Sep 24, 2014 - Mental Health services across Cardiff and the Vale of Glamorgan, which .... 6 ONS and DWP data from Publi
Together for Mental Health
Cardiff and Vale Local Partnership Board Annual Report 2013 – 14
“WORKING IN PARTNERSHIP”
Contents
1.0
Introduction from the Local Partnership Board Chair
2.0
Mental Health and Wellbeing in Cardiff and Vale University Health Board
2.1
Local Mental Health and Wellbeing Needs Analysis
2.2
Cardiff and Vale Local Partnership Service Delivery Model
3.0
Delivering Together for Mental Health
3.1
Promoting Better Mental Wellbeing and Preventing Mental Health Problems
3.2
A New Partnership with the Public
3.3
A Well Designed, Fully Integrated Network of Care
3.4
One System to Improve Mental health
3.5
Delivering for Mental Health
4.0
Summary and Conclusions: Looking ahead to 2015 and beyond
Annex 1 LHB Report against Together for Mental Health Delivery Plan Actions 2012 – 2016 Annex 2 Membership of the Cardiff and Vale Local Partnership Board
Introduction from the Local Partnership Board Chair
As Chair of the Mental Health Local Partnership Board I am pleased to submit the second annual report of the Cardiff & Vale Local Partnership Board which demonstrates our continued progress against the actions set out in the national strategy “Together for Mental Health” The Membership of the Local Partnership Board has been drawn from a wide range of Stakeholders who are able to give an informed view and provide positive contributions to the partnership agenda and this in turn has ensured a commitment to the implementation of our Local Delivery Plan. A considerable amount of work has been undertaken over the last year, to improve Mental Health services across Cardiff and the Vale of Glamorgan, which continue to focus on developing sustainable services for those suffering mental health problems. These include developing more health promotion and prevention strategies, developing expertise amongst people to manage aspects of their own illnesses and continuing with the redesign of services towards a community focus. The Local Partnership Board meetings in Cardiff and Vale have been used as opportunities for agencies to share aspects of the delivery plan requiring collaboration and a service user and carer focus to develop. These closer working arrangements with partner organisations, such as local authorities and the third sector have joined up the way in which we provide care across our organisations and the involvement of service users and carers at the heart of this process will ensure that they help shape a first class Mental Health service for the future. . There will be many challenges ahead with the financial constraints all Health Boards and Partner agencies face but the current economic climate should be seen as an opportunity to embrace Partnership collaboration and integrated working practices to deliver “recovery” focussed patient centred care.
Dr Annie Procter Chair Cardiff & Vale Local Mental Health Partnership Board
2.0
Mental Health and Wellbeing in Cardiff and Vale University Health Board
2.1
Local Mental Health and Wellbeing Needs Analysis
Population Size The population of Cardiff and Vale of Glamorgan is growing rapidly. Currently, around 479,000 people live in this area and between 2003 and 2013, the number of people increased by 9.3%, almost double the Wales average at 4.7%. The number of people aged over 85 years has increased by 28% between 2003 and 2013 1. Age and Gender The city of Cardiff has a skewed population compared to the \vale of Glamorgan because of the large numbers of students and disproportionately fewer older people. As a higher proportion of mental disorders develop between the ages of 14 to 20, Cardiff has greater incidence of mental illness. In contrast, with its greater proportion of older people, the population of the Vale is likely to comprise a higher overall percentage of people with dementia than Cardiff. Ethnicity The proportion of people from the black and ethnic minority (BME) community 2 in the Vale of Glamorgan is 4% and is similar to the Wales average at 6%. In Cardiff, however, the proportion stands at 16% 3. Research shows that the incidence of psychosis is higher in the African Caribbean and Black African populations 4. Educational Attainment The percentage of Year 11 school leavers who were known to be not in education, employment or training (NEET) in 2013 in Wales was 3.7%, ranging from 3.8% in the Vale of Glamorgan to 4.9% in Cardiff 5. In general, people with a psychotic illness have fewer qualifications and are more likely to have left school before the age of 16 with no qualifications, compared to other groups. Unemployment The percentage of people who are claiming one or more employment related benefits in Wales stands at 14.7%, whereas in Cardiff and the Vale, this is slightly
1
Office of National Statistics (ONS) mid-year population estimates (MYEs), 2003 and 2013
2
BME defined as all non-white ethnic groups aggregated from KS201EW table (ONS, Census 2011)
3Office
of National Statistics (ONS) Census 2011, KS201EW.
4
Morgan et al, First episode psychosis and ethnicity: initial findings from the AESOP study, World Psychiatry, 2006, 5:1, 40-46.
5
Careers Wales Pupil Destinations from Schools in Wales, 2013
less at 12.2% and 11.9% respectively. Mental health conditions are the primary reason for those claiming health-related benefits 6. Housing and Homelessness The number of households in Cardiff who were deemed to be eligible, unintentionally homeless and in priority need was 690 in 2013/14. In the Vale of Glamorgan this was 195 7. Statistically, you are more likely to have a mental health condition if you are homeless: 43% of those accessing homelessness projects in England were suffering from a mental illness. Diagnosis of Mental Illness According to the GP registers in Cardiff and the Vale as at March 2013, there were 4,111 people with a diagnosis of a serious mental illness. There were also 2,485 people with a diagnosis of dementia. However, according to the Alzheimer’s Society, this represented only 46% of people with dementia in the community 8; therefore under-diagnosis is an issue, despite Cardiff and Vale having the best detection rate in Wales. Deprivation Deprivation is associated with poorer mental health outcomes and those with a poorer level of income are more likely to have a common mental illness. Deprivation in the Vale of Glamorgan is largely clustered around Barry and 6.4% of the Vale areas fall into the 10% most deprived in Wales. In contrast, areas of deprivation in Cardiff are mainly in the southern arc of the city and 15.8% of Cardiff’s areas fall into the 10% most deprived in Wales 9. 6
ONS and DWP data from Public Health Wales Observatory, Nov 2009 to August 2010
7
Info base Cymru, 2013/14. Available from: http://www.infobasecymru.net/IAS/themes/housing/tabular?viewId=26&geoId=1&subsetId=
8
Alzheimer’s Society, http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=1666
9
This is taken from the results of the Welsh Index of Multiple Deprivation 2011.
10
WHS, 2011-12, WG. http://wales.gov.uk/docs/statistics/2013/131001-welsh-health-survey-localauthority-health-board-results-2011-2012-en.xls (Table 8) 11
Quality and Outcomes Framework, June 2013, WG http://wales.gov.uk/docs/statistics/2013/131021-registeren.xls 12
Psymaptic, http://www.psymaptic.org/prediction/psychosis-incidence-map/
13
Daffodil Projections, Welsh Government, 2014
14
Produced by Public Health Wales Observatory, using Audit+ (NWIS).
15
Using data produced by Public Health Wales Observatory, taken from ONS, GROS & NISRA
16
Figures produced by Public Health Wales Observatory, using ADDE & MYE (ONS)
Prevalence According to the Welsh Health Survey 2011-12, 11% (age-standardised) of adults in Wales reported currently being treated for a mental illness and this is identical to the Cardiff and Vale prevalence of 11% 10. This is likely to be an underestimate of the people who have a mental illness as surveys suggest that in England 16% of people have a common mental illness. In terms of a diagnosis of a serious mental illness (schizophrenia, bipolar disorder and other psychoses), there are 4,111 people on primary care registers with these conditions, which is 0.8% of the total GP list size 11. A prediction tool, PsyMaptic has calculated that, in Cardiff and the Vale, we would expect to find 74 new cases of psychosis per annum, between the ages of 16-6412. In Cardiff the number of persons age 30 and over predicted to have dementia in 2013 was 3,577 rising to 5,242 in 2030. In the Vale of Glamorgan, the number of persons age 30 and over predicted to have dementia in 2013 was 1,740 in 2013 rising to 2,905 in 2030 13. There are 2,485 people with a diagnosis of dementia on GP registers in Cardiff and Vale. When adjusted to take account of the age structure of the population, the dementia rate is 2.9 per 1,000 people, compared to 2.7 per 1,000 people for Wales as a whole 14 Service usage Benchmarking data shows that the Adult Community Mental Health Team caseload per 10,000 weighted populations is 147 within Cardiff and Vale, which is similar to NHS Benchmarking data of 140. Within this service, there are 252 contacts per whole time equivalent, compared to 240 across the UK. The numbers of admissions per 100,000 populations are 245 in Cardiff and Vale, compared to 234 across UK benchmarking data. Bed occupancy in Cardiff and Vale is 115%, whereas across the UK it is 91% on average. Suicide Suicide rates in Wales are higher than in England but lower than in Scotland and Northern Ireland 15. During the period 2003- 2012, European age-standardised rates (EASRs) among men (aged 15+) in Cardiff and Vale ranged from 16 per 100,000 in the Vale of Glamorgan to 19.4 per 100,000 in Cardiff, similar to the Wales rate of 20 per 100,000 males. In women the EASRs in Cardiff and Vale ranged from 4.9 in the Vale of Glamorgan to 5.8 in Cardiff which is slightly higher than the Wales rate of 5.3 per 100,000 females 16
2.2
Cardiff and Vale Local Partnership Service Model
The Cardiff and Vale Mental Health Local Partnership Board have worked with key stakeholders to develop services that people want and need. The University Health Board and Partners strive in what we do and are excited about plans for the future. Continuous quality improvement and increasing efficiency and productivity are central to the strategy. The Cardiff and Vale University Health Board UHB currently deliver primary, community, inpatient and tertiary mental health services out of five hospital sites and twelve community bases through over 64 integrated teams. The range of services includes core mental health services such as adult and older peoples community mental health multi-disciplinary teams and aligned in patient beds but also support, specialist and tertiary services. Cardiff and Vale University Health Board now provide Primary Mental Health Support Services working alongside the established GP practice-based primary care counselling service, delivering into Primary care services in meeting the needs of low and medium intensity mental health support alongside Assertive Outreach Services including provision for the City Centre and Homeless. Early Intervention efforts to detect and intensively treat first episode psychosis support the work of the generic adult services. Also in support of these cornerstone services are the Tier 3 Eating Disorders Specialist Team, Tier 3 Borderline Personality Disorder Support Team, Perinatal Specialist Service and the Specialist Rehabilitation teams across Cardiff and Vale to support recovery and move on. A Post Traumatic Stress Disorder team is closely aligned with the all Wales veteran services hosted by Cardiff and Vale. There is a designated tier two eating disorder team delivering specialist interventions across community mental health teams and supporting specialist interventions in primary care. A Range of Low Secure and Forensic services, including in patient beds, community team and criminal justice liaison services are available with a range of substance misuse services including NHS inpatient provision. The mental health service continues to provide support collaboratively across the UHB with Liaison services present in Emergency Unit, general hospital wards, poisons and elderly wards. Elderly mental health specialist services include Crisis Resolution (REACT) community older people’s team – one of the few across the UK, working alongside the Memory team and Young Onset service and Nursing Home Liaison. The delivery of Psychological Therapies is becoming increasingly embedded in core services with specialist support. The working age and older people’s Community Mental Health Teams across Cardiff and the Vale of Glamorgan continue to offer the cornerstone of community mental health care. The teams are fully integrated between the local authorities and the health board and form the base from which specialist secondary mental health care is co-ordinated for the majority of the most vulnerable service users.
There is an intention to promote mental wellbeing and where possible prevent mental health problems developing, improving individual and community resilience:
Enhancing emotional resilience through education and awareness-raising Prevention through targeted health promotion Mental health wellbeing employment promotion and workplace initiatives Good quality and secure housing enhancing well-being Reducing social isolation Improved mental health services signposting and organisation links
The vision of the Cardiff and Vale Mental Health Partnership Board and its partners is:
To be recognised as leading organisations in the provision of adult mental health, MHSOP and substance misuse care that has at its heart health and well-being. To link population needs to service delivery and positive health outcomes. For people with mental health problems to have access to information and support that promotes understanding, self management where possible and healthy lifestyles. To consolidate and strengthen services for people suffering serious mental health problems based on equality for all groups with protected characteristics including BME and sensory loss. To enhance partnership arrangements to deliver a better range of integrated services To become a better organisation by building on involvement with stakeholders and strengthening governance. To improve the quality and increase the value of services delivering tier 1 targets and enabling recurrent financial balance. To consolidate and develop the range of services provided through modern, purpose designed accommodation.
The Community Health Council has worked with the Health Board when engaging with the public, carers and relatives on service changes within the Western Vale. Continuous ongoing engagement has been undertaken with Carers and Relatives at the Iorwerth Jones Centre and St. David’s Hospital which have enabled concerns and carers experiences to be shared with the University Health Board Mental Health Clinical Board in an open forum and the CHC continues to scrutinise services provided by the University Health Board Mental Health Clinical Board within Primary and Secondary care.
3.0 Delivering Together for Mental Health 3.1
Chapter 1 - Promoting Better Mental Wellbeing and Preventing Mental Health Problems
What will this look like for Cardiff and Vale Local Partnership Board? The Local Partnership Board will strengthen existing partnerships within the ‘Time to Change’ intentions and develop new arrangements, to help deliver a better range of integrated services. It is recognised that individual Partner organisations may need to develop alternative operating models to enable all to provide high quality care more innovatively and efficiently. To support this process the Local Partnership Board will continue to ensure that the principles of mental health promotion and inclusion are embedded in all activities with potential areas for community outreach to be identified and strengthened. What are the key challenges facing us?
Dementia It is estimated that the number of people suffering from dementia in Cardiff and the Vale of Glamorgan will rise by 53% between 2013 and 2030, and therefore it is important to act upon this data to ensure robust service provision to both Service Users and Carers CAMHS To improve the emotional and mental health of children and young people which has been identified as a priority by the University Health Board Children and Women Clinical Board and Cardiff and Vale partnership arrangements. Physical Health and Wellbeing The Cardiff and Vale Mental Health Local Partnership Board recognises the importance of t promotiing physical health and wellbeing as a key enabler to help improve mental wellbeing. Suicide and Self Harm To further clarify the definition of self harm versus Para-suicide/Non intentional overdose and a working definition is needed to properly collect data. Veterans Mental Health The challenges identified by service users and partner organisations through specific feedback events are as follows:: • Growing demand. • 400-500 people contacting Social Services each month. • Need to support people at home to a greater extent. • The new Social Services and Wellbeing Act will encourage greater expectation amongst the public.
What have we achieved in the last 12 months? Dementia The Dementia 3 Year Plan was created as a partnership initiative,by the Cardiff and Vale University Health Board, both Cardiff and Vale of Glamorgan local authorities and a wide range of Third sector partners, with input from service users and carers. It was formally launched in 2014. In order to deliver on this Plan, a multi-agency Dementia Taskforce was formed and has met twice in order to deliver on the actions • Around 20 Dementia Friends Champions trained. • Friend’s sessions to be rolled out. • Wyn campaign pilot project rolled out and 62 contacts made within the first three months. • Work has been undertaken by a range of partner agencies with PA consultancy to review the current use of Telecare services across Cardiff and the Vale. A report with recommendations for the way forward has been produced by PA consultancy. • Dementia champions developed within Community Resource Teams and train the trainer model commenced. • ‘10 minutes of your time’ carers survey undertaken, with overall positive results. • Exchange programmes and research undertaken by the SPIDER project to develop a dementia re-ablement service.
•
A consultant psychiatrist from Cardiff has won a national award for his work with dementia patients, Dr Sabarigirivasan Muthukrishnan, Consultant Old Age Psychiatrist for the Community REACT Service, was awarded the 2014 Best Consultant Service Development prize by the Royal College of Psychiatrists The award recognises Dr Muthukrishnan’s recent paper, Community Response Enhanced Assessment, Crisis and Treatment (REACT) Service – Economic Evaluation of the Service.
Physical Health and Wellbeing The past twelve months has seen mental health awareness community events coordinated by third sector with service user involvement - i.e. 4 Winds, communities first, Cardiff Mind, Mental Health Forum Young People’s Group (range of third sector- Amber Project, Women’s Aid ,Llamau, Barnardo’s, Ely Ace, cavamh, Grassroots, the Sprout and Cruse).
