Mike Hedges AM

Chair – Petitions Committee

National Assembly for Wales

Ty Hywel

Cardiff Bay

Cardiff

CF99 1NA

Dear Mike,

Petition: P-05-736 - To Make Mental Health Services More Accessible

Thank you for your letter of 22 February 2017 seeking our views on the issues raised by the above petition and the subsequent response from the Cabinet Secretary.

Hafal fully supports the points that have been made in the petition. Despite having unique and pioneering mental health legislation in Wales (Mental Health (Wales) Measure 2010), and an all Wales Cross Government Mental Health Strategy in place (Together for Mental Health), many people who require fast and easy access to mental health services are still not receiving the support they need.

Many people living with a mental health problem, and carers, have told us about how they have been unable to access mental health services when they need them. We regularly hear comments such as, ‘I have to reach a crisis point before I receive any help or support’, or hear carers telling us that as a result of ignoring their concerns the person they care for has deteriorated to an extent that they are in need of a crisis service or are admitted to hospital.

We also hear from people how they have difficulty in knowing which part of the service they need to contact in order to receive help and support. For people experiencing a mental health problem or illness for the first time it is usually the GP who is the first point of contact, whilst for people who have previously received a secondary (or specialist) mental health service it is often appropriate to make contact directly with that service.

Irrespective of which part of the service someone seeking help and support initially makes contact with, people expect to receive an early and accessible intervention that addresses their needs. A particular issue we frequently hear about is the lack of communication across and between services. This despite the intention of Welsh legislation such as the Mental Health Measure and the Social Services and Wellbeing Act to ensure greater joined up and integrated services.

Many people who experience mental health problems need support from a broad range of services such as health, social care, housing and employment, and we think it is crucial for all these services to work together in a seamless and co-ordinated way. But often we find that organisational interests and budget constraints outweigh working together for the common good or in the best interests of the individual. Too often silo working comes first and successful outcomes come second.

Moving forward, we think greater clarity is needed in defining the role of GPs, the Local Primary Mental Health Support Service (LPMHSS) and secondary (specialist) mental health services so that people are better able to access the right service at the right time and in the right place. We would like to see access and eligibility criteria be more transparent, and we want services to be more flexible ensuring that, ‘no-one who approaches a mental health service should be turned away without help.’

We want to see better communication and better relationships between and within primary and secondary mental health services, and to see more service provision aimed at preventing people reaching a crisis point rather than delivering what often looks like a crisis driven service. Welsh Government policy commitments such as those set out in the Mental Health Crisis Care Concordat and in various early intervention initiatives are welcome but are not yet fully embedded in service models across Wales.

We want to see carers and families being listened to when they tell professionals their loved one needs help and support. We want to see services designed in such a way that they can act swiftly and where appropriate immediately. Often the urgency and risk is not realised until a formal assessment is undertaken, and sometimes this can be too late and sometimes result in a tragedy occurring.

In Wales we know how many people are accessing Local Primary Mental Health Support Services, how many people are being assessed within 28 days and how many people are receiving treatment within 28 days of referral. In secondary mental health services we know how many people have a valid Care and Treatment Plan. But we struggle to know how many people are getting any better as a result of the care and treatment they receive. We can’t measure how many people are achieving successful outcomes, or receiving therapy that is meeting their needs. We therefore want to see better and smarter outcome focused performance indicators that include capturing service user/patient experience.

Hafal continues to work closely on all of these issues and many more with the Welsh Government, Health Boards, local authorities and others to try helping tackle many of the long standing problems there have been relating to mental health services in Wales. We know that there is a strong political commitment to improve mental health services and a strong willingness amongst health and social care professionals to ensure people receive the best possible service. 

I hope that we have provided some helpful comments and suggestions on how to improve mental health services in Wales, and that in developing better services we ensure that the views and the voices of those who use services, and carers, are heard the loudest. Please let me know if you would like any further information or advice.

Yours sincerely,

Alun Thomas

Chief Executive