percentage of respondents who suggested additional areas

indicates that the majority were content with the list suggested

Access to counselling 3Increase staff in Primary Care 3Children/adolescent mental health service 2Improve access to secondary care 1Improvements to pathway way for suicidal patients 1Other 3

Access to counselling 3Increase staff in Primary Care 3Children/adolescent mental health service 2Improve access to secondary care 1Improvements to pathway way for suicidal patients 1Other 3

Q13 Please rank the over importance of these factors in determining mental well-being for the population in general

85%82%

61%

56% 56%

46%

34%

30%27%

15%

65%

35%

24%

18%15%

18%15%

4% 3%1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Support of closefamily and friends

Availability/choiceof employment

Loneliness Financial security Standard ofhousing

Quality ofeducation

Interaction withpeople who

provideinterventions and

support

Access to socialamenities

Exercise Diet

% o

f res

pond

ents

2011 (n=142) % ranked 1-5 % ranked 1 and 2

The top 2 factors that HCPs feel are important are support of close family and friends and availability of employment. However only the first factor is consistently ranked 1st or 2nd. The factors listed could be considered ones that HCPs feel they have little, if any, influence over.

NB: Respondents could choose up to 5

Q13 Which other factors determine mental well being?• There were only 5 respondents to this part of the question which

generated 3 groups of factors.• Again, as with previous questions this indicates respondents were able to

choose the factors they felt determine mental well being from the given list

Drug/alcohol 2Society expectations 2Accomodation 1

Drug/alcohol 2Society expectations 2Accomodation 1

Wales Mental Health in Primary Care

WaMHinPC

Q14 Have you heard of WaMHinPC before this survey?

49.3

50.7

26.4

73.6

0 10 20 30 40 50 60 70 80

Yes

No

% of respondents to question

2009 (n=148) 2011 (n=142)

There has been a 23% increase in the proportion of people who had heard of WaMHinPC before the survey

Q14 Have you heard of WaMHinPC before this survey? Split by HB

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

National

ABM n=15

Aneurin Bevan n=37

Betsi n=36

Cardiff n=15

Cwm Taf n=19

HD n=17

Powys n=5

% of respondents that have heard of WaMH in PC

National ABM n=15 Aneurin Bevan n=37 Betsi n=36 Cardiff n=15 Cwm Taf n=19 HD n=17 Powys n=5

Doctors in ABM, Aneurin Bevan, Cardiff, Cwm Taf and Hywel Dda are more likely to have heard of WaMH in PC.

Q15 If you have heard of WaMHinPC before, how?

51%

32%

19%20%

0%

10%

20%

30%

40%

50%

60%

Via email via information sheet via the WaMHinPC website via a colleague

% o

f res

pond

ents

who

hav

e he

ard

of W

aMH

inPC

2011 (n=65)

Over half of the HCPs who have heard of WaMHinPC have done so via email

Q15 How else have you heard about WaMHinPC?

• In addition to the options given respondents have heard about WaMHinPC via conferences

Conference 4Meeting 2Newsletter 1RCGP 1

Q16 Did you complete the WaMH in PC survey in 2009?

Yes21%

No79%

n=135

For the 2011 survey it can be considered that there is a new group of HCPS who have completed it.

Q17 Which of the following WaMH in PC information sheets have you received, read and used?

0%

10%

20%

30%

40%

50%

60%

Information Sheet 1 –Improving Mental Health Outcome

through Sustained Employment

Information Sheet 2 –The Impact of

Emotional Distress on Health

Information Sheet 3 –Positive Choices

Suicide Prevention Training framework

Information Sheet 4 -Mental Health and

Housing

Information Sheet 5 -Mental Health and

Parkinsons’

Information Sheet 6 -Mental Health (Wales) Measure 2010 – Issue

1, June 2010

Information Sheet 7 –Improving Mental Health Outcomes through Sustained

Employment

% o

f res

pond

ents

Information sheet received Information sheet readInformation sheet useful Information sheet used as part of a patient consultationInformation sheet used as part of pratice training and education

n=39

There is a pattern with the information sheet that can be seen. The HCPs remember receiving the sheets, fewer read them and even fewer find them useful. Only information sheets 2 & 6 appear to have been used in clinical practice.Further research maybe required to discover how they can be made more relevant

Q18 Of the standards that WaMHinPC are developing which are the priority areas?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Dementia Care Child andAdolescent

Mental HealthServices

Mental Healthand Substance

Misuse

Mental Health(Wales) Measure

2010

Carer Matters Eating Disorders Veteran MentalHealth

Prisoner MentalHealth

Mental Healthand Deaf and

Hard of Hearing

% o

f res

pond

ents

who

rat

ed 1

st, 2

nd o

r 3r

d

n=136

HCPs feel that dementia care and CAMHS are priority areas.