Suicide and Self-harm A local audit mapped against the ‘Talk to Me’ action plan has been conducted within the following process: • Divided into national and local actions • Actions given a ‘Red Amber Green rating’ • Red and Amber actions structured thematically Local themes identified are as follows: • Plans and policies • Service development • Training and development • Access to support services • Cross-cutting areas – Children and Young People – Care leavers – Prisons – Employers – Suicide hotspots To meet the needs of the outstanding actions, a Suicide and self-harm multiagency steering group has been formed. The Collaborative will share good practice and function as a mechanism whereby key external/internal review recommendations lead to actions that are overseen and facilitated as a rolling programme of change. Veterans Mental Health Welsh Government has announced the All-Wales Veterans Health and Wellbeing Service will be re-named Veterans NHS Wales to raise awareness of the special services it provides. It helps veterans access health services tailored to their specific needs; The Cardiff and Vale University Health Board has appointed a Board Champion in line with all Health Boards across Wales. What are our service innovations? Dementia Within dementia care, the development of a dementia re-ablement service model by SPIDER (Supporting Public Service Innovations using Design in European Regions) is a real innovation, which will be adapted to meet the needs of people with dementia and their carers.
Solace Carers Centre is presenting the second Art in Dementia exhibition in collaboration with Partners across Cardiff and the Vale of Glamorgan.
CAMHS The Families First Fund has provided a robust framework for partners to develop structured and targeted support and intervention programmes for children and families across Cardiff. Barnardo’s is the Lead Provider for the CADARN Emotional Wellbeing strand of the Cardiff Partnership Board. Suicide and self Harm Cardiff and Vale University Health Board deliver ASIST training which staff participate in, and is also being delivered to Cardiff University. There are plans to develop a training package for training police within custody suites. The local authorities have supported social work and social care officers and Peer Support Workers to undertake the ASIST and MHFA training Veterans Mental Health The Veterans Mental Health Group brought together veterans, planners and providers in 3 meetings (110+ people) to share information. The Penarth Pavilion event with 70 in attendance included 30 veterans with mental health issues plus 12 older people with mental health issues. other initiatives included: o Meeting to promote Dementia Supportive Communities o Veterans support meeting (40 participants) o Steering group with veteran involvement
Where do we require further action? Dementia Within dementia care, more training and development is required within the general hospital ward setting. A University Health Board Dementia Champions Network will be launched in 2014 in order to remedy this. There is also a need to develop a community anti-psychotic initiation policy. Physical and Mental Wellbeing There is a need to reinforce a range of integrated community opportunities that promote recovery and wellbeing. The Emotional and mental health workstream has identified the need for enhanced communication between the third sector and statutory partner and has established a local expert advisory group to implement this action. Time to Change Wales All partners should identify Time to Change Champions with responsibility to raise awareness of mental health and to promote positive images of mental health when developing services. Further work is required to promote mental wellbeing within vulnerable yet hard to reach groups such as young carers, people within the criminal justice service and people from a minority ethnic group and to ensure that mental wellbeing of whole populations is considered as part of Equality Impact Assessments when developing services. Suicide and Self-harm There is a need to develop a UHB Suicide and Self-harm Policy, plus a multi-agency principles framework for suicide and self-harm Veterans Further work is needed to clarify gaps and build better networks, communication and support for veterans with mental health problems. Many veterans are not well informed about mental health or mental health problems and appropriate help is not always on hand.
Our priorities for the next 12 months
Dementia • Over the next 12 months the Dementia Taskforce sub-groups will be formed to deliver on the Dementia 3 Year Plan actions for Year 1. The main priorities include: the development of dementia supportive community pilots; the creation of a dementia re-ablement model, the launch and ongoing support of the Dementia Champions Network and a telecare strategy across Cardiff and the Vale of Glamorgan.
Physical and Mental Wellbeing Cardiff and Vale University Health Board have made a commitment to work with other partner organisations and engage meaningfully with Clinical Boards across the UHB to achieve success with wider health issues. Examples of these collaborations are :•
The Promoting Positive attitudes towards Mental Health through the Culture change. This group is responsible for ensuring all staff understand the impact of Mental Health services moving to University Hospital Llandough following the decommissioning of Whitchurch Hospital. • Exploring ways of working to help our Emergency Unit Teams, look at liaison services and consider different models of support. • Demand management work is being investigated to explore GP referrals into our Community Mental Health Team’s, investigating differences and understanding them. • The Dementia care pathway straddles many clinical boards. The programmes demand cross board interaction, collaboration and a willingness to make the wider populations healthcare needs a priority to all. Let’s Get Physical! Sets a challenge to GPs, other health and social care professionals, Health Boards, local authorities and the Welsh Government to support service users and carers to improve their health.
Mark Drakeford with Junaid Iqbal in the Gardens at Hafal, St Fagans
CAMHS •
Improving the emotional and mental health of children and young people has been identified as a priority by the University Health Board Children and Women Clinical Board and Cardiff and Vale Partnership Board.
Suicide and Self-harm • Over the next 12 months we will expand the membership of the Suicide and Self-harm Steering Group and develop a University Health Board Suicide and Self-harm Policy, plus a multi-agency principles framework for suicide and self-harm.
Veterans • Cardiff MIND is to roll out the MHFA Armed Forces Community course which will teach how to recognise the signs and symptoms of mental health problems and provide initial help to guide a person towards appropriate professional help.
Service User experience Veteran’s service “I served in the Royal Electrical and Mechanical Engineers from 2005 until 2011. I gathered a lot of experience in within the time I served both soldiering and trade. I deployed to Afghanistan in March 2009 as a vehicle mechanic. After a few days of being on tour I was attached to the Royal Marines for the duration of my tour, in which none of the experience I had gathered before could have prepared me for the months that lied ahead. Without the help from the Veterans Service I don't think I would ever be able to move on from the bad times I found myself in. I would recommend the NHS Veteran Service 100% to anybody who finds themselves in similar situations. I would like to thank everybody at the Veteran Service for all the help and support they have delivered and because of them I can finally carry on with life with my family.”
3.2
Chapter 2 - A New Partnership with the Public
The Cardiff and Vale Partnership Board will continue to provide leadership, influence and support to ensure successful delivery of the Strategy and the Local Delivery Plan and increase ownership in the Strategy through promoting wider involvement and engagement with acknowledgement of the value of Service Users and Carers in the process of taking the Strategy forward. What are the key challenges facing us? Local approaches to Service User and Carer engagement - Co Production of the report Cardiff and Vale University Health Board have worked collaboratively with service users and older people's carers for a number of years. Both Cardiff and Vale of Glamorgan Local Authorities and Cardiff and Vale University Health Board provide funding to service user and older people’s carer involvement projects through Sefyll and Nexus. The purpose of the projects is to develop ways for service users and older people's carers to be a part of the day to day design, planning and evaluation of services. This includes representation from service users and carers on planning and strategy groups and recruitment panels. There is service user and carer representation on the Local Mental Health Partnership Board, supported by Sefyll, Nexus and Hafal. In order to address the gap for family/carer involvement, Hafal successfully bid for Big Lottery funding for a Carer Participation Officer for Cardiff and the Vale of Glamorgan in February 2014. The purpose of the project is to develop partnership between families/carers and adult mental health service providers. The role is funded until 2017. Since this appointment, Hafal have developed engagement processes and opportunities for families and carers of people using adult mental health services, including link with Cardiff and Vale University Health Board. Service user and carer involvement officers will continue to work on ways of identifying what people want from services and identifying barriers to engagement with services. Service user and carer involvement, through Sefyll, Nexus and Hafal will continue to develop links for co-productive working with other partners in mental health. Provision for Welsh speakers Cardiff and Vale UHB has identified the following key challenges: • The lack of progress in integrating Welsh language skills into the organisations’ recruitment process and practices. • The continuing unavailability of patient appointment letters continues to be a risk, but steps are being taken by Clinical Governance. • The lack of progress by Cardiff and Vale University Health Board to integrate Welsh language into staff assessment of skills and using them as part of the services they provide.
Equality and Diversity The Cardiff and Vale University Health Board opposes all forms of unjustifiable discrimination and recognises that some groups and individuals in society experience unfair discrimination in employment and in their contact with public services. Discrimination can take the form of treating people less favourably because of their age, colour, culture, disability, ethnic origin, gender, gender re-assignment, language, facial disfigurement, marital or civil partnership status, nationality, carer status, pregnancy or maternity issues, responsibility for dependants, sexual orientation, social class, religion, belief or non belief or political beliefs. It can also arise from failing to take account of differences between people and groups which can result in barriers to access to services and opportunities. What have we achieved in the last 12 months?
Tackling Stigma and Discrimination The Vale Dementia Supportive Communities launch took place on 24th September 2014 at Barry Leisure Centre, supported by The Cardiff and Vale University Health Board, Vale of Glamorgan Local Authority, CAVAMH and Vale Council of Voluntary Services.
Engagement on local priorities for mental health As part of the annual reporting of the Local Mental Health Partnership Board, Sefyll, Nexus and Hafal worked with in partnership service users and carers to design and carry out an engagement exercise to identify views and priorities for mental health services in Cardiff and the Vale. A service user and carer led committee was established to plan how best to collect feedback. It was decided that a variety of mechanisms for gathering views should be offered. These were: • Group sessions held in community settings and with existing support groups • A paper questionnaire, with ballot boxes, issued in the community • An online questionnaire • A feedback session with service users and Carers and professionals
Over 140 people told us what they felt was good about services, what was bad and what they feel the priorities should be next year. There were 94 individual responses through the questionnaires and group sessions and these have been used to identify the most prevalent issues for service users and their families and carers. Additional sessions were held with CAMHS service users, service users with hearing loss and dementia carers. These have been separately reported as there was a different methodology to the group sessions and questionnaires.
This was the first year that this approach has been taken and it will be evaluated and further developed next year. From 2014, this will be a continuous engagement exercise with service users and carers which will include progress against benchmarks set this year. It will also be used to identify who is not engaging with us and develop ways to address this.
Services used by respondents
Primary Secondary Third Sector Crisis Inpatient CAMHS
Fig.1 Service used by respondents
Fig. 2 Feedback analysis Summary reports collated by Service Users, Carers and Families can be found at the close of the chapter. Provision for Welsh speakers As part of its own Welsh Language Scheme, the Cardiff and Vale University Health Board has to submit an annual report to the Welsh Language Commissioner by June of each year, providing an overview of how the organisation has been working to comply with its Scheme. The report for 2013/14 demonstrates that the organisation has made progress in key areas such as: • Development of monitoring systems by the Equality, Diversity and Human Rights Sub Committee. • Continued success of the Welsh language category at the annual staff awards • Improvements in the Welsh language version of the website. • Providing bilingual signage at the organisations capital projects. Health and social services care for people as individuals, ensuring that they are accurately assess and their care needs met. Peoples' cultural identity and language needs must be at the heart of this because it is an essential element to good quality care and high professional standards. Whilst trying to Improve the quality of care - it is important to recognise the concept of language need. For many Welsh speakers, language is an integral element of their care e.g. some people with dementia or Mental Health Service Users and Carers.
Equality and Diversity The Cardiff and the Vale of Glamorgan is one of the most ethnically and culturally diverse areas in Wales. Stakeholders including the public, patients and members of staff expect the University Health Board to be proactive about equality, diversity and human rights as well as meeting its obligations under the equality, diversity and human rights legislation. The Cardiff and Vale University Health Board recognises that it also has a social, moral and ethical obligation to promote equality of opportunity and outcome, foster good relations and eliminate discrimination, victimisation and harassment and to uphold human rights principles. Lloyds Banking Group have provided funding for Nexus to carry out BME involvement activities which has facilitated black and minority ethnic focus groups to gather the experiences of communities in relation to Older People’s Mental Health as a partnership event in liaison with Communities First, attended by other third sector groups, University Health Board and local councillors this allowed minority ethnic groups to share their experiences with providers and planners and outcomes shared with providers. Nexus, cavamh jointly facilitated black and minority ethnic focus groups to gather the experiences of communities in relation to Older People’s Mental Health and a partnership event in liaison with Communities First, Mind Cymru Time To Change, and also attended by other third sector groups. What are our service innovations? Deafness and Hard of Hearing Collaboration between the Mental Health service, deaf and hearing loss community, related organisations and service users is aiming to improve access and care and treatment to people with hearing loss, deafness and mental health problems. Following a successful stakeholder consultation event during the summer of 2014, a local steering and implementation group has been established to progress with a multi agency action plan. The plan aims to ultimately provide bespoke services for this ‘hard to reach’ group and is currently looking at best practice in this area. Black Minority and Ethnic Groups The University Health Board and Local Authority services are engaged with BME representatives to raise awareness through Time To Change and other initiatives including health promotion, access to mental health services, improving staff diversity through recruitment and giving special consideration to the challenges that face asylum seekers.
Where do we require further action? The Deaf and Mental Health collaborative action plan intends to identify and develop a range of mental health specialist workers to be further trained to provide bespoke triage, care and treatment services across the spectrum of mental health providers. The efforts will be initially targeted at greatest need within primary care and specialist community services. Our Primary care support services are collaboratively using the equality impact process to understand BME needs within primary care including asylum seekers, the challenges of a multi-lingual population, and other hard to reach groups.
Summary prepared by Families and Carers in Adult Mental Health. Priorities for 2014-2015 Introduction In July 2014, Hafal began an exercise to find out the views of families and carers of people in adult mental health services. The purpose was to identify priorities for mental health in Cardiff and Vale. This work was conducted in line with Outcome 10.1 in Together for Mental Health: To ensure that service users of all ages and their families and carers are fully involved in service development. The findings are included in the body of this report and are summarised in full below. Background Family and carer involvement in Cardiff and the Vale is undergoing a period of development. Until this year, there was no dedicated involvement worker coordinating the views of families and carers in adult mental health. In February 2014, Hafal appointed a Carer Participation Officer to take this work forward. Since the inception of the project, Hafal have started to build links with local families and carers and find opportunities for them to get involved in the design, planning, delivery and evaluation of services. Methodology In order to find out what service users and their families and carers think of mental health services in Cardiff and the Vale, service users, carers and involvement officers designed an engagement exercise that took place throughout July and August 2014. A committee of service users and carers was set up to co-ordinate the work. It was decided by that committee that the most effective way of gathering feedback was to visit service users and carers in community settings across Cardiff and the Vale. This was done by visiting support groups and meetings and asking people attending what they think of services during a fortnight of events known as ‘Feedback Fortnight’. An online and paper questionnaire was issued to ask for feedback, so that we could gather as many views as possible. Broad questions were asked on what people felt was good or bad about the services they receive. Suggested topics were include for people to consider, including CMHTs, GPs, police, housing and education. In Cardiff and the Vale, Hafal held two focus group sessions with families and carers, to discuss what was good about services, what was bad about services and suggested ideas for improvement. We also received written responses through completed questionnaires. The findings and ways forward suggested by families and carers are discussed in this report. We would like to thank everyone who gave their time to talk to us during this exercise. Issues for families and carers The following issues were identified and discussed, and recommendations put forward by families and carers.
