Norman Lamb at Brecon & District Mind

Roger Williams MP, Norman Lamb MP and Val Walker, Service Director of Brecon & District Mind

Last Thursday Brecon and District Mind hosted an Open Forum on Mental Health with Norman Lamb MP – Minister of State for Care and Support. The session was facilitated by Roger Williams MP for Brecon & Radnorshire. During the hour-long session many important issues were covered, including changing the health system to put mental health on a parity with physical health, the failings of the system for children and young people, concern around funding for vital third sector services in the community such as Brecon Mind, and the needs of carers. Norman’s talk was followed by a Q&A session with Brecon Mind members.

There is not space to cover the entirety of the Open Forum here in one blog post, so we have highlighted some of the points that Norman made during his visit. 

Disparity between services for mental and physical health

I wanted to say something briefly about my complete passion for mental health. 1 in 4 of us at some stage in our life will experience some form of mental ill health. It may be mild depression or anxiety or it may be something more enduring. Most families are touched by it in some way. Our family very much is. What I talk about is not just because I happen to have a job as the Minister for State responsible for mental health. It is something I really care about. The thing that is quite shocking is the disparity between how people with mental ill health are treated by the system despite the great work of people working within the services. But the system, in my view, discriminates against people with mental ill health. I can talk primarily about my experience in England but I suspect it is not much different to here.

In England if you have suspected cancer and are referred by your GP you have a right to see a specialist within two weeks and a right to start treatment within a month of diagnosis. If you suffer from mental ill health, if you perhaps are a youngster who experiences a first episode of psychosis, you have no such right. There is no such entitlement to access treatment on a timely basis. And I just don’t see how that is right. We know there is a wealth of evidence that if you intervene quickly with a youngster who suffers a first episode of psychosis, you can often rescue that person, you can stop the deterioration of condition and give that person the chance of a good life. 

The Open Forum on mental health

So how unacceptable is it that those people don’t have any right to access evidence-based treatment which we know gives the person the chance of recovery. Particularly in mental health the quicker you intervene the greater chance you have of achieving a good result for that individual and potentially rescue someone from a lifetime of a pretty miserable experience for very many people - out of work on benefits, not enjoying things that the rest of us take forgranted. It costs a fortune to deal with the damage and the effects of negligence on that person. So the moral and economic case for proper investment in mental health is overwhelming. If you make the investment you ultimately end up saving money further down the track as a result. That is the central message that I have been trying to get into government, NHS England and also to apply the moral pressure on organisations locally to take mental health more seriously.

I am on a mission to try and change this (the disparity between physical and mental ill health). So in England we are introducing the first ever waiting time standards for mental health so that if you experience a first episode of psychosis the standard will be that you start your treatment in two weeks from referral by your doctor. We start by saying that 50% of youngsters should be seen within two weeks, and then progressively in subsequent years we want to increase the percentage, but you have to increase the capacity in mental health services to be able to do this.

Increasing Access to Psychological Therapies

Kirsty Williams, Assemby Minister Brecon & Radnorshire 

and Harold Proctor of Powys teaching Health Board

We have also got in England the IAPT programme – Increasing Access to Psychological Therapies. It is fantastic for mental health. For the first time we have rich data, information, evidence about how many people are waiting, how long they waiting and whether they are recovering as a result of their treatment. We can monitor the programme to understand which providers are performing well and which are failing people, where access is very poor. The result of this is that in 2010 300,000 got access to psychological therapies. This year it will hit about 900,000, an increase of three times, so it’s a big advance and a programme that is delivering massive results for people. There are thousands of people that have recovered from depression and anxiety. The evidence is very strong; not only of recovery but that if you invest money you achieve a saving in the long-run. You get people off benefits, you get them back into work, you give people a good life with the chance for self-respect and some dignity.

Crisis care

Crisis care is where the disparity between physical and mental health is probably at its greatest. If you suffer from a physical health problem the system may be under pressure but an ambulance will arrive and you will be taken to an Accident & Emergency department and you will have access to a specialist who understands your condition. If you have a mental health crisis it is completely haphazard what happens to you. And you could end up in a police cell. This is intolerable in a civilised society.