Q19 Which other areas would you focus on (for quality standards)?• There were 11 suggestions for additional areas to focus on from 12

respondents (see below)• From the small number of respondents to this question it can be

suggested that either HCPs consider the WaMHinPC list to be adequate or can not think of any other areas

Adult ADHDBereavementCarersClinical psychologyCounselling in PCDepressionHousingLearning DisabilitiesModerately severe MH problemsPersonality disordersService redesign

Adult ADHDBereavementCarersClinical psychologyCounselling in PCDepressionHousingLearning DisabilitiesModerately severe MH problemsPersonality disordersService redesign

Q20 Are you aware that Part 1 of the Mental Health (Wales) Measure 2010 requires local primary mental health support service to be established and these services are expected to be introduced in October 2012?

Yes34%

No66%

n=141

Just over a third of HCPs are aware of the detail of the Mental Health Measure

Q20 Are you aware that Part 1 of the Mental Health (Wales) Measure 2010 requires local primary mental health support service to be established and these services are expected to be introduced in October 2012? Split by LHB

0% 10% 20% 30% 40% 50% 60% 70% 80%

National

ABM n=15

Aneurin Bevan n=37

Betsi n=36

Cardiff n=15

Cwm Taf n=19

HD n=17

Powys n=5

% of respondents that responded yes

National ABM n=15 Aneurin Bevan n=37 Betsi n=36 Cardiff n=15 Cwm Taf n=19 HD n=17 Powys n=5

Doctors in ABM are the most likely to have awareness of the detail of the Mental Health Measure

Q21 What is your level of understanding about Part 1 of the Mental Health (Wales) Measure?

None69%

Some26%

Good5%

n=141

Nearly 70% of HCPs have no understanding of the Mental Health Measure. Also only 40% of HCPs feel it should be a priority area for WaMHinPC to focus on. Those that had received the information sheet (n=13) on the MH Measure had a slightly better understanding, 54% answer some or good.

Q21 What is your level of understanding about Part 1 of the Mental Health (Wales) Measure? Split by HB

HCPs in Powys, Cardiff and Aneurin Bevan have less of an understanding of the Measure compared to the national average. Perhaps further education is required across Wales.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

None Some Good

% o

f res

pond

ents


Q22 What improvements to primary care practice would you wish to see as a result of the implementation of Part 1 of the Measure?• There were 49 respondents to the question, 41 of which detailed improvements.

Of these 49, 43% stated they had no knowledge of the Mental Health Measure.

• The area with the most suggestions was a hope that more mental health trained workers would be in primary care. These could either come from existing primary care staff, secondary care workers moving into PC (temporarily or permanently) or from other sectors.

• The second most mentioned improvement was better access to MH services and support. This links with Q12 where HCPs feel that the interface with secondary care is a priority area for improvement

More MH trained workers in PC from SC or elsewhere 15Better access to MH services and support 9Closer engagement/communication with services 5Improved pathways 4Counselling made available 3Other 2Improved training for PC 1MH promotion 1Support for long term MH conditions 1

More MH trained workers in PC from SC or elsewhere 15Better access to MH services and support 9Closer engagement/communication with services 5Improved pathways 4Counselling made available 3Other 2Improved training for PC 1MH promotion 1Support for long term MH conditions 1

Q23 Are you aware of the National Dementia Vision for Wales?

Yes18%

No82%

n=141

Less than 20% of HCPs are aware of the National Dementia Vision for Wales. As with the Mental Health Measure, education maybe required.

Q24 What key improvements would help you manage patients with dementia?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Support with managingbehavioural disturbance

Improved support in diagnosis Dementia specific training Better communication withspecialist services

Support with sharing thediagnosis

% o

f res

pond

ents

n=138

Over 80% of HCPs would like to see an improvement in support with managing the behavioural disturbances in patients with dementia

Q24 What other improvements would help you manage patients with dementia?• Carer support and respite is consider an improvement that is required. • Four respondents, from 3 health boards, also felt that the current service

works well.

Carer support/respite 4Current service works well 4Training on disease and medication 2Younger patient support 1Earlier diagnosis 1Long term care 1Community support 1

Patients

Q7 Do you have any Welsh speaking patients?

Yes70%

No30%

2011 (n=194)

70% of HCPs have Welsh speaking patients. Across HBs this ranges from 38% in Aneurin Bevan and 100% in Hywel Dda.

Q8: If yes, do you think that the language needs of your Welsh speaking patients are being met?

Yes 67%

No 33%

2011 (n=130)

Two thirds of HCPs consider their Welsh speaking patients needs are being met. This is achieved through Welsh speaking HCPs or the patient speaks English. HCPs feel the needs are not being met when a doctor or nurse does not speak Welsh.

Q8 How are Welsh speaking patient’s needs being met/not being met?• Welsh speaking patients are not having their needs met as GPs do not

speak Welsh or there is little literature in Welsh

• Welsh speaking patients are having their needs met as they are able to speak English or the primary care staff are able to speak Welsh

GP/Staff do not speak Welsh 9Little literature in Welsh 1GP/Staff do not speak Welsh 9Little literature in Welsh 1

Patients also speak English 14GP/Staff speak Welsh 10Patients also speak English 14GP/Staff speak Welsh 10

Q25 Do you considered the cultural background of BME patients?