What works well During the sessions, we asked families and carers what worked well. In both groups, families spoke of the positive impact talking therapies had for their loved ones. Two carers spoke of how the Liaison Psychiatry service had been the key to their son getting the right help. One carer praised the clozapine nurses, a service that wasn’t available to her son when they lied in England. There was also praise for third sector support through day services and one carer said they would like to see more befriending services, as that had worked well for her daughter. Am I a Carer? The term ‘carer’ isn’t always something that families identify with. Some of the people in the groups spoke of how they saw themselves as family and not necessarily a carer, despite providing regular support to their loved ones. There is a danger that people will not access help and support, or understand their rights, because they don’t identify with that label. Although most of the carers at the group had requested a carer’s assessment, some had not as they had not thought themselves eligible. Those who had been through carers assessment said they hadn’t expected it to be so intrusive and most had waited some time to get one. Recommendation Raise awareness on the role of the family in supporting a loved one so that they understand their entitlements as a carer, how to get an assessment and what to expect from one Are families and Carers listened to? Don't dismiss my carers as hysterical or over emotional - they live with me every day and have to experience the consequences of my illness on a day-to-day basis - you don't. During the group sessions, families discussed whether or not they felt listened to by the people responsible for their loved ones care. Comments were made about the following services. GPs Some participants felt that GPs did not have an adequate understanding of mental health, including the difficulties in getting a loved one to attend an appointment, not being penalised if a loved one does not attend appointments due to their mental health and offering suitable times for appointments for carers. Community Mental Health Teams Some carers spoke of the notable improvement since the introduction of integrated Community Mental Health Teams in staff attitudes towards the family. One carer spoke of how in the past she had felt staff blamed her for her son’s condition and how much attitudes had improved in recent years. However, in discussions among the groups there was a consensus that there is still an inconsistency in attitudes towards families and carers. Some felt fully listened to and, where appropriate, involved in their loved ones care. Some felt this was dependant on the attitude of individual members of staff. The groups discussed how
important it was to have the right staff who exercised common sense and compassion by listening to and considering concerns raised by families. Police A number of carers spoke of their interactions with the police, particularly around sectioning. One carer felt the term ‘section’ did nothing to explain what was going to happen. Another carer spoke in detail of how police did not include or discuss with her what actions they were planning to take with regard to her son. She felt that if they had done so, she could have calmed the situation and limited the distress of her son. She also spoke of how intimidating it was to have police attend her house in full riot gear and how a place of safekeeping should not be a police cell, as it is not suitable for a crisis situation. Recommendations • Families and Carers to deliver awareness sessions to service providers to help build a mutual understanding of the role families play in supporting loved ones • Raise awareness with families/Carers on how the CMHT works and their right to be heard • Work with Hafal Integrated Family Support to promote a point of contact for families within Community Mental Health Teams • Work with Carers Champions in GP surgeries to develop information and support for mental health Carers • Any work relating to section 136 practice needs to involve the views of families and Carers Better informed families and carers In group discussions, it was felt there is an assumption that families and carers instinctively know what to do after a loved one is diagnosed with a mental health condition. Participants pointed out that they are often in the dark themselves and know little about mental health and the system a loved one is entering in to. Carers spoke of how they would feel better able to support a loved one if they understood some of the following issues: • Understanding and managing a loved one’s condition • Understanding the mental health system • Knowing their rights as carers and how to exercise them • Knowing about appropriate, local support for loved ones • Knowing of support and information available to families and Carers Discussion turned to ways in which this could be improved. Families and carers suggested that simple information on what to expect could be made available. They felt that, at the point of contact with services, a handbook/information pack should be given to families. Recommendation Families and carers to work with the UHB to develop an information resource that can be used by primary and secondary care staff
Better communication within services There was positive discussion on how the introduction of care co-ordinators had improved things. Some carers spoke of how care co-ordinators had helped organise housing and social activities through liaison with other service providers. However, it was felt that there are still areas that need improvement. Staff changes sometimes affected the continuity of care and families often had to explain a situation over and over, something that can cause emotional distress. It was suggested that new staff should prepare more before meeting service users and their families by reading patient notes thoroughly. Two carers also spoke of delays in care when moving to a new area. There were delays in transferring records, although the carers were complimentary about a service being offered quite quickly. They did feel it would have been beneficial to have information about local support and services. Recommendation Families to be better informed of the Care and Treatment Planning process to help with continuity of care and the care objectives set by their loved ones Family roles in crisis There was a lot of discussion in the groups about how families felt help only really comes at a point of crisis. There was praise for the crisis resolution team, with one carer speaking of how it helped her daughter remain at home. However, many families found it problematic knowing where to access immediate help in a crisis. Some spoke of how difficult it was to access crisis help out of hours, sometimes only getting an answer phone from the out of hours team and in some cases, no one calling back to respond to their message. Others tried to access crisis help through an out of hours GP and had similar problems getting hold of anyone. Families feel they could be better equipped to deal with a crisis if there were clearer information about who they should call for out of hours support. Some carers felt that crisis often occurred because there wasn’t focus on early intervention. The groups discussed how they felt they could play a role in maintaining good mental health for the people they supported. In order to do that, carers would like more information on local support available and better understanding of the mental health system. Recommendation • Families need to be involved with any work on early intervention, so their role in helping prevent crisis is understood and supported by agencies such as the local authority, health board and the police • Information on ‘what to do in a crisis’ made available to families and Carers Supportive employers Some of the carers in the group were still in employment and others were retired. Some carers spoke of the support put in place by their employers to help them maintain their caring role. However, others spoke of how their employer had not supported them and one felt forced to leave employment to continue her caring role. Some carers felt there was still stigma in the workplace around mental health
Recommendation Raise awareness with employers about mental health and particularly on how they can help support people in a caring role Appropriate Services There was discussion about how well services currently fit the needs of service users. One carer spoke of how her son was housed with a much older age group, which led to a decline in his mental health. There was some discussion in the groups about day/community support available to service users. Some carers also spoke of how day support wasn’t varied enough, and did not offer appropriate vocational and education focussed activities or opportunities. It was also felt by some carers that the current support wasn’t suitable for younger service users and there was little offered to help people in their teens and twenties develop age appropriate social networks. Recommendation Further work needs to be done to develop appropriate day support that is suitable for different abilities and ages Children and Adolescent Services We received some written responses from parents of children in CAMHS services. The main concerns were that there was pressure on services, that crisis support is not readily available and there needs to be more support for parents. Comments to be passed to CAMHS services and 3rd sector for children and young people. BME Two carers spoke of support available for mental health carers in the BME community. Both were complimentary of the services available but one felt that there needed to be more done to break down stigma in Muslim communities. It was felt this could be done through more in-reach work within those communities. Recommendation More work can be done to meet with BME groups in their own communities to raise awareness about mental health services that are available and identify potential barriers to access Next Steps • Monitor any progress made against the recommendations in this paper and report back to families and Carers on a regular basis via our Carers Updates. •
Begin a new, annual engagement exercise with families and Carers and look at ways we can develop links with more families across Cardiff and the Vale.
Summary prepared by members of the Service User and Carer Planning Group. An online and paper questionnaire was issued to ask for feedback, so that we could gather as many views as possible. Broad questions were asked on what people felt was good or bad about the services they receive. Suggested topics were include for people to consider, including CMHTs, GPs, police, housing and education. The questionnaire was available online for a month. Paper questionnaires and ballot boxes were distributed in the following locations • Community Mental Health Team reception areas • Community hubs and locations where support groups meet • Community day support centres • Older peoples support centre • CAMHS reception There was a final event at the end of August 2014 where service users and carers addressed their feedback to a panel of service providers. Discussions at this meeting centred on: • Help and support available for young onset dementia Carers • Concerns around training and competence of private agency Carers • How talking therapies are commissioned and provided • Help for young people aged 13-16 • Education and training on mental health awareness in schools • The benefits of prescribing pharmacists in the community Reasons for the chosen approach It was felt that this approach would encourage more detailed feedback on services and it provided an opportunity for people to discuss a wider variety of topics. The committee felt that a one off event was limited and may exclude some people from sharing their views. A more mixed approach would cater to different audiences with different needs, in a more familiar setting. The questionnaires also offered anonymity for people who did not want to publically discuss their views. Findings Around 120 people gave their views; a mix of service users and their families and carers. The final panel event was attended by a further 32 people. The findings were collected and analysed to identify key themes. There was a lot of positive feedback about the general performance of CMHTs, with a third of respondents praising the work they do. Over half of respondents used community day services and the overwhelming majority of them cited the positives of that service as an opportunity for peer support with other service users and having access to advice and support to help them to manage their day to day lives (for example, money and housing advice) The findings strongly reflected the need for a recovery focused approach to care as stated in the Cardiff & Vale Charter for Mental Health, particularly the principles below. The Mental Health Charter states that every person in Cardiff and the Vale of Glamorgan has the right to mental health services that: Treat everyone as a capable citizen who can make choices and take control of their own lives. Are guided by the individual’s views about what they need and what helps them Give people the information they need to make their own decisions and choices
Specific Findings including examples of some comments received: Community Services (mainly voluntary sector) – Over half (50%) of those taking part use community day services. The majority valuing time spent with others in a similar situation to themselves; information, advice and support with everyday living, for ‘4 Winds is an excellent facility for anyone with mental health problems. Access 7 days a week; staff provide direct listening support and referral to other organisations for help and advice’ . Psychological therapies – One in five (20%) mentioned talking therapies. The main concerns being access, waiting times, number of sessions and lack of choice British Sign Language – not enough counsellors or therapists use BSL There is a 12 month waiting list for counselling.’ ‘I had to wait 18 months for CBT ‘6 sessions of CBT was not enough Information and education – One in five (20%) would like more information and education to help them understand and manage their own mental health 11% felt there should be more education to tackle mental health stigma CMHTs – Feedback was generally positive, with a third (33%) of those taking part praising the work they do. However, many felt that CPNs are overworked My CPN and Psychiatrist are amazing. I couldn’t wish for better Feeling listened to – Over a third of people (33%) feel it is important to be listened to although many felt this did not happen ‘My GP was understanding and empathetic; providing me with a range of options explaining each and letting me decide which was best for me. He let me know his door was always open and that I could return to see him anytime, if my mental health deteriorated.’ Psychiatrists – Views were mixed, focussing on access, waiting times, quality and continuity of care, partly due to the use of locums. ‘My psychiatrist is very good. The best I have had in 30 years. She listens and is straight talking.’ ‘My Psychiatrist left and I have seen 4 different Psychiatrists in the past year.’ Access to services – 13% said services were not available when they needed them. Crisis Recovery and Home Treatment Service - One in ten (10%) had negative experiences of using the crisis service. Some felt the definition of ‘crisis’ was too narrow. Families and carers talked about the problems and lack of support for dealing with a crisis out of hours. ‘It is a bit like a mystery service. They have a very narrow interpretation of crisis’. “Crisis team helped my daughter to remain at home”
CAMHS - Long waiting lists and concerns over access to crisis services for young people. Communication - One in ten (10%) felt communication between services was poor ‘Police Officers need more training in working with people who have mental health problems Care and Treatment Plans – Lack of consistency, with some not even knowing if they had one. GPs never attending care plan meetings ‘No care or treatment plan was provided after 2 requests
3.3
Chapter 3 - A Well Designed, Fully Integrated Network of Care
Integrated care brings together inputs from all partner agencies in the delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency A significant area for the promotion of an integrated network of care are Services for children and adolescents with emotional and mental health needs which has been under significant scrutiny in recent months locally and nationally with concerns expressed about the ability of services to meet need. In October 2013 the University Health Board initiated a work programme to agree a sustainable service model for emotional and mental health services. Five key areas of work were identified and are being taken forwards: • Delivery of a model for Primary Mental Health Services • Agreement on a Specialist Secondary CAMHS service Specification • Development of a model multiagency model for Children whose behaviour causes risk to themselves or others • Closer working arrangements with Welsh Health Specialist Services Committee for the planning of Intensive Community based services and inpatient provision • Services to be designed based on a user experience
What are the key challenges facing us? Service Innovations to improve quality and safety Cardiff and Vale Action for Mental Health co-ordinates 3rd sector participation in Joint reviews e.g. in relation to community opportunities, housing, MHSOP and developed a CMHT contact form- a pilot to support service users to link to 3rd sector agencies via CMHTs (in liaison with 3rd sector groups and CMHTs) Access to Psychological Therapies The Cardiff and Vale UHB will aim to provide psychologically minded services which will ensure a focus upon the quality of relationships between practitioners and service users in the delivery of all treatment and interventions. These relationships provide the foundation for effective service delivery alongside developing a tiered system, deploying evidence-based practice and drawing upon service user feedback (practice-based evidence). MH Measure The Mental Health (Wales) Measure 2010 (the Measure) is a unique piece of legislation designed to provide a legal framework to improve mental health services in Wales. Implementation of the services required by the Measure began, on a phased basis, in January 2012. Section 48 of the Measure places a duty on the Welsh Ministers to review specific
sections of the Measure. An Inception Report 1 was produced in 2013 which described the process proposed to fulfil that function and to also comment more broadly upon the progress of implementation. Out of Hours/Crisis Section 136 Concern has been raised through an inspection by Her Majesty’s Inspectorate of Constabularies (HMIC), Her Majesty’s Inspectorate of Prisons (HMIP), the Care Quality Commission (CQC) and Healthcare Inspectorate Wales (HIW) in the following areas related to the use of s136, Mental Health Act 1983. This concern focused on two main areas: • Examined the extent to which police custody is used as a place of safety under section 136 • Identified the factors which either enable or inhibit the acceptance of those detained under section 136 into a preferred place of safety, such as a hospital or other medical facility. CAMHS/Children response to WAO/HIW Report Childhood mental health problems are very common with one in ten children having a diagnosable emotional mental health problem which could benefit from support. The level of emotional mental health problems in our young population is increasing and services have not developed to keep pace with this. In particular for young people, this growth is in the areas of recognition of stress, anxiety, depression and behavioural issues, including risk taking behaviours which may nevertheless go on to become enduring problems. The work programme is designed to deliver models of support The Children, Young People and Education Committee has agreed to undertake an inquiry into Child and Adolescent Mental Health Services (CAMHS). Health and Social Services need to work closer together on the “assessment of risk” combining both the clinical assessment and the social assessment. The lack of a joint approach puts some very vulnerable children at serious risk. This lack of an overall and joint approach leads to the most vulnerable being passed around the system, including between different areas and services as a cost shunting exercise. Services for children and adolescents with emotional and mental health needs have been under significant scrutiny in recent months locally and nationally with concerns expressed about the ability of services to meet need. In October 2013 the University Health Board initiated a work programme to agree a sustainable service model for emotional and mental health services. Five key areas of work were identified and are being taken forwards: • Delivery of a model for Primary Mental Health Services • Agreement on a Specialist Secondary CAMHS service Specification • Development of a model multiagency model for Children whose behaviour causes risk to themselves or others • Closer working arrangements with WHSCC for the planning of Intensive Community based services and inpatient provision • Services to be designed based on a user experience
Progress towards a co-morbid Substance Misuse pathway Statutory substance misuse services are under review by the Area Planning Board (APB), to ensure effective integration and seamlessness with recently commissioned 3rd sector open access and throughcare / aftercare substance misuse services that are now operational across Cardiff and the Vale. The need for effective joint working and communication remains a challenge in an environment where demand for clinical service capacity remains high, such as the capacity to release staff for training and development in effective co-morbidity clinical practice
What have we achieved in the last 12 months? Service Innovations to improve quality and safety Access to Psychological Therapies MH Measure Part1 Cardiff and Vale PMHSS service is now able to offer a Part 1 assessment within 28 days to at least 80% of those referred. Further, the service offers a range of evidence-based group interventions which were not available prior to the Measure with plans to introduce further medium and high intensity evidence-based interventions in due course. Part 2 There is a consistent format of care and treatment plan across secondary mental health services, and recognition within secondary mental health service providers of a holistic approach to delivering care according to the eight areas of life. Each person receiving secondary mental health services has a designated care coordinator to oversee the care and treatment plan. Part 3 Part 3 has provided a right of access to former users of secondary mental health services. Service users eligible under part 3 do not need to attend the GP first. This relies upon providing effective discharge planning and the provision of information upon discharge to inform the person of their eligibility and how to access an assessment via self referral Part 4 Advocacy Services have been widely expanded under the mental Health Measure with awareness raising and uptake of the service greatly increased. The Advocates are integral to mental Health settings and available to all General Health settings including Velindre NHS Trust for patients with associated mental health needs. The Co-Creating Healthy Change project The project is funded for four years. Since April 2014, the project has continued to support Sefyll activities, whilst also organising distinct activities and building new relationships. The project began commissioning workshops about collaborative care and treatment planning in light of the Mental Health (Wales) Measure 2010. These workshops form part of the projects wider work to increase the involvement of people using CMHT
services with CMHTs by addressing the need of the people to be involved in planning their own care, and in the potential that this collaboration could have for recognising and accurately assessing need, as well as encouraging Cardiff and Vale University Health Board to fulfil their statutory obligations. Out of Hours/Crisis Supportive Recovery Service – Ward West 2 at Whitchurch Hospital was established as a 14 bed Supportive Recovery Unit in November 2013.The new service now offer more appropriate accommodation for existing service users (those who previously receive care on ward East 1 and those who are place on other acute wards but need to specialist intensive support that this Unit will offer). The new Unit also offers opportunities to repatriate service users who currently receive their care from independent sector. Crisis Assessment Ward – this service commenced on 6th January 2014 following the upgrading/adaptation of Ward East 5A at Whitchurch Hospital. The new Crisis Assessment ward operates on 14 beds and acts as the single point of access into adult acute in patient services. Centralisation of Crisis Team Support – the former “Patient Resource Centre” at Whitchurch Hospital was converted as a base for the South Crisis Team in October 2013. The accommodation has the benefit of being close to the main hospital entrance where all emergency assessments are carried out and both Crisis Teams are now located in close proximity to the Crisis Assessment Ward (East 5A).In the longer term the Crisis Teams will transfer to purpose designed accommodation in the new Adult mental health In patient Unit on the University Hospital Llandough site. Section 136 Cardiff and Vale University Health Board and South Wales Police have researched a joint project run by Leicestershire Police with Leicestershire Partnership Trust Since December 2012. A car is staffed by a police officer and a mental health nurse. They attend or give telephone support to front line officers dealing with incidents where a member of the public appears to be in a mental health crisis. The additional expertise is designed to come up with the most appropriate way of dealing with the individual. As a result, the number of people detained under Section 136 of the Mental Health Act has fallen by around 40 per cent. In the Autumn of 2013 a multi-agency professional group from Cardiff and Vale area visited the Leicester services and are currently formulating a report on the benefits to local services of a similar scheme in pilot. CAMHS • An agreed service specification for Specialist CAMHS services • A clear link with the All Wales planning network and WHSCC • A report from service users which will inform future service developments • Agreement to a model for primary health care
Progress towards a co-morbid Substance Misuse pathway The co-morbidity pathway has been developed and implemented across Cardiff and the Vale, with a cohort of service users from across the spectrum of complexity and need being managed using the new approach. The work has been sponsored by the national Effective Services for Vulnerable Groups (ESVG) Board, and has contributed to the development of a revised national service framework for comorbidity that is due for publication shortly. This work has been supplemented by a broad training and development programme across adult mental health and substance misuse service practitioners. The management of co-occurring substance misuse and mental health needs in under 18s is effectively managed with the specialist young people’s substance misuse treatment service being imbedded within CAMHS services. Dementia A joint Taskforce in Cardiff and the Vale of Glamorgan have brought together health, local authority and third sector partners, patients and carers, to develop a three year plan to help people avoid, delay and cope better with dementia. The Taskforce aims to have rolled out various schemes and strategies across the whole of Cardiff and the Vale of Glamorgan at the end of the 3 years. It meets every 3 months to ensure that actions are kept on track. An event was held in October chaired by Marcus Longley encouraging UHB staff to explore Dementia care in their clinical settings. Each clinical area will present their thoughts on managing dementia care in their unique areas. The symposium debate will enable Cardiff and Vale University Health Board Clinical Board's to develop thinking around dementia care to ensure the UHB has an action plan moving forward. The Alzheimer’ Society has implemented Referrals to other key agencies and liaison requirements.