So last February we published the Crisis Care Concordat. We got twenty national organisations to sign up to it. It is the first set of standards for crisis care in mental health that we have ever had. It tells you there that there should be a 24/7 helpline available so you can get access to support any time of day and night. There should be proper liaison psychiatry in hospitals, and in A&E if your problem is a mental health problem you will get access to a specialist. It critically says we should end completely the practice of putting under 18s in police cells and halve the number of adults who end up in in police cells this year compared to two years ago. In my view it should become a “never” event. Parts of England have demonstrated it is possible. They don’t get more money, they have just organised themselves better.

The role of carers and the Open Dialogue approach

I am acutely aware (mental ill health) affects the whole family. It can have a massive impact on other people’s lives. Providing support for the whole family is critically important. There is a very interesting development called Open Dialogue. It is the approach they use in Finland. The whole idea is that it is a recognition that mental health is crucially related to relationships with other people, and to try and deal with someone’s mental ill health in isolation is a mistake. Their whole approach is that when crisis occurs you get the whole family engaged straight away.

It’s absolutely the case that a family trying to cope with mental ill health very often has no idea how to handle it, whether what they do has an adverse or positive effect, whether to be tough with the person or gentle and understanding. Getting the balance right is so often incredibly difficult, so to involve the whole family seems a very attractive approach. There are now four trusts in England that have taken this approach and pooled some money between them to train psychiatrists and other health workers to develop the model in this country and critically to evaluate as they go through.

Transition from children’s to adult services

We have a massive issue with this cliff edge at 18. You get to 18 and are then told children’s services come to an end. You’re suddenly told you’re in adult services. 18 years old is a very difficult age for many people. They are going through real transitions in their own lives, maybe going to university, maybe leaving school, it may be all sorts of teenage angst that you are trying to cope with in your own mind, and to suddenly force a complete change of service seems completely daft. I’m trying to force a move away from a one size fits all date for transition. It’s often “abandonment” to be honest. A service needs to stick with someone if that’s the appropriate thing to do. There are several areas, my own county of Norfolk, where they have a youth service that takes you through to 25. Because it is a youth service it is more attuned to what might be more appropriate for you at that point in your life.

I also think third sector organisations working collaboratively with statutory sector organisations are more subtle and pliable in getting the right response for a youngster. So I think a collaboration between statutory and voluntary sector services works more effectively.

Janet Pardue-Wood, Acting Director of Mind Cymru, meets 

Kirsty Williams AM and Roger Williams MP.

Voluntary sector

My view is that the voluntary sector plays a crucial role. When I was at Gofal earlier they were talking about how they had entered collaborations with some of the health boards around Wales. We have this awful problem of people being put into out-of-area placements, often a long way from home. There is no ambition to give them a better life, they are just hidden away from view at enormous cost to the tax payer, it is an extraordinary outrage really. Their role can be to identify these people and find a mechanism to get them back into community and rebuild their life.

Gofal gave a wonderful example of a woman who was a serious alcoholic whose life was in a complete mess, she had been in secure accommodation. She is now living back in her own home and working in a charity shop three days a week. She contributes to local community efforts, she has a life. It’s fantastic. Three or four years ago no one assumed she was capable of that, she would just have been locked up as a risk or threat to everybody. It does not have to be like that.

Roger Williams rounded off the session by complimenting Brecon & District Mind on the work that they do in their community and thanked them for hosting the Open Forum.

Thank you to Freda Lacey and Brecon & District Mind for providing photographs from the day.

Together for Mental Health - Assembly Ministers have their say

Assembly Ministers debated the second Annual Report on Together for Mental Health on Tuesday in the National Assembly for Wales. I watched a large chunk of the debate online on Senedd TV, and you can read the Record of Proceedings here, and dip into video records, to catch up. (Start at 16.26pm, unless you want to find out more about the local government settlement…)

Together for Mental Health sets out Welsh Government ambitions for improving mental health and a vision for mental health services across Wales and was published in 2012. It is the first mental health strategy for Wales that covers people of all ages.