Yes82%

No18%

n=112

Over 80% of HCPs say they consider the cultural background of their BME patients. An additional 26 HCPs state they have no BME patients

Q25 What culturally sensitive services do you offer?• The most common type of service offered was translation and/or

interpretation • Some HCPs had awareness of the culture and customs of their patients• However 13 HCPs stated they offered no services

No services offered 13Translation/Interpretation 7Awareness of culture/customs 4Female healthcare professionals 1

Q26 How many patients do you personally treat who have been diagnosed with an eating disorder?

023%

1 – 361%

4 – 511%

6 – 104%

10+1%

n=137

Nearly a quarter of HCPs have no patients with a diagnosed eating disorder. The majority of HCPs have 1 to 3 patients

Q26 How many patients do you personally treat who have been diagnosed with an eating disorder? Split by LHB

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

0 1 – 3 4 – 5 6 – 10 10+

% o

f res

pond

ents


Cardiff has the highest percentage of HCPs who have no patients with an eating disorder. Hywel Dda has the highest proportion of HCPs with 10+ patients.

Respondents

Q27 and 28 Gender and age of respondents

0%

10%

20%

30%

40%

50%

60%

70%

Male Female <30 31-40 41-50 >51

% o

f res

pond

ents

2011 (n=141) 2009 (n=128)

Q29 Professional background

80.5

19.5

81.7

18.3

0 10 20 30 40 50 60 70 80 90

GP

Practice nurse

% of respondents to question

2011 (n=123) 2009 (n=126)

There is nearly an identical split in the panel of doctors and practice nurses for 2011 and 2009.

Q29 If not a GP or practice nurse please state your profession• In addition to GPs and practice nurses, practice managers, CPNs and

counsellors completed the survey• 79 respondents skipped this question therefore their profession is

unknown

Practice manager 4CPN 3Counsellor 33rd sector 2Advanced nurse practioner 2Commissioning manager 1GP Registrar 1MH Liason nurse 1Psychiatrist 1

Q30 Heath Board of Respondent

10.7

26.425.7

10.7

13.6

12.1

3.6

15 15

23.3

7.5

10

22.5

6.7

0

5

10

15

20

25

30

Abertawe BroMorgannwg University

Health Board

Aneurin Bevan HealthBoard

Betsi CadwaladrUniversity Health Board

Cardiff and ValeUniversity Health Board

Cwm Taf Health Board Hywel Dda HealthBoard

Powys Teaching HealthBoard

% o

f res

pond

ents

to

ques

tion

2011 (n=140) 2009 (n=120)

Aneurin Bevan and Betsi Cadwaladr contributed the most respondents to the survey. Both had an increase compared to 2009. Hywel Dda saw a 10% drop

Q31 Do you have a special interest in mental health?

29.4 28.7

70.6 71.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 (n=136) 2009 (n=129)

% o

f res

pond

ents

to

ques

tion

No Yes

Q32 Do you have a specific qualification in mental health?

9.43.1

90.696.9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 (n=138) 2009 (n=130)

% o

f res

pond

ents

to

ques

tion

No Yes

Even though 29% of HCPs say they have an interest in mental health, only 9% have a formal qualification. This is, however, an increase compared to 2009.

Q32 Which mental health qualifications do you have?• The top qualification mentioned was Registered Mental

Nurse• Even though 13 people answered yes to the question, 17

respondents stated a qualification• Practice nurses did not state any qualifications

RMN 4Counselling 3Postgrad course 3Section 12 approved 3Substance misuse 2MH First Aid 1Psychoanalyst 1

Key Conclusions

• Support is needed across the mental health pathway

• Secondary Care referrals and interface with primary care needs improvement

• Awareness of WaMHinPC has increased

• Knowledge of Mental Health Measure and National Dementia Vision is low

Recommendations

• There is a range of views across the Health Boards from time spent on MH to knowledge on certain topics. It would be interesting to see what is being done in these areas.

• Improvements in secondary care referrals and interfaces are required. Are there examples of best practice where primary and secondary care feel the system is working?

• Knowledge of Mental Health (Wales) Measure 2010 and the National Dementia Vision for Wales is low, education might help to raise awareness.

• Use of WaMHinPC information sheets is low. Perhaps ask HCPs what they want to see from the information sheets. Do the information sheets offer anything from what is being produced from other organisations? Is there any best practice examples?

Technical Learnings for future surveys

• The questions that ask for Health Board and profession should be at the beginning

• Only have confident or competent questions (Q9 & 10) as both questions provided the same answer

• The length of survey should be shortened as approximately 30% of respondents did not answer every question

• The questions on general awareness of the MH measure and the detail should be switched (Q21 and Q20)

• If the survey aims to get the view of people within clinical practice, should those that do not see patients (practice managers) have their answers excluded?

Wales Mental Health in Primary Care

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