What are our service innovations? Mental Health Measure The Measure has service to be a lever in reinforcing the recovery approach. This is both in terms of service design and what we are doing to how we are doing it. The Measure support the ethos of early intervention, self help, health promotion, illness prevention and a prudent approach where services users receive support according to need and not service design. It is also an important step in demand management into secondary care mental health services which had continued to increase until Part 1 has been more established – with now early signs of a flattening or reduction in referral numbers. Service users have more explicit entitlement to a greater say in their care and treatment and are raising the standard of care planning. There is more flexibility between primary and secondary care with boundaries less restrictive. It is important to stress that the efficient running of the model is to a large degree dependant on the decision making of GPs and referral quality.
The implementation of Part 4 of the measure has ensured through the commissioning process robust monitoring arrangements and an enhanced access to Advocacy Support. Advocacy service availability to all in patients has supported a more collaborative approach in ward environments to care improvements. Out of Hours/Crisis/Section 136 The Cardiff and Vale UHB new Crisis Assessment Ward intends to provide a high quality assessment service for those who cannot be safely managed in their usual home by the Home Treatment Team. The ward aims to improve the service user experience at the point of needing further assessment in a safe environment, with the goal of a focussed admission facilitating a return to their usual home or appropriate alternative treatment setting within 14 days. Access to Psychological Therapies A more psychologically – informed care model has been introduces to adult CMHTs and other teams with the “Team Formulation” led by Psychology staff. The “Living life to the full” CBT Group programme is being rapidly developed. A greater provision of “Emotion Regulation Groups” (DBT skills informed) is likely to help in reducing selfharm. The waiting lists for Psychological therapy in our adult CMHTs have been reduced. CAMHS/Children response to WAO/HIW Report • Agreement to a model of care for Primary Mental health support that will encompass the requirements of Part 1 of the measure and capacity building in schools • The agreement of a Multiagency approach to a risk assessment service for young people with behavioural issues to address those who currently do not meet the criteria for a specialist NHS CAMHS service but who none the less require support.
Progress towards a co-morbid Substance Misuse pathway The combination approach of managing and piloting a new service pathway across the full spectrum of complexity, coupled with a comprehensive staff training and development programme has been particularly innovative, and recognised at a national level as an area of service where overcoming barriers between different public service sectors can deliver learning that is applicable elsewhere. These findings have been used to inform the redevelopment of the national comorbidity service framework.
Where do we require further action? Mental Health measure Within primary care to broaden the range of psychological interventions on offer and move to a single point of access between primary care and primary care counselling services. Using the equality impact process to further identify impact on and how to provide services for hard to reach groups such as asylum seekers, BME groups and the deaf. The Cardiff and Vale ‘feedback fortnight’ from service user groups identified ‘collaborative care planning’ as a priority for the next phase of development for TFMH – systematic internal quality monitoring, multi-agency recovery training and developing the use of the ‘service user lens’ national outcome tool across the whole of the region is planned. Access to Psychological Therapies There are still clear needs for a dedicated OCD treatment service, more dedicated time to work with early-onset psychosis, greater capacity to treat complex trauma in the Traumatic Stress Service, and psychologist-led input in areas of physical health such as obesity, diabetes and heart disease. There is an opportunity significantly to enhance the psychological therapy provision at tier 1 by greater integration of Primary Care counseling and PMHSS, with the delivery of guided self-help (e.g. for eating disorders) and shorter forms of CBT (e.g. for less complex traumatic stress) Partners need to ensure outcome and performance monitoring processes are developed alongside National Core Data as designated in the policy implementation guidance for Psychological Therapies. CAMHS The ability to provide a rapid response to young people to assess risk, provide advice and develop a support plan.
Our priorities for the next 12 months
Mental Health measure • Single point of referral for all primary care mental health services • Broaden range of psychological interventions • Develop third sector collaboration and capacity to deliver elements of the primary care model • Systematic monitoring of collaborative care plan production. Access to Psychological Therapies Implement recording and performance monitoring systems regarding competency development in the workforce and delivery /access to psychological therapy Work towards designated delivery and supervision time within roles/posts Implement competency development training plan Audit areas of gap against NICE guidance Review pathways to ensure stratified (stepped provision) appropriate to need and competency of the workforce using prudent healthcare principles Support psychological therapy delivery and competency development across the University Health Board CAMHS/Children response to WAO/HIW Report • Implementation of the Primary Mental Health Model • Implementation of the ‘Risky Behaviour multiagency model Progress towards a co-morbid Substance Misuse pathway • Continued management of the service user cohort within the new pathway • Continued accountability to the national ESVG Board • Implementation of any additional requirements as outlined in the revised national service framework following publication • Continuation of the cross-discipline training and development programme
Service User experience Mental Health Measure The recent second part of the Gofal snapshot of people's experiences of primary mental health services in Wales found that when asked if the person managed to access the service, advice and /or treatment they needed, of those people resident in Cardiff & Vale (N=194), 58% answered 'yes' or 'mostly' (compared with the national average of 49.3%). In the same survey when asked if services accessed through primary care led to improved mental health and wellbeing, of those people resident in Cardiff & Vale, 46.2% answered 'yes' or 'mostly' (compared with the national average of 37.2%). Access to psychological therapies One in five service users and carers told us that they would like increased access to psychological therapies. A number spoke of how they had benefitted from psychological therapies. Comments centred on waiting times for therapies being too long and the duration of therapies being too short. 'Counselling was useful but too short after a long wait to get it' There is an obvious demand for more timely access to psychological therapies and for the duration of the therapies to be on an individual needs basis. Considering this alongside the fact that almost one in five respondents wanted more information and education to manage their own wellbeing, and that 13% of respondents wanted more community support, any developments in those areas should consider ways in which they could meet the current demand around psychological based therapies. A separate session was also held with 25 service users with hearing loss. Comments largely centred on a lack of British Sign Language trained psychologists. People felt that the use of an interpreter was not appropriate as during counselling sessions, they were speaking about personal issues and did not want a third person present. Suggested actions Mapping exercise of the current provision of psychological therapies in Cardiff and the Vale, including available community support and self help resources
CAMHS Service User and Carer Feedback We had a number of responses from service users and carers and an additional session was held between the UHB and young people using CAMHS services. Specific issues raised were around • the service needs to have a more personal feel • crisis services for under 18s need to be quicker and easier to access • more information available, e.g. through leaflets • support through transition to adult services, including meeting adult teams • better communication between different parts of the service • choices in care and feeling listened to and involved in care, not just listening to parents
CAMHS Continued What does caring for your Mental Health mean to you? • Taking part • Having a say • Being listened to • Feeling of belonging • Being part of something • Getting together- group • Being united within a group • Common aims/ goals/ working towards something • Helping towards something • A positive thing • Sense of achievement • Fearful of something new • Commitment • Equal • Meeting others/ sociable • Digital
Chapter 4 – One system to improve Mental Health
To achieve integrated healthcare, policy-makers, service planners and commissioners need to better understand the indivisibility and unitary nature of physical and mental health, which means that distinguishing between them is likely to lead to an incomplete response to people’s needs as well as flawed thinking about mental health. Focus should be on major social and structural influences such as education, unemployment, housing, poverty and discrimination, rather than just on support given to individuals based on a medical diagnosis of mental illness. Such support can clearly have a positive effect but may be limited in the extent to which it can improve health by mitigating adverse social factors.
What are the key challenges facing us? Housing The feedback from all sources identified similar issues to address at strategic and operational levels including the need to develop mechanisms for ongoing communication. In response the muti-stakeholder Planning Group was formed to discuss strategic developments and and to draft and implement an Action Plan. The planning group has developed protocols for the improved sharing of information between inpatient areas and housing to avoid unnecessary delay in discharging people into suitable accommodation. Cardiff and the Vale of Glamorgan Councils have initiated procurement of Floating Support providers to work with adults with service mental health problems living in their own homes. The providers will link with the CMHTs through the Care and Treatment Planning processes to provide specialist recovery focussed support.
Employment Helping people with a mental health condition to return to work is considered to be a key part of their recovery. The aim of the Cardiff and Vale Employment Strategy Group is to develop and implement a strategic approach to improving the employment rates of adults with mental health conditions in Cardiff and the Vale of Glamorgan. Cardiff and Vale UHB is also working with Cardiff Council, Vale of Glamorgan Council and other partner organisations to strengthen local understanding of the likely impacts of welfare reform and to develop an effective collective response to safeguard and support citizens.
What have we achieved in the last 12 months? Housing The Housing and Mental Health Planning Group was established in 2012 following: • The Wales Audit Office Report on Housing and Mental Health • A Cardiff and Vale wide multi-stakeholder conference • Workshops with people in contact with services.
The Cardiff and Vale Mental Health Clinical Board has appointed a Housing Development Manger to ensure a smooth pathway for service users both in hospital and when settled in the community. The Housing Officer works across the community and housing to ensure continuity across service provision. The Cardiff and Vale University Health Board Mental Health Clinical Board aims to reduce delays significantly by April 2014. Employment There are two employment/vocational advisers working in Adult Mental Health Services supporting individuals who are seeking paid employment, using the ‘Individual Placement and Support’ model of Supported Employment. They have supported 20 people into new jobs over the past twelve months and have helped 4 people to avoid losing their jobs due to their mental ill-health. In addition, we employ paid ‘Peer Support Workers’ in two of our teams. These are people who have lived experience of severe mental health conditions, whose role is to model recovery to others, using their experiences to give hope that recovery is a possibility for them as well. Volunteering is also greatly valued by people with mental health conditions, either as a pathway to paid employment or as an end in itself.
What are our service innovations?
Housing A new dispersed supported housing scheme will seek to provide rehabilitative services to those with severe and enduring mental health problems. Delivered through a collaboration between Gofal and Cardiff and Vale University Health Board The service provides community resettlement, recovery and rehabilitation for adults with mental health needs with the aim of enabling service users to reach the stage where they can manage their own tenancy. Services are delivered through the Care and Treatment Planning process in partnership with the Vale Community Rehabilitation Team, Community Mental Health Team, and the Vale of Glamorgan Supporting People Team.
Where do we require further action? Employment Whilst much progress has been made in raising awareness of the importance of work in recovery, much remains to be done. Welsh Government is involved in a bid for European Funding for an ‘Out of Work Peer Mentoring Programme’, which may allow access to much needed resources to improve matters for people with mental health conditions. Riverside Advice work collaboratively on integrated and targeted referrals around benefits advice but it is not possible to quantify the impact that welfare reforms may be having on the mental and physical health of our service users. We are also developing volunteering roles to reflect the aspirations of our service users, either as a pathway towards paid employment or as an end in itself. Our priorities for the next 12 months Housing The following key actions have been identified as key priorities: • To continue to reduce Delay in Discharge from hospital • To increase secondary MH clients accessing support in community to reduce relapse (i.e. Supporting People Supported Accommodation and Floating Support; Communities First) • To look for new models to support step down from High cost Health and Social Care packages, increasing independence and following recovery model. Employment The Employment Strategy Group will: • Improve recruitment outcomes for people with mental health conditions. • Improve retention rates, including the management of sickness absence in the workplace, including primary care. • Promote mentally healthy workplaces to include becoming exemplar employers in the public sector. • Increase participation in and access to educational opportunities, including career progression. • Promote the value of volunteering and create more opportunities within involved organisations.
Service User experience Housing A small number of respondents spoke of the positive impact of having a tenant support worker. Of all respondents, 5% said they had good experience in supported housing and through tenant support workers in social housing, specifically the receipt of one to one support to enable them to live independently. One carer spoke in detail of the need for age appropriate supported housing and how a young man being housed with older people had a detrimental effect on his mental wellbeing. Education Only a small number of respondents commented on education. Two respondents spoke of the positive support they had received in higher education. Questions were raised at a panel event about education in schools around mental health, to help early intervention. Employment Very few respondents spoke about employment. A small number of carers spoke about how important it is for employers to understand the role they play in supporting their loves ones. One spoke of how she was forced to give up work due to having to take time off to support her daughter. Another spoke of how her employer recognised her role as a carer and had put in place appropriate support to allow her to continue work.
3.5
Chapter 5 - Delivering for Mental Health
The Health Minister, Professor Mark Drakeford, has called 2014 the ‘Year of prudent healthcare’. He has described prudent healthcare as: “healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patients benefit. ‘Doing things better’ or ‘doing better things’? This is one of the biggest questions facing mental health service providers. In other words, do we try to be more efficient, or do we develop those services – and ways of working – that we know will deliver most benefit? The answer, of course, is that we need both. But ‘doing better things’ is particularly tough, because it means re-thinking how we organize services and how we deliver them. This is what ‘Prudent Healthcare’ is really all about. This is the new approach set out by Welsh Government which calls on all of us to apply a few simple principles to everything we do. Some of these, such as ‘Do no harm’ or ‘Work with patients as partners’, are easy to accept, but hard to implement. Others, such as ‘provide the minimum effective intervention’, or ‘only do what only you can do’, are not only difficult to implement, but can seem to threaten good quality care. Isn’t this rationing by another name? The answer is, not if it’s done properly. The health service has a long-developed habit of providing what it thinks patients need, of sometimes getting involved in care which delivers little that patients actually value. A Prudent way of working is to focus on the outcomes which patients want; to think through rigorously with the patient what is most likely to deliver those outcomes, and who needs to work together to achieve them; to consider how to provide them in the simplest and quickest way possible; and to review effectiveness, changing tack if necessary. We already do this sort of Prudent healthcare much of the time: the challenge is to make sure that we always do it. We already have a care and treatment planning process in mental health which embodies this approach: we need to make it work as well as it possibly can, always and for everyone. This is a big task, involving some serious re-design of services and ways of working by all the partners in mental health, but it should ultimately deliver both more effective care, and a more efficient service.
Professor Marcus Longley Vice Chair Cardiff and the Vale UHB
What are the key challenges facing us? Data set Pilot Recognise and understand challenges of the local services on an All Wales mental health context by being able to compare, learn from and redesign services with reliable sharing of information. The work of the Local Partnership Board The Mental Health Local Partnership Board strengthens local public service management to tackle ‘fundamental and unmet' challenges from a Service User and Carer perspective. To achieve this, the Board are responsible for overseeing the performance of Together for Mental Health and workstreams to address mental health issues in Cardiff and the Vale of Glamorgan. These issues have been identified through Partnership working and the Board will monitor progress to provide support and challenge as necessary Innovations within the workforce The continued development of peer support worker roles in mental health services in Cardiff with an ongoing project that aims to train and employ people who have experienced mental health conditions to become peer supporters for people who need mental health care.
What have we achieved in the last 12 months?
Data set Pilot • Commitment to fully invest resource into all NHS Mental Health benchmarking information fields • Prepare for piloting all Wales core data set, clinical gateway assessment tools and ‘service user lens’ outcome toll for roll out to all Cardiff and Vale mental health integrated services • Consulted Service Users and Carers on quality of current and future information needs Prudent Healthcare Public Health Wales was asked to run four workshops to test the idea of ‘prudent healthcare’ in the context of NHS services. The workshops were co-ordinated in March and April 2014 The work of the Local Partnership Board Use 2015 MH partnership board arrangements to support Service Users and Carers to identify priorities from public consultation as a forum to hold to account mental health providers to meet targets in themed areas such as CAMHS, collaborative care planning, information provision.
Innovations within the workforce Peer Support Workers The ongoing project aims to train and employ people who have experienced mental health conditions to become peer supporters for people who need mental health care. The roles are more responsive to the needs of people with mental health conditions, as they feel empathy and trust with the worker because they have had similar experiences They also provide employment opportunities for this group when it’s often difficult to gain work when you have a mental health condition.
What are our service innovations?
Data set Pilot • Single integrated electronic patient record across all integrated NHS and LA services including older people’s services • Further developing benchmarking analysis of NHS MH information. • Use of a range of social and other media use opportunities to de-stigmatize mental health issues, such as service anthologies, broadcasts, Facebook and collaboration with partners to initiate a single information platform.
Where do we require further action?
Data set Pilot • Standardising data and assessment tools in local mental health services to complement national ability to plan mental health care • Standardise for sharing and quality purposes local Mental Health provider service user records. • Increase range of access and information platforms to promote access, understanding and de-stigmatisation The work of the Local Partnership Board The Third Sector Cardiff and Vale Mental Health Forum held a workshop in 2014 and the following points were taken from workshop on Together for Mental Health. • Joint Training in all mental health areas- (multi-sectoral inc housing probation etc) • Implementation of Care and Treatment Planning acc to MH Measure – more • service user involvement, more s/u signing off of care plans, timely reviews, • better links between mental health staff and other care providers at all stages • Better and more talking therapies- long waiting lists • Impact of welfare rights changes • GP training and attitudes- negative experience of BME community, family and carers
• • • • • •
Lack of BME staff in mental health services Impact of Funding cuts /changes to commissioning processes support services for younger men- 25- 45, one to one support, support for people who have suffered sexual abuse, services for people who fall between a number of stalls
Our priorities for the next 12 months
Data set Pilot • Pilot core data set on rolling program throughout mental health collaborative. • Mental Health services for older people’s patient record electronic integration. • Investigate range of access and information platforms to promote access, understanding and de-stigmatisation
Service User and Carer Feedback Prudent Healthcare Prudent healthcare is based on the principle that 'involving people in the care they receive can provide huge practical benefits to the health service' (Achieving Prudent Healthcare in NHS Wales: 1000 Lives Report, 2014). The main issue identified by service users and carers as part of this reporting was around being listened to. One in five (21%) of respondents felt they were not listened to by mental health professionals. A further 16% of respondents spoke positively of how they were listened to by mental health professionals. In total, over a third of respondents highlighted the importance of being listened to. We do not have further details on whether this is an issue of perception or a lack of mutual agreement about care. However, 4% of respondents mentioned they had been misdiagnosed. We recognise the complexities of perceptions of being listened to and involved in care. These feelings can lead to a less productive therapeutic relationship between service users and carers and professionals and, in some examples, led to service users disengaging with services. However, we do feel more work needs to be done to identify why people feel they are not listened to and how that barrier, perceived or otherwise, can be addressed. 'GP is hopeless, doesn't listen' 'The last psychiatrist I saw was very good - listened and asked me about other things going on in my life' Work of the Local Partnership Board Suggested actions to determine the layout of the Together for Mental Health Annual Report: The format of the report is quite difficult to decipher in terms of contents and detail and feel the following amendments to layout would improve understanding • Production of separate reports against the plan in relation to younger people, adult and older people’s services: these could run sequentially but the amount of detail required against each action is difficult to decipher. • That responses be colour coded against each area- younger people, adults, ilder people . • The report to include the full TfMH action plan - ie including leads, outcomes expected, and then progress to date listed alongside. • Entries against each area of the Welsh Government Together for Mental Health action plan- we note that not all sections of the action plan are reported against. It would be helpful to have responses against each sub-action.
Summary and Conclusions: Looking ahead to 2015 and beyond
This document reflects on another period of significant collaborative developments within the strategy, with a focus on tackling stigma, health promotion, illness prevention and recovery. The Cardiff and Vale collaborative, as part of its ongoing efforts to reduce stigma through use of the media and publications, intend to enhance the impact within the ‘Time to Change’ approach from within the wider organisation, through staff personal stories. Investments and progress has been seen in mental health primary care, collaborative work with the police and ambulance services and schemes to promote admission avoidance. The forthcoming year will see the mental health partnership arrangements used to prioritise and drive collaborative developments in the direction of service user and carer defined priorities. The Cardiff and Vale service user and carer ‘feedback fortnight’ held in the lead up to the delivery plan submission, has identified key areas within Together for Mental Health for improvement. In order to respond to these priorities, the focus and dynamic of the mental health partnership forum will change. Service Users and carer representatives will now set the agenda for these meetings based on the priorities identified and hold mental health providers to account through the 14/15 period for delivery of services against these priorities. This is a very welcome and innovative change. There will be a continued focus on collaborative care planning, the quality of community care and treatment received, how service information is accessed and provided, how service users are supported to understand and best use those services available and how this all happens whatever the age of the service user.
Cardiff & Vale Local Partnership Board
LHB Report against Together for Mental Health Delivery Plan Actions Chapter 1: Promoting Better Mental Wellbeing and Preventing Mental Health Problems
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Outcome 1: Population wide physical and mental wellbeing is improved; people live longer, in better health and as independently as possible for as long as possible Mental Wellbeing is integrated into all 1.1 To ensure that mental wellbeing is d. Key partners to ensure that mental wellbeing is equality Impact assessments given equal priority with physical given equal priority with physical wellbeing in There is recognition by the MH Clinical wellbeing in the development and impact assessment. Boards that promotion of physical health delivery of policy, programmes and Ongoing from December 2012 assists in improved mental wellbeing. services. NOTE: THIS ALSO Physical health screening within community CONTRIBUTES TO OUTCOMES settings is a joint partnership with GPs and to 2and 3 promote physical wellbeing in inpatient settings the Clinical Board has employed a GP service to ensure the physical wellbeing of patient with severe and enduring mental health problems and also helps with early identification of underlying physical health problems. Health lifestyle groups are held within the inpatient setting and in MHSOP day services. The implementation of the Integrated Assessment process has ensured that a person’s mental wellbeing is always considered as part of the assessment for all older adults. Police conduct risk assessments in custody, Public Protection Department referral forms
(PPD1s). Improving the emotional and mental health of children and young people has been
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Progress identified as a priority by the Children and Women Clinical Board and Cardiff and Vale partnership arrangements. Families First Fund has provided a robust framework for partners to develop structured and targeted support and intervention programmes for children and families across Cardiff. Barnardo’s is the Lead Provider for the CADARN Emotional Wellbeing strand. Family First services in this package offer early intervention and are delivering accessible and inclusive services across the age range. Excellent links are in place with PMHT (CAMHS) in Cardiff and the Vale RBA Model of delivery and implementation and evaluation in place to measure and monitor service provision. School Counselling Initiative Third sector mental health and wellbeing services advertised via Cardiff and Vale MH Services directory Info Leaflet on MH and wellbeing services produced for BME communities Hafal in partnership with Mental Health Foundation, BiPolar UK and supported by Diverse Cymru – Have delivered ‘Let’s Get Physical’ national campaign around mental health and is a campaign primarily about people with a serious mental illness (SMI) and their carers taking action themselves to
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Progress improve their own physical health care. People have been setting their own goals by: • Sourcing and preparing healthy, high quality, good value food • Finding ways to become more active • Being assertive in getting the right support from health professionals to stay well
f. Key partners to ensure that, where appropriate, mental wellbeing is included whenever healthy lifestyle messages are being communicated to the public utilising the 5 ways to Wellbeing. Ongoing from October 2013.
PHW are developing a toolkit. Mental health awareness community events co-ordinated by third sector with some service user involvement - ie 4 Winds, BRE communities first, Cardiff Mind, MHF Young People’s Group (range of third sector- Amber Project, Womens Aid ,Llamau, Barnardos, Ely Ace, cavamh, Grassroots, the Sprout and Cruse.
Outcome 2: People and communities are more resilient and better able to deal with the stresses in everyday life and at times of crisis 2.1 To improve resilience of children and young people.
a. Local Health Boards (LHBs) and partners to ensure use of All Wales Maternity Record to identify women at risk of postnatal depression or psychosis. Ongoing from October 2012.
Partnership working between the C and V UHB and Barnardo’s is in place with specialist midwives from the Elan team who focus specific care on vulnerable women. This work is progressing to include pop up ante natal clinics in partnership with other statutory and 3rd sector partners to ensure a wider and more inclusive and accessible outreach service is developed. Partnerships are also being developed between 3 rd
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c. LHBs to develop and put in place protocols for referral for advice from GPs or specialist services in place for obstetric services in Wales.
Referrals and information sharing from the Public Protection Department to Mental Health Services and Children’s services.
d. LHB, LAs and Third Sector to ensure that family focused interventions deliver improved public mental health and wellbeing, most notably
Local arrangements for all programmes in place and remit include a focus on emotional and mental health in children and young people in the context of their family environment.
• • •
Flying Start Families First
Integrated Family Support Service. Ongoing.
Presentation on EMH delivered by Cadarn and Child health to Cardiff Children and Families and board targeted at awareness and joint working The CAMHS pathway for Behaviour Management is implemented across Cardiff and Vale to enable an early response for young people at risk of conviction Regular communication, sharing of practice and additional operational work with programme managers across FF,CF,FS,IFST, neighbourhood management teams now in place Diverse Cymru BME Mental Health Project – we have worked with a number of families and have referred onto the Flying Start project in Splott and the Yemeni Centre
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Progress Hafal has worked in collaboration with Local Authority to realign its services in order to provide Integrated Family Support (IFS) imbedded in each CMHT. The service as access to PARIS and aims to deliver WellBeing focused interventions for the whole family in partnership with CMHT. The integration of this specialist intervention as also started to raise the profile of carers within the CMHTs daily work and an increase in the number of carers receiving a carers assessment and subsequent support. The service will shortly be working on a imbedded a wellbeing tool kit into the carers assessment forms, this is hoped will aid in tracking the effectiveness of the support being provided. The service is currently part time and allocation to each CMHT is 15hrs, but with the inclusion of health partnership there may be a real opportunity to expand the service into much needed areas and look at joint commissioning.
2.3 To improve resilience of communities.
a. All agencies to identify contribution of third sector on mental wellbeing and resilience and to consider how joint working can further complement statutory provision. Ongoing.
Clinical Boards and Local Authorities have in place service level agreements with 3rd sector providers to help recovery focussed service user interventions to promote MH wellbeing and other examples include joint working with crisis services and also in the
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Progress provision of recovery focussed tiered levels of care that promote resilience and wellbeing. The Local Authorities continue to prioritise 3rd sector organisations that promote service user and carer involvement. Working links established between Cardiff and Vale Action for Mental Health, MHF and Communities First teams - some initiatives under way. Increased involvement of third sector and joint working with the third sector in policing and mental health. Reinforcement of a range of integrated community opportunities that promote recovery and wellbeing. Emotional and mental health workstream has identified the need for enhanced communication between the third sector and statutory partner and has established a local expert advisory group to develop this action. 3rd sector integrated in practice onto key strategic reporting groups The 3rd sector through FF funding is offering regular joint training and network opportunities for professionals across the strategic partnerships to link in and share good practice whilst disseminating and promoting emotional health and wellbeing issues that are relevant to children and
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Progress families. Families First funding has enabled a multiagency city wide bereavement service to be developed to support Children Young people and families All CMHTs to make representation on the local Neighbourhood Management Committee. To ensure that the mental wellbeing of the neighbourhood is promoted through the work of the committee. Diverse Cymru BME Mental Health Project work with a diverse range of people, including refugees and asylum seekers. We value the services and benefits of working with the wider voluntary and statutory services for our client group. Some of the services we are involved with are: CMHT’s, ‘Team around the Family’, multi-disciplinary teams, Whitchurch Hospital, ‘Oasis’ support service for refugees and asylum seekers, etc A significant part of the Hafals IFS service is related to well being of the whole family unit. This on regular occasions means sourcing community opportunities for the service users, as this is the outcome requirement for the carer. The service is also providing a much needed link between statutory and third sector provision by enabling a sign posting and internal information sharing with all CMHT
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Progress staff.
2.4 To further reduce levels of suicide and serious self harm.
b. LHBs, LAs, Third Sector and Criminal Justice Agencies to continue working in context of the 2012 PHW review of Talk to Me Suicide and Self-harm Action Plan.
Local Cardiff and Vale Advisory Group will be established to localise the Talk to Me Suicide and Self-harm Action Plan. Further clarification is required regarding the definition of self harm versus parasuicide/Non intentional overdose. A working definition is needed to properly collect data. The policy is currently out to consultation Monitor progress against the police’s Suicide, Self Harm and Mental Health Action Plan. An Education led Interagency group has been established to develop pathways to address self harm in children and young people. The LSCB Self Harm Protocol in place – some uncertainty remains in respect of the status of this protocol currently and whether in fact it has been reviewed and launched on a National level? Multi Agency Emotional Health and Wellbeing Forum meets quarterly and Self harm strategy is being developed 3rd Sector can provide SAFETALK training Cardiff and Vale of Glamorgan Adult Services have worked with Cardiff and Vale housing in the development of a protocol for dealing with distressed/suicidal callers to
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Progress housing staff and offered a number of training sessions to raise awareness of mental health and suicide. YMHFA training has previously been made available
c. LHBs and LAs to embed and mainstream MHFA and ASIST rollout training.
The Clinical Board and the Learning, Education and Development department have invested in Mental Health First Aid (MHFA) training this is provided across the LHB focussing on all areas but concentrated currently on areas such as Emergency Unit and the new University Hospital Llandough Mental Health Unit. All unqualified staff receive the training and the Clinical Board also have ASIST training which staff participate in and is also being delivered to Cardiff University. An initiative is being developed for training police within custody suites. The local authorities have supported social work and social care officers and Peer Support Workers to undertake the ASSIST and MHFA training and is promoting MHFA or mental health awareness training for all front line staff. Provided awareness raising training sessions to Local Authority Housing Hub staff to ensure appropriate signposting of people
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Progress experiencing mental distress and suicidal thoughts. From a children’s perspective training was delivered to FF network in 2013/ 14 but no further events currently planned due to limited capacity within 3rd sector to facilitate. This needs to be picked up through the work of the CandYP group. It can be accessed through MIND if services have available funding MH 1st Aid, working with people who self harm and working with people at risk of completing suicide training has been made available for third sector via Mental Health Forum training programme Diverse Cymru BME Mental Health Project, project Manager is an ASIST First Aider.
d. LAs, LHBs, Welsh Ambulance Service, NHS Trust, Third Sector, Police and Prison Services to develop person centred responses to manage and reduce the number of episodes of serious self harm in Wales. Ongoing.
Work currently underway with police, 3rd sector and WAS Trust looking at evidence based service models of provision to respond to individuals who repeatedly access services to ensure a coordinated and agreed response with the Service User. Within paediatric services ongoing discussion with EU/LA/Child health/CAMHS re pathway and risk assessment and risk management plan which will be focused on person centred planning and intervention Information for young people and awareness
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Progress of a new young person led social media site relating to self harm needs to link to work on the primary mental health support model for children Services provided by third sector, e.g. Amber Project. Third sector training in place regarding working with people who self harm and those at risk of completing suicide.
e. LHBs and LAs to embed and mainstream MHFA and ASIST rollout training.
As above.
f. LHBs to refer to NCISH national reports. Ongoing.
Clinical Boards and Local Authorities have been actively involved with the MH Leaders Collaborative to develop an integrated approach to manage serious incidents. Systems and processes are well established within the Clinical Board when a serious incident occurs and significant learning has changed practice this learning is being shared by other LHBs and LAs The Closing the Loop project group ahs been established with Public Health Wales to look at learning form serious incidents and homicides and to ensure learning is embedded into practice
g. Public Health Wales to work with LHBs and LAs through the Mental Health Leaders’ Collaborative to develop integrated approach to managing serious untoward incidents including suicide and self harm by April 2013.
The potential benefit of a shared government system between CAMHS and the Children and Women’s Clinical Board has been recognised relating to serious incidents and
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Progress issues of concern and forms part of the liaison arrangements.
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Chapter 2: A New Partnership with the Public
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Outcome 4: People with protected characteristics and vulnerable groups, experience equitable access and services are more responsive to the needs of a diverse Welsh population. 4.1 To reduce inequalities for vulnerable groups with mental health needs, ensuring equitable access and provision of mental health services.
a. LHBs and LAs to routinely meet their obligations under the Public Sector Specific Duties (Wales) addressing the diverse needs of their local populations in service redesign and commissioning. Ongoing.
Equality Group in place but recognises there are difficult to reach Groups in Cardiff and the Vale based on language religion BME. Action has been identified by the University Health Board Equality Group. Draft BME action plan developed between UHB and Mental Health Forum BME Sub Group
Diverse Cymru BME Mental Health Project – our services include: • • • • • •
Community Support Information and Advice Befriending Signposting Hospital visits for in-patients and resource to staff Services for Professionals
Police provide Equality and diversity training and awareness on mental health, officer training and awareness raising on mental health. Arrangements have been put in place between CAMHS and Child Health to improve access to services for children with learning disabilities. Co-location of CAMHS and Child Health improves collaborative
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Progress working with hard to access groups but challenges exist to targeting these vulnerable groups due to future workforce and capacity issues. A draft of a Mental Health Commissioning Strategy is in development and takes into account inequalities across the population. Hafal continues to work collaboratively with all statutory sectors in addressing inequalities for individuals with mental health needs. And with the start of IFS service providing family well-being interventions in their respected communities, the regular remodelling of hafal day services to meet needs and the introduction of adult carer specific participation project, we aim to engage hidden carer/families in future service design and commissioning.
c. LHBs to carry out and publish Equality impact assessments on service delivery plans. Ongoing.
Currently in place
The Alzheimer’s Society provide: o BME Outreach Service in Cardiff o BME Dementia Café o
Talks to BME Groups
Cavamh provide o MHF BME Network for groups interested in improving access and services for people from BME
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Progress communities o nexus- BME project - focus groups and talks with BME groups Riverside Advice: Overall the service due to the appointments being made through referrals from support organisations ensures and enhances access to welfare rights services, also again referrals provide better outcomes on early intervention / prevention. Inequalities, stigma and discrimination suffered by people experiencing mental health problems and mental illness are reduced. Diverse Cymru BME Mental Health Project services include: • • • • • •
Community Support Information and Advice Befriending Signposting Hospital visits for in-patients and resource to staff Services for Professionals
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Sub Action d. LHBs and LAs to provide culturally appropriate assessment, responding to communication and translation needs. Ongoing.
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All local authority staff are trained in diversity awareness and will use translator services as required. Qualified Social Workers are additionally trained in Anti-Oppressive practice and offer AOP role modelling throughout their practice which is supported by supervision The Clinical Board has a recognised need and a Toolkit is being developed with the 3rd Sector through Diverse Cymru. 3rd Sec: UHB BME action plan includes training in use of interpreters- provided by Race Equality First as part of World Mental Health month (Big October).to UHB and third sector staff
Outcome 5: Welsh speakers in Wales are able to access linguistically appropriate mental health treatment and care where they need to do so. 5.1 To ensure that Welsh speakers receive services through the medium of Welsh when needed and to increase language capacity in the workforce.
a. NHS and Social Services to ensure that principles of the Welsh Language Strategic Framework including the ‘active offer’ are mainstreamed into service delivery. Ongoing.
A local Group has been established to consider this issue. All Welsh Speakers have been identified within the mental health Service with registers available to all staff. Access to Welsh speakers through the PSC, through officers when dealing with incidents and in custody. Welsh language training provided by the force, and mandatory for
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Progress promotion.
b. LAs and LHBs to deliver language awareness training for all staff coming into contact with people with mental health problems. April 2014 and Ongoing
Training is available on Welsh Language awareness and meet and greet training available to all frontline staff with good participation rates.
Outcome 6: People in Wales have the information and support they need to sustain and improve their mental health and self manage mental health problems. 6.1 To ensure that people of all ages are better informed about mental health and mental illness, with age appropriate information being available.
c. LHBs and LAs, together with Third Sector Partners, to ensure that Mental Health Service User Development Officers (MHSUDOs) maintain up to date web based directories of local mental health services and information available and to share these with appropriate organisations such as C.A.L.L. and NHS Direct Wales. Ongoing from October 2013.
Cardiff and Vale Action for Mental Health provide up to date information via the on line Mental Health Services Directory and signposting. Hard copy of Mental Health Services directory available. The “Directions” is another Directory specifically aimed at users and carers of older peoples mental health services, including YOD, and nexus. Primary mental health service in place to support other agencies and sign post to appropriate information. Parents and children can access information
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Progress from a wide range of sources although more work is required to collate and maintain a single point of access.
Outcome 7: People with mental ill health experience less stigma and discrimination and feel that these problems are being tackled. 7.1 To ensure that there is a concerted effort to sustainably reduce the stigma and discrimination faced by people with mental health problems
b. NHS and LAs to act as exemplar employers providing mentally healthy workplaces in their support to staff and tackling stigma and discrimination in their service delivery. Ongoing
Team Managers working in adult social care in the Vale of Glamorgan have attended a Mental Health workshop to highlight issues of discrimination and value of MH promotion. Employment Strategy Group established working with Local Authority/Third sector Peer Support worker scheme being implemented across LA and Health and 3rd Sector led by Cardiff and Vale UHB Police Internal training and awareness on mental health. Work has been undertaken with the Youth Service and young researchers to better understand their view of access to services and how to best avoid stigmatisation
c. LHBs and LAs to identify TTCW Champions to raise the profile of mental health across their
Clinical Board Nurse has delivered TTCW awareness to staff and members of the
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organisations, drive out discrimination and address stigma amongst staff by December 2012
Cardiff and Vale Equality Group. Mental Health awareness training is being developed for roll out across all local authority departments during 2014/15.
BME Time to Change service users’ Stories planned in Big October awareness training via TTC Mind Cymru Anti stigma training via big October, plus service user led recovery training, presentations on carer experiences Alzheimer’s Society: •
Dementia Friends Raising Awareness initiative
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Carers Information Support Programme
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Training to professional groups
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cavamh:
•
sefyll/nexus support service users and carers to have a voice through their recovery and involvement stories
The Local Authorities are exploring options for nominating senior officers and/or council members as TTCW
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Outcome 8: People feel in more control as partners in decision making about their treatment and how it is delivered. 8.1 To ensure that service users feel listened to and are fully involved in decisions about their own care.
a. LHBs and LAs to ensure active participation of service users and carers in the development, delivery and review of their Care and Treatment (in line with Part 2 of the Mental Health (Wales) Measure 2010. Ongoing from June 2012.
Assertive Outreach and Primary Care are signed up to “Shared Decision Making” with Service Users ands have agreed to become pilot sites for role out of the initiative. Service Users appointed to Mental Health Measure Groups for Parts I, II and III The local authorities are working with 3rd sector partners and Hafal to strengthen communication and involvement with carers through better identification, carers assessments and ongoing support/consultation within all CMHTs. Barnardo’s have co facilitated participation events WITH THE young People’s Involvement Group for young people in respect of reviewing the Mental Health measure on behalf of LHB and WG. This also included the Maze Advocacy Project, Trosgynnal and cavamh. The YP involvement is includes a range of groups- including Cardiff Womens aid, the Sprout, Llamau, the Amber Project, AsCymru, UHB (17 agencies on young people’s involvement mailing list).
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Progress Alzheimer’s Society: Carers’ Consultation and Community Voice with Nexus cavamhSefyll and Nexus projects, CMHT community voice. Alzheimer’s : Carers Information and Support Programme cavamh: Training provided by Sefyll, cavamh via CMHT Project
b. LHBs to ensure training is provided on care and treatment planning using the prescribed materials produced by Lincoln University to all Care Co-ordinators by end 2013.
Training in progress and ongoing for completion by 2013
c. LHBs to provide service users and their carers with opportunities to discuss and agree service and treatments options. Ongoing.
‘Partners in Care’ leaflets are available in all CMHTs. All CMHT staff are aware of their responsibilities under the Carers Strategies (Wales) Measure 2010 to consult with carers when drafting a Care
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and Treatment Plan with service users. d. Voluntary sector working as part of Mental Health Action Wales to provide training for service users to enable them to play a full role in the development of their Care and Treatment. Ongoing
3rd sector training on Mental Health Measures and Person Centred Planning provided via Mental Health Forum and CAVAMH. Opportunities for training have been advertised and begun to take place via Sefyll. Hafal can provide training Pilot planned at the Pendine CMHT to train peer support workers to promote understanding of person centred care plans on a one to one basis with service users within the CMHT - training produced and delivered by service users, a partnership with the Pendine CMHT, service users and Sefyll, cavamh. This is a partnership of service users, UHB and third sector Nascent Young People’s Involvement Group to promote understanding of person centred care plans
e. LHBs to implement good practice guidance and training for staff working with service users to help them understand treatment options available. (Standard 9 Doing Well, Doing Better). Ongoing.
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8.2 To ensure that relevant patients access Independent Mental Health Advocacy (IMHA).
a. LHBs and LAs together with IMHA services to implement Part 4 of the Mental Health (Wales) Measure 2010 for newly eligible patients. Ongoing.
Implemented April 2012
b. Independent Mental Health Advocacy providers to ensure the availability of appropriately trained advocates to meet the new statutory duties on LHBs and LAs within the Mental Health (Wales) Measure 2010. Ongoing from 2013.
Implemented April 2012
NOTE: ALSO CONTRIBUTES TO OBJECTIVES 11 and 13
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CAHMS have in place access to mental advocates for young people.
Outcome 9: Families and carers of all ages are involved in assessments for support for their caring roles. 9.1 To ensure support for families and carers through implementation of the Carers (Wales) Measure 2011.
a. LHBs and Trusts in conjunction with partner LAs to draw up local Carers Information and Consultation Strategies by October 2012.
NOTE: ACTION TO BE UPDATED FOLLOWING PUBLICATION OF REFRESHED STRATEGY
The University Health Board Patient Experience team are actively involved in looking at maximising the carers’ measure within the mental health setting and will work closely with the Clinical Board to ensure robust involvement. Implemented in January 2013 The Local Authorities work in partnership with Hafal to offer advice, support and respite to cares as part of a Carers Assessment process.
Outcome 10: People of all ages and communities in Wales are effectively engaged in the planning delivery and evaluation of their local mental health services. 10.1 To ensure that service users of all ages and their families and carers are fully involved in service development.
a. HBs and LAs to agree and put in place robust arrangements for engaging service users and carers of all ages in the design, delivery and monitoring of local services by Sept 2013.
Proposals to repatriate Services which are currently delivered to the Western Vale by ABMU are currently in development and Service Users sit on various groups to discuss future delivery and engagement in a
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NOTE: ALSO CONTRIBUTES TO OUTCOME 17
Service Users are actively involved in UHB interview processes. Service Users who have participated in the peer support worker training have developed a Training package for future Peer Support initiatives. There is good Partnership working with Service Users and Carers but the UHB acknowledges that this is an area that will always require constant review. The involvement of service users and carers in CAMHS service design and delivery is currently minimal and requires far more consideration in liaison with service planners. Work has been undertaken with the Youth Service and young researchers to better understand their view of access to services and how to best avoid stigmatisation. Cardiff Families First Emotional Health and Wellbeing services are working towards The National Participation Standards Multi- stakeholder Young People’s Involvement Group established to build engagement with young people, share and facilitate involvement opportunities b.
MHSUDOs to develop mechanisms to ensure
Service User Reps on approximately 20
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active engagement in local planning mechanisms of people of all ages by February 2013.
Planning Groups including subgroups and also involved in Workshops and Events.
(Standard 5 Doing Well Doing Better guidance egovernance manual).
Further guidance is required in order to engage children and young people in this area
c. WG and LHBs to ensure active engagement of service users and carers on Mental Health Partnership Boards at national and local levels – Ongoing from March 2013.
The Cardiff and Vale MH Partnership Board has full representation of Service Users and Carers including Adult Mental Health, MHSOP, CAMHS and BME representatives.
Alzheimer’s:Service User Involvement Network cavamhwork of Sefyll and Nexus / Advisory groups Riverside Advice: feed back we get from clients on our service to help improve and design services better
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Chapter 3: A Well Designed, Fully Integrated Network of Care
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Outcome 11: Service users experience a more integrated approach from those delivering services. 11.1 To ensure that public services work together to provide an integrated approach.
a. LAs, LHBs and third sector to further develop integrated services provision and to review care pathways against the aspirations of Together for Mental Health by December 2013.
Current examples of integrated service include: Integrated CMHTS PMHSS Crisis Teams An integrated model for agreeing the funding of Commissioned care for adult mental health is being rolled out between the UHB and local authorities, that aims to reduce delayed decisions and ensure that people’s care and treatment is appropriately funded. More work required particularly in MHSOP Services. A range of programmes in place reflecting both strategic and operational aspect of services focusing on children, young people and families (TAF, FF, IFSS, EMHW, LEAG).
Barnardo’s working with 16+25 year olds in transition, from CAMHS to AMHS ~ developing and integrated approach with relevant stakeholders. Support aimed at engaging young people in meeting their
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Progress developmental needs and accessing education, training and employment opportunities alongside structured social activities Joint training of GPs (PMH and Barnardos) Developments have been ongoing with regard to pathways for the treatment of neurodevelopmental disorder, crisis intervention both 9-5 and out of hours and intervention/management of 16-18 yr olds. Further clarity is required re:operational issues between partner agencies to ensure efficient and appropriate service delivery Menu of GP training developed with third sector covering 5 areas of mental health training prescribed by Wg. Take up to date via this method slow. Consultation on model for community adult day services including with service users and carers , has taken place: results being collated for Steering group and service users and carers.
f. LAs to work together with the NHS to enact new duties from implementation of the Social Services Act. The Social Services and Well Being (Wales) Act 2014 achieved Royal Ascent in May 2014 with an implementation timetable until April 2016.
The Local Authorities have produced a Legal Advice Briefing in preparation for the changes. A working group to plan for the implementation of the Act will be coordinated with partners during 2015.
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11.2 To ensure effective transition between adult and CAMHS Services.
a. LHBs, working with LAs and Third Sector, to develop plans to manage transition for young people effectively by November 2013.
Transitional pathways from CAMHS to AMHS are in place. Revision is necessary in order to take into account definitions of Parts 1 and 2 of MHM. Health and Social Care representation on the Cardiff and Vale Local Safeguarding Children’s Board is established. Further operational liaison between services required to ensure effective and efficient transition. Work is in progress to develop a clear protocol to replace the current pathway that is clear and robustly followed by all agencies involved in the transition from Young People. Barnardo’s has developed a service to assist up to 20 young people aged between 16 and 25 in their transition from CAMHs to AMHs via Families First in Cardiff.
Alzheimers have a YOD programme of Dementia and Community Support Provision including Day Care via Ty Hapus. cavamh co-ordinates 3rd sec involvement in joint planning where this is
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Progress highlighted.ie CYP CEMH working group Diverse Cymru BME Mental Health Project have been invited by the Royal College of Psychiatrists: Plan to introduce a transitions framework for BME to look specifically at transition arrangements for patients from BME background from Child and Adolescent Mental health services to Adult MH services
11.3 To ensure substance misuse co-occurring with mental health problems is managed effectively.
a. Each Substance Misuse Area Planning Board (SMAPB) and Local Mental Health Partnership Board (LMHPB) to have in place clear protocols and integrated pathways between mental health and substance misuse services, in line with the Service Framework Meeting the Needs of People with a Cooccurring Substance Misuse and Mental Health Problems by September 2013.
Protocols developed and in place and a clear pathway developed. Training commenced with PMHSS and CMHTs to address the needs of Service Users in Primary Care and Community Settings. A Joint lead for Substance Misuse has been appointed and is working with the SMAPB to plan and Commission Services at all tiers for adults and children. A Multi agency approach to provision for complex clients is in place. Improvements in information sharing with substance misuse agencies
b. LMHPBs/SMAPBs to ensure all relevant
Integrated care pathway in place
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staff are trained to recognise and respond to people with co-morbid substance misuse and mental health problems, and have a clear understanding of protocols and integrated care pathways in place by September 2013.
Training completed for key staff, and being rolled out further Staff Cardiff and Vale contributing to the redevelopment of the DD national service framework by Welsh Government National Effective Services for Vulnerable Groups Board is monitoring the implementation of DD pathways in C and V in order to secure shared learning for other localities
11.4 To improve access to CAMHS a. LHBs to ensure that All Youth Offending Teams (YOTs) have designated time from an expertise in Youth Offending appropriate CAMHS professional and access to Teams. forensic CAMHS. Ongoing from March 2013.
There are a number of links to the Youth Offending Services including close liaison between the Physical Health Nurse and the CAMHS Primary Mental Health Team. Local YOS have access to a Mental Health Advisor within the forensic service. Access to CAMHS for generic referral is in place. There is currently no pathway into the children’s mental health services in a crisis situation or out of hours.
11.5 To improve physical and mental health care for those with chronic conditions including mental health problems.
a. LHBs to ensure effective liaison services to assure needs for people with mental health problems in the DGH setting are met. Ongoing from April 2014.
To promote physical wellbeing in inpatient settings the Clinical Board has employed a GP service to ensure the physical wellbeing of patient with severe and enduring mental health problems and also helps with early identification of underlying physical health problems. Current liaison review by the DSU
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Progress happening 3 year dementia plan developed The Clinical Board and the Learning, Education and Development department have invested in Mental Health First Aid (MHFA) training. This is provided across the UHB but is concentrated currently on areas such as the Emergency Unit and the new University Hospital Llandough Older People’s Mental Health Unit. All unqualified staff receive the training and the Clinical Board also has training which staff participate in and which is also being delivered to Cardiff University. An initiative is being developed for training police within custody suites. In addition, we have extended the advocacy service to support service users in all hospital settings and established a community advocacy service. In order to achieve this CAMHS services require commissioning to provide liaison.
b. LHBs to provide physical health liaison to assure physical healthcare needs in mental health settings are met. Ongoing
There is recognition by the Mental Health Clinical Board that promotion of physical health assists in improved mental wellbeing. Physical health screening within community settings is a joint partnership with GPs and, to promote physical wellbeing in inpatient settings, as mentioned in 11.5a the Clinical Board has employed a GP service to ensure the physical wellbeing of patients with
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severe and enduring mental health problems. It also helps with early identification of underlying physical health problems. The Mental Health Clinical Board will work closely with the appropriate UHB Clinical Boards to ensure effective liaison for physical health needs for clients in both DGH and Mental Health settings.
Outcome 12: People of all ages benefit from evidence-based interventions delivered as early as possible and from improved access to psychological therapies. 12.1 To ensure the expansion of primary care mental health services. NOTE: ALSO CONTRIBUTES TO OUTCOME 13.
a. LAs and LHBs to implement Primary Care Schemes in conjunction with third sector where appropriate and in line with the requirements of Part 1 of the Mental Health (Wales) Measure 2010. Ongoing from October 2012.
Implemented in part October 2012 and full team in place April 2013 Links are being established between the CAMHS service and the Primary Care Scheme and a Service Level Agreement is being put in place.
c. Each LHB to ensure competent workforce trained to deliver the range of interventions under the measure with a formal supervision structure including those commissioned from other sectors. 12.2 To ensure that patients are supported to access their rights for re-assessment with regard to the
a. LHBs and LAs to establish systems in conjunction with Third Sector where appropriate to ensure that eligible patients are
Compliant and 3rd sector training has taken place via CAVAMH and the MHF.
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Mental Health (Wales) Measure 2010, when required.
aware of their rights to reassessment in line with Part 3 of the Mental Health (Wales) Measure 2010 by October 2012.
12.3 To improve access to and provision of Psychological Therapies.
b. LHBs and LAs to review cross sector staff competencies in delivering psychological therapies and undertake gap analysis by June 2013 c. Each LHB to constitute a Psychological Therapy Management Committee (PTMC) to advise on local mechanisms to take forward and develop psychological therapy services in line with WG Policy guidance and to take into account the baseline review. Ongoing d. Each LHB to ensure competent cross sector workforce trained to delivering the range of interventions within a formal supervision structure. Ongoing
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Psychological Therapies Management Committee established. The committee is required to undertake mapping of competencies and resource to deliver evidence based psychological therapy. It is working to develop and integrate care pathways with appropriate and timely access to psychological therapies and to develop procedures for monitoring access and delivery of therapy as defined in the policy implementation guidance. The policy requires that formal supervision structures are agreed. A training plan has been developed and will deliver training to upskill staff to deliver level A and level B therapies and to embed delivery in group format to pathways of care. Training places will be available across the UHB and there is discussion with CAHMS to ensure appropriate allocation The Families First services have
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Progress adopted a family strength based model including: •
Brief Solution Focus Therapy
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Motivational interviewing
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Restorative approaches
New Head of Clinical Psychology in Child Health linking closely with work in this area. Alzheimer’s Society has: o Collaboration with Solace in the Vale of Glamorgan o Roll out of therapeutic initiatives across Cardiff and the Vale: o Singing for the Brain o Life Stories o Dementia Café cavamh co-ordinates o 3rd Sector counselling organisations network o information leaflet to GPs, UHB mental health services and public providing evidence of standards and service
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12.4 To ensure effective access for a. LHBs and LAs to ensure that they have in children and young people to place pathways to provide appropriate CAMHS Services. specialist inpatient and community CAMHS (e.g. CIIT FACTS) for children with mental health problems. Ongoing from October 2012.
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Developing communication with WHSCC with regards to commissioning specialist CAMHS Diverse Cymru BME Mental Health Project are designing a CAMHS BME mental health awareness session to deliver to CAMHS staff.
b. LHBs to put in place clear pathways for children with mental health problems in crisis. Ongoing
Children and Women Clinical Board are working with Adult Mental Health, CAMHS and WHSCC to establish clear pathways.
c. LHBs to ensure that inappropriate admissions of those under 18 to adult wards reduced. LHB to designate a ward with appropriate staff training safeguarding checks in place for unavoidable admissions by December 2012.
Designated ward and staff have received training and all child admissions reported to WG as a matter of process.
d. Staff on designated wards to have completed formal training on needs of young people. Ongoing from June 2013.
As above
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12.5 To ensure veterans receive services appropriate for their mental health needs.
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e. LHBs working with LAs to produce guidance as to the range of local services available from specialist CAMHS for all other children to be developed by March 2013.
Specialist CAMHS referral criteria in place. Further work on developing a service specification required.
a. LHBs to continue to commission and/or provide specialist community Health and Well Being Services for veterans in each area. Ongoing.
All Wales Veterans Health and Wellbeing Service in place with Cardiff acting as the hub (Spokes are established in other Health Boards) Funding provided by Welsh Government to ensure robust service provision for all veterans with Mental Health issues. Under cavamh a Veterans' Mental health Support Group has been running for 3 years. This group arranges meetings to hear the views of veterans, to provide them with information and give them direct access to service providers such as Combat Stress, All Wales Veterans Welfare and Wellbeing Service, LAs (which have signed up to the Armed Forces Covenant) MOD Veterans Welfare Service, etc and local politicians. (2) Welsh Government Armed Forum comprising local politicians, Royal Navy, Army and RAF officers, Local Authority Officers, members of veterans' charities such as Royal British Legion, SSAFA, representatives from Welsh Government, cavamh. (3) Both Cardiff and Vale councils have now signed up for the Armed Forces Covenant.
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Progress (4) NB The management of Penarth Pier Pavilion has stated that as part of its operational programme it wishes to maintain a mental health dimension with some emphasis on dementia and veterans. Room 217 in the Pavilion, named after the Dambuster Squadron of the RAF, will be dedicated to veterans of all three services and mental health. A Veterans' sub group will be created to manage this, - includes cavamh (nexus)
b. Clinical networks to disseminate knowledge The Clinical Board works with the MH Leaders Collaborative to ensure knowledge and share best practice by March 2013. sharing and evidencing best practice as appropriate across the Mental Health Service.
c. LHBs to develop care pathways for veterans to access substance misuse services by March 2013.
The MH/Substance Misuse Lead Nurse is currently working with the Veterans service to ensure robust service provision for veterans with MH/SM dual diagnosis.
d. LHBs work with substance misuse and mental health providers to ensure veterans with PTSD have timely access to substance misuse treatment.
Cardiff is one of two pilot areas in Wales that will have a specialist substance misuse nursing post established for veterans, as part of the work programme through the charity Combating Stress
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12.6 To ensure appropriate and timely interventions for people in custody.
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e. LHBs to establish Armed Forces Forums and Mental Health Clinical Networks. Ongoing from December 2012.
As above
c. LHBs to commission and/or provide prison mental health / CAMHS services in accordance with the published guidance by October 2014.
A small Team is currently in place to deliver Prison Mental Health Services and demonstrates a satisfactory position in Secondary Care. PandIC Clinical Board are responsible and are commissioned to deliver Primary Care Services within the Prison service. Diversion at point of arrest nurse in place in Cardiff Bay Police Station. The UHB recognises that further work is needed in this area particularly post arrest/remand. Youth Offending Services will link with Forensic CAMHS for young people in custody.
d. LHBs to develop a care pathway for those who need to receive care or secure provision, away from their local area by 2013.
All Wales Secure service network has developed a pathway in collaboration with WHSCC which includes involvement of the UHB Clinical Board.
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Outcome 13: Service user experience is improved, with safety, protection and dignity ensured and embedded in sustainable services.
13.1 To ensure service users of all ages are safeguarded from harm while accessing mental health services.
a. LHBs and LAs to work together with third sector to implement safeguarding legislation and policies. Ongoing.
UHB, LA and 3rd Sector representatives working together on the Safeguarding Steering Group. And progress being made against each element but further work is required to ensure robust policies and procedures. Clinical Board and Local authority staff are robustly trained in Safeguarding children, adults and POVA services. The Deprivation of Liberty Safeguards are promoted across the care home and inpatient areas to ensure that any relevant person is properly and independently assessed to ensure that any action is in the person’s best interests.
Alzheimer’s Society works in collaboration with Safeguarding agencies All Mental Health 3rd Sector Organisations were governance monitored by CandV UHB and were satisfied that all policies and procedures are up to date and are continually reviewed on a regular basis.
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b. Services to review arrangements as the Social Services Wales Bill becomes law. Timescale to be confirmed.
13.2 To ensure that services are planned and delivered based on safety, dignity and respect.
c. LHBs and LAs to adopt and share learning from published child practice reviews, POVA cases and relevant reviews by WAQ, HIW, CSSIW, Estyn and NCISH. Ongoing
In place. Action plans issued when child or POVA are actioned.
a. LHBs, LAs and Third Sector to provide services that strive to improve the experience of all service users in line with Doing Well, Doing Better. Ongoing.
LHB, LAs, 3rd Sector and service user and carers are all represented on the MHPB and Joint Operational Groups. The new Adult Inpatient Unit design commissioned by the UHB has had full SU and Carer involvement to ensure the setting will create an environment which has improved experience and recovery focussed delivery at its heart. The UHB has developed a robust Dignity and Respect action plan to ensure and improved experience for Service Users and their families with values based training for all staff. All stakeholders signed up to the Mental Health Charter. Annual training provided to third sector via the Mental Health Forum and CAVAMH
Diverse Cymru aims to make a real difference to people’s lives through delivering services that reduce inequality
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Progress and increase independence; supporting people to speak for themselves and to connect with decision makers; creating opportunities for participation and development; raising awareness of equality issues; and inspiring people to take action against inequality The Recovery Steering Group is implementing an action plan to improve experience Recovery leaflet and charter drawn up and to be circulated.
13.3 To improve in-patient environment in mental health services, ensuring care is appropriately balanced between inpatients and community services.
a. LHBs to ensure plans in place to ensure inpatient facilities are provided in modern, fit for purpose environments.
MHSOP Unit opened 2012 with Carers involved and on completion has been the recipient of a Building Excellence Design Award. Capital Plans in place to modernise Adult Inpatient Services and the new Adult Inpatient Unit design commissioned by the UHB has had full Staff, SU and Carer involvement to ensure the setting will create an environment which has improved experience and recovery focussed delivery at its heart.
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b. LAs, LHBs and third sectors to develop joint local strategies to reduce delays in transfers of care, rates of admission to mental health beds - including repeat admissions within 28 days by April 2014.
The Clinical Board working with LAs and housing services to reduce delays in transfers of care and the Clinical Board has appointed a Housing Manger to ensure a smooth pathway for service users both in hospital and when settled in the community. The Housing Officer works across the community and housing to ensure continuity across service provision. The Clinical Board aims to reduce delays significantly by April 2014
c. LAs, LHBs and third sector to undertake joint training on care and treatment planning to include Health, Social Care and Housing teams training together to implement effective admission and discharge processes within care pathways by April 2014.
Housing and Mental Health Action Plan contains initial training to LA housing providers about ‘who does what where in mental health’ and the role of the care coordinator. Training has been provided by UHB and cavamh to over 50 LA housing providers about ‘who does what where in mental health’ and the role of the care co-ordinator in line with the Housing and Mental Health Action Plan. Monitoring and evaluation recorded. Vale LA has started to provide training to UHB staff about housing services and how to access. Hospital discharge protocol has been reviewed and circulated. Evaluation of impact to follow.
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d. LHBs and LA to ensure Crisis Resolution Home Treatment / Community Intensive Intervention support available for people of all ages within and out of hours by December 2012.
The service provision is as follow across Cardiff and the Vale. Adult Service 24hr Younger persons 24hr MHSOP 9am-5pm Community Intensive Therapy Team 9-5 Monday to Friday
13.4 To improve older people’s mental health services, ensuring they are based on clinical need rather than age, with transitions managed effectively.
a. LAs and LHBs to have in place integrated assessment and care management systems and processes based on clinical need, ensuring dignity care and respect.
Young Onset Dementia Service being developed.
b. LHBs and LAs have protocols in place to manage transitions between adult and older persons mental health services. Ongoing
There is not a specific transition process from Adult to MHSOP to ensure continuity of care and, therefore, the patient would continue with Adult Services and only be
NOTE: ALSO CONTRIBUTES TO OUTCOMES 11, 12 and 14
The Butterfly scheme has been re-piloted in six clinical areas. The Butterfly Scheme allows people whose memory is permanently affected by dementia to make this clear to hospital staff and provides staff with a simple, practical strategy for meeting their needs. The patients receive more effective and appropriate care, reducing their stress levels and increasing their safety and well-being.
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Progress transferred to MHSOP if clinical need dictated. This is dealt with on a purely case by case basis and there is robust collaboration between the MHSOP and adult directorates when appropriate.
c. NHS, LA and Third Sector staff, including Primary Care Mental Health workers who come in contact with older people, to receive training to ensure they recognise and respond to signs and symptoms of mental illness such as depression and other functional illness, dementia and co-morbid conditions in older people by April 2013.
The Part 1 leads for Cardiff and Vale have received W.G plaudits for developing two initiatives which have been adopted on an All–Wales basis which includes a core competency/training scheme for primary care workers of different professions and levels of experience. The Butterfly Scheme 13.4 (a) Cognitive Impairment Pathway 13.4 (a)
13.5 To improve dementia care, including for younger individuals, in all settings across Wales.
a. LHBs and partners to implement the WG National Dementia Vision document, including young onset dementia services Ongoing.
NOTE: ALSO CONTRIBUTES TO OUTCOMES 11, 12, and 14. b. All Part 1 PCMHS staff trained to assess for memory loss and common mental health conditions in the elderly by January 2013
National Dementia Vision document and integral part to service delivery. Young Onset Dementia Service being developed. There is a primary care partnership working alongside the memory team. A UHB-wide dementia training strategy supported by LED Please see 13.4 (c)
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c. LHBs to implement 1000 lives + dementia Intelligent Targets. Ongoing.
Dementia 1000 Lives+ Community Group in place, with Implementation plan for 2013/14. Dementia intelligent targets implemented and compliance monitored by the Clinical Board Quality and Safety Committee.
d. All newly diagnosed people provided with Alzheimer’s Society Dementia Information Packs. Ongoing.
Memory Team staff offer this routinely where appropriate.
f. LHBs and LAs to ensure access to specialist advice available to all care homes.
Provision of enhanced care and treatment within the community (predominantly at home), including crisis intervention for people of any age with an established dementia diagnosis and adults who have developed a serious mental illness or disorder for the first time in later life, usually aged sixty-five or over.
‘Directions’ Handbook and guide to Older Persons Mental Health services in Cardiff and the Vale recommended by Memory Clinic and available on line on cavamh website
All Care Homes in Cardiff and Vale have been offered MCA/DoLS awareness training by MCA/DoLS team.
13.6 To review Eating Disorder Services for all ages.
a. LHBs to commission and complete review of the pattern and cost effectiveness of inpatient eating disorder treatment across all ages services by end 2013.
Tier 3 specialist services in place and discussions with WHSCC on the development of eating disorder intensive support services.
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c. LHBs to develop services in line with outcome of review and Eating Disorders: A Framework for Wales by end 2015. Outcome 14: Providers are positively managing risk, supporting people to increase their levels of hope and aspiration and enabling them to realise their full potential through recovery and enablement approaches.
14.1 To ensure that services are based on a recovery and reablement approach supporting to gain more control over their lives.
a. LHBs and LAs to ensure that Care and Treatment Plans for service users embed the principles of recovery and reablement, where appropriate, from October 2012.
The Recovery Charter has been developed and endorsed by all stakeholders. The Recovery Steering Group co-ordinated recovery implementation initiatives to support recovery through training and awareness raising. The Service User and Carer Involvement Delivery Group is ongoing. Part 2 of the measure assists with cultural change but the Partners recognise more work is needed.
b. All Care Co-ordinators are competent in using recovery and other relevant skills through Care and Treatment Planning training, using Lincoln University materials. Ongoing.
Assertive Outreach and Primary Care are signed up to “Shared Decision Making” with Service Users and have agreed to become pilot sites for roll out of the initiative.
Diverse Cymru BME Mental Health Project practice and promote recovery and resilience through a Recovery Plan and Outcome Star which charts their progress through their personalised plan.
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c. LHBs and LAs to ensure that individual service user views of what recovery means to them become a core part of Care and Treatment Planning. Ongoing from October 2013.
All care coordinators to attend Service User led Recovery training during Spring 2014.
d. Service users to act as trainers for professional staff to support cultural change. Ongoing.
Through the Recovery Steering Group service users are delivering recovery training to UHB staff over 2014/15
e. LHBs and LAs to provide support for children in addressing issues of attachment and developmental problems. Ongoing.
14.2 To develop service culture for positive risk management.
f. For people with dementia, LHBs, third sector and LAs to provide services that support them to maintain independence for as long as possible, sustaining quality of life. Ongoing.
The provision of enhanced care and treatment within the community (predominantly at home), including crisis intervention for people of any age with an established dementia diagnosis and adults who have developed a serious mental illness or disorder for the first time in later life, usually aged sixty-five or over
c. LHBs, LAs and Third Sector to ensure evidence based risk assessment training is provided for appropriate staff to extend to cover all settings, client groups and all ages. Ongoing.
The Deputy Chair of UHB to arrange broader debate on positive risk taking.
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Chapter 4: One System to Improve Mental Health
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Outcome 15: People of all ages experience sustained improvement to their mental health and wellbeing as a result of cross-Government commitment to all sectors working together. 15.1 To ensure that people with mental health problems have access to advice and support on financial matters.
a. LHB and LA staff to establish links and contacts with debt advice services to assist people in managing their finances. Ongoing from April 2013.
Local Authority debt advice service expanded and debt clinics available. The UHB Commissions Riverside Advise to provide robust debt and benefit advice across Cardiff and the Vale. MH Forum Welfare Rights group in place to update on changes and training opportunities.
15.2 To improve mental wellbeing by improving the condition of housing.
b. LAs and LHBs to develop plans for joint working and developments on housing and associated services incorporating mental health as a priority by June 2013.
The Clinical Board working with LAs and housing services to reduce delays in transfers of care and the Clinical Board has appointed a Housing Manger to ensure a smooth pathway for service users both in hospital and when settled in the community. The Housing Officer works across the community and housing to ensure continuity across service provision. The Clinical Board aims to reduce delays significantly by April 2014. Improved cooperation is evident between
Action
Sub Action
Progress
LSSA, UHB and housing to share housing need information and plan for future supported housing. Housing and Mental Health Action Place in place. 15.3 To reduce homelessness and help people with mental health problems sustain tenancies.
c. LAs to implement Supporting People Programme Guidance ensuring that commissioning decisions take account of mental health needs. Ongoing.
Supporting People Programme spending under review. All client groups being considered including Mental Health housingrelated support services. Diverse Cymru BME Mental Health Project have a good relationship with the housing agencies and liaise with tenancy support so that our service users are able to sustain their tenancy with support from multi-agency partnership working. However this can be difficult if private renting, we have made phone calls to landlords regarding state of property, noise from other tenants within the property.
e. LHBs to provide senior representation on Supporting People Programme Regional Collaboration Committees by December 2012.
Sefyll planning service user representation to RCC andSian Harrop-Griffiths, Assistant Planning Director, attends to represent the LHB.
f. Social landlords (local authorities that still own their own housing and registered social landlords)
Housing management staff consider all forms of vulnerability of their tenants and
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Action
Sub Action
Progress
take into account the needs of people with mental health problems when discharging their landlord functions. Ongoing.
residents and provide the relevant support to maintain tenancies where possible. Many staff attended Mental Capacity Act and other relevant training. Diverse Cymru BME Mental Health Project has a good relationship with the housing agencies and liaise with tenancy support so that our service users are able to sustain their tenancy with support from multi-agency partnership working
15.4 To ensure vulnerable groups have equitable access to safer homes
a. Professionals, Fire and Rescue Services and LHBs to promote safe homes through fire safety and slips and trips initiatives. Ongoing.
The UHB is currently working in Partnership with the Fire service to consider an initiative dealing with promoting safe homes through fire safety and slips and trips advise. Relevant safety advice provided by Police Officers to vulnerable individuals. Markers on police systems to aid responses. Diverse Cymru BME Mental Health Project has met with South Wales Fire and Rescue Service and we have distributed a number of fire and safety leaflets to our BME Service users
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Action
15.8 To ensure that the physical health needs of people with mental illness are recognised and better met.
Sub Action
Progress
b. Staff awareness to be raised of where there is heightened risk for home fire or falls for vulnerable individuals (such as those with dementia) and of the need to share information on those individuals with the Fire and Rescue Service and other relevant agencies. This will ensure appropriate action is taken to mitigate the risks where possible.
Staff awareness will be included as part of the above initiative.
b. LHBs and PHW to ensure that general health promoting initiatives are signposted for people in contact with mental health services. Ongoing from April 2013.
NOTE: SEE ALSO ACTION 1L3 IN CHAPTER 1
15.9 To promote employment opportunities for people with mental health problems.
Making Every Contact Count project is being piloted with the involvement of PMHSS to consider health promotion issues for people in contact with Mental Health Services.
a. WG, LAs and the NHS Wales to act as exemplar employers in developing workplaces that support mental wellbeing, and both recruit and retain people with lived experience of mental illness. Ongoing from March 2014.
Peer Support and employment advisor working with Remploy. LHB used as exemplar with WG in developing All Wales training with SU involvement in developing the training Level 4 to achieve accreditation with AGORED Cymru
b. All agencies to formulate policies to promote mentally healthy workplaces including policies to make reasonable adjustments to assist people to gain and retain employment.
The Mental Health Clinical Board is signed up the “Mindful Employer” through involvement with the Clinical board Nurse. cavamh has offered training to 3rd sector in Mindful Employer status
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Action
Sub Action
Progress
Diverse Cymru as an organisation are Mindful Employers, have an Investors in People award and have a United Kingdom Investors in Equality and Diversity (UKIED) award Diverse Cymru BME Mental Health Project deliver BME mental health awareness raising to mental health statutory and voluntary workers in Wales
15.10 To promote the health and wellbeing of the people of Wales by enabling people to access information from libraries to promote, manage and improve their health status throughout their lifetime. NOTE: SEE ALSO ACTIONS UNDER OUTCOME
a. LA library services and public libraries to work with PHW to promote BPW. Ongoing
All Cardiff and Vale libraries are involved in the Book Prescription Wales scheme. Further promotion of the scheme to take place around World Mental Health Day The Cardiff and Vale UHB 2014 Annual General Meeting posed the following question to members of the public: How can we improve the information and the way we give it to Service Users, Carers and members of the general public. The feedback will be analysed and reflected and taken forward to improve the lines of communication.
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Chapter 5: Delivering for Mental Health
Action
Sub Action
Outcome 16: Staff across the wider workforce recognise and respond to signs and symptoms of mental illness and dementia. 16.1 All staff across the public sector to promote a culture this is respectful and experienced as empowering.
a. LHBs, LAs and Third Sector to ensure all their services embed a culture of dignity and respect. Ongoing.
The UHB has developed a robust Dignity and Respect action plan to ensure and improved experience for Service Users and their families with values based training for all staff. The Partners recognise that assessment is an ongoing process and needed across UHB, LA and 3rd Sector organisations. Survey being undertaken in relation to involvement practice in line with user and carer involvement action plan Police staff training and awareness raising for mental health.
b. LHBs and LAs with their partners to ensure that all relevant staff in the wider workforce receive training in mental health awareness raising, addressing stigma and discrimination and know how to get specialist support when they need it. Ongoing.
The Clinical Board and the Learning, Education and Development department have invested in Mental Health First Aid (MHFA) training this is provided across the LHB focussing on all areas but concentration currently on areas such as Emergency Unit and the new University Hospital Llandough Mental Health Unit. All unqualified staff receive the training and the Clinical Board also have ASIST training which staff participate in and is also being delivered to
Action
Sub Action Cardiff University. An initiative is being developed for trainers to train police within custody suit
Outcome 17: Inspirational leadership and a well-trained, competent workforce in sufficient numbers ensure a culture which is safe, therapeutic, respectful and empowering 17.1 To ensure a sustainable skilled workforce that helps people improve health as well as treat sickness.
a. LHBs to develop sustainable and affordable workforce plans to support the delivery of Together for Mental Health. Ongoing.
The Mental health Clinical Board is signed up to the Accelerated Development programme identifying leaders of the future of which the UHB have 35 members of staff with involvement of LED and presented UK wide. The Programme includes a robust management course with national accreditation.
b. Personal Development Plans (PDPs) to be in place for all staff with annual appraisal process. Ongoing.
The Mental Health Clinical Board are introducing “Appraisal April” with all Senior Managers hosting appraisal surgeries in March 2014. All Senior management will undertake their Appraisals January to March and all other staff will complete appraisals by May to coincide with “Mandatory May” when staff will undertake mandatory training
c. LHBs, LAs and Third Sector to adopt evidence based team working with an emphasis on clinical networks and locality teams. Ongoing
Improved Commissioning arrangements using a pathway specification has helped deliver a wide range of third sector services which enhances partnership working and codelivery of service provision.
Action
Sub Action d. All clinical staff to be engaged in 1000 Lives and trained in methodologies. Ongoing f. Mental Health Clinical Leaders Group to be expanded for all ages to participate in a clinical leadership programme pilot during 2013
In addition, the following actions will provide assurance that the aims of Together for Mental Health are being delivered 19.1 To ensure that appropriate arrangements are in place to oversee the implementation of Together for Mental Health at national and local levels.
b. LHBs to put in place local multi-agency partnership arrangements on LHB footprint by January 2013.
NOTE: SEE ALSO ACTION 10.1 IN CHAPTER 2
19.2 To ensure that the appropriate infrastructure is in place to measure progress in delivering the key actions of Together for Mental Health
c. Local partnership boards to routinely consider unmet need in the planning and delivery of services. Ongoing from 2015.
The Cardiff and Vale MH Partnership Board is in place and membership mirrors the cohort of the National Partnership Board to ensure consistency of approach with added membership as necessary. The Local Partnership Board has robust terms of reference and meetings are held quarterly to report on progress made against “Together for Mental Health.”
Appendix 1
Cardiff and Vale Mental Health Partnership Board
Membership 2013/14 Group/Organisation Represented
Name
Position and Organisation
Cardiff and Vale MH PB Chair
Annie Procter
Mental Health Clinical Board Director
Mental Health Cardiff and Vale UHB
Ian Wile
Mental Health Cardiff and Vale UHB
Alan Davies
Mental Health Head of Operations and Delivery, Cardiff and Vale UHB Service Development Manager, Cardiff and Vale UHB
Adult Mental Health
Martin Ford
Directorate Manager, Adult Mental Health
MHSOP Joint Operational Group
Dr Simon O’Donovan
Clinical Director, MHSOP
All-Wales Chief Housing Officer Panel
Mike Friel
Housing Officer – Vale of Glamorgan LA
Natalie Southgate
Operational Manager –Housing Strategy, Cardiff Council Vale of Glamorgan Local Authority
Mental Health Promotion - Public Health Wales
Dr Suzanne Wood
Consultant in P H Medicine PHW
All-Wales Senior Nurses AG
Jayne Tottle
Clinical Board Nurse, Cardiff and Vale UHB
Clinical Psychology
Dr Jane Boyd
Social Services Vale of Glamorgan
Andy Cole
Head of Psychology, Counselling, Cardiff and Vale UHB Social Services Vale of Glamorgan Council
Social Services Cardiff Council
Sian Walker
Director of Adult Services Cardiff Council
South Wales Police
Claire Thomas
Detective Chief Inspector, SW Police
Carers x2 for CAVAMH Service User and Carer Network
Norman Howlett Vacant
MHSOP Carer Rep Adult Carer rep
CAMHS Network Planning Group
Clare Ball
Clinical Director, SW CAMHS Network
Women and Children Cardiff and Vale UHB
Dr George Findlay/ Dr Cath Norton
Women and Children Clinical Board Director, Cardiff and Vale UHB
Mental Health Cardiff and Vale UHB
Dr Maria Atkins
MH Clinical Director, Cardiff and Vale UHB
Prison Service
Dr David Seely
Clinical Psychiatrist, HM Cardiff Prison
GP Representative
Vacant
GP, Cardiff and Vale of Glamorgan
Third Sector: Forum and Housing and Mental Health Planning Group
Linda Newton
General Manager, CAVAMH
Third Sector: Adult
Richard Bundy
Area Manager, Gofal
Third Sector: MHSOP
Melanie Andrews
Area Manager, Alzheimers Society
Third Sector: Children and YP
Sara Payne
Barnardos
Service Users x 2 for CAVAMH Service User and Carer Network BME Representative
Gwyneth Statham Richeldis Yhapp Suzanne Duval
Service Users
Youth Offending Team Probation Service
Ingrid Masmeyer Paula Barnett Peter Greenhill
YOT Manager, Cardiff YOT Manager, Vale of Glamorgan National Probation Service
Substance Misuse/Addictions
Conrad Eydmann
Head of Commissioning for Substance Misuse Cardiff and Vale UHB
Employment
Vacant
Job Centre Plus
Education
Linda Cooper
Cardiff University
Community Health Council
Bob Woodward
Cardiff and Vale CHC Member
Diverse Cymru