Vaughan Gething, the Deputy Minister for Health, introduced the debate by saying: Mental health services have made real progress throughout 2014. By further embedding the Mental Health (Wales) Measure 2010, we are continuing to make tangible improvements to care whilst ensuring service users’ views are heard. On average, over 2,600 people are now seen locally every month by primary mental health support services. These deliver advice, information and services, including befriending, books on prescription, physical activity and psychological therapies.

His introduction also included a reference to the work around dementia in Brecon’s dementia friendly community which we have previously written about here. A groundswell of interest in dementia support of communities has seen Brecon and Swansea recently gain official ‘working to become dementia-friendly’ status, and I am proud that we are continuing to fund the charity (The Alzheimer’s Society) to continue this important work in Wales.

Darren Millar, AM, who moved several amendments, said that: There’s no doubt that there has been progress, and long may it continue, but the pace of progress, I think, is something that we need to address. He also acknowledged the contribution of the Third Sector: I would like to put on record… the acknowledgement of the fantastic work that the third sector is doing to address mental ill health issues in Wales, whether that is Mind, Gofal, Hafal or the whole host of other organisations—local organisations, as well—that are doing their bit.

Prior to the debate the mental health charity Gofal had carried out a survey of people who had been in contact with services, and circulated the findings to Assembly Ministers. Whilst the survey highlighted some positive changes, there were also concerns expressed in the findings. Darren continued: One in 10 GPs, and a growing proportion of GPs, according to service users, do not understand or are insufficiently empathetic to mental ill health issues. More alarmingly, a quarter of other staff in primary care are insufficiently understanding or empathetic of people’s concerns.

Darren continued: The other issue, of course, as well, is that it appears that a growing proportion of people are simply having pharmaceutical interventions rather than some of the psychological interventions that I know all parts of this Chamber support the need to increase and improve access to.

Kirsty Williams, AM for Brecon and Radnorshire, wanted to know what steps were being taken to ensure parity between physical and mental health services. She pointed out that progress had been made in reducing the stigma associated with mental health, but that this brought its own problems. Members will have heard those problems highlighted in the all-party group this afternoon, where there certainly was a feeling that, perhaps, the report was on the rosier side of how things felt on the ground to those people using the service, to the third sector organisations involved in helping deliver services for people in communities, and to people caring for relatives or friends who are suffering from mental distress and ill health.

David Rees, AM, who had chaired the cross-party meeting on mental health just prior to the debate, said: It was felt that service user and carer representation on the national partnership board needed greater support to actually ensure that the diverse views across Wales could be fed into the board through improved pathways to achieve that engagement. I therefore hope that the Deputy Minister will be able to give reassurances that the individuals who represent the service users and carers on that partnership board will be given that support to engage with a wide range of bodies to allow a wider spectrum of views to be presented in order that services can be shaped to continue the improvements we have seen to date.

Other issues debated included:

• The pressure on Child & Adolescent Mental Health Services.
• The Veterans NHS Wales Service.
• Access to crisis beds.
• Care and treatment plans.
• Mental distress in the workplace.

Vaughan Gething made closing comments to respond to many of the issues raised. There is not space to address all of these here, but I will just pick out his response to David Rees’ point above. Vaughan said: Patient voice and choice in designing healthcare is a core element of our prudent healthcare approach….I want to, in closing, recognise again the contribution of the wider voluntary sector in helping to deliver not just support, both the design and delivery of our services here in Wales.

You can read more about the amendments that were tabled and voted upon and the outcomes on the Record of Proceedings here (from 17.27pm).

The Assembly Ministers have had their say. Do you think Together for Mental Health is working effectively to bring about improvements in the planning and delivery of mental health services in Wales? Let us know in the comments box below.

The BIG talk about mental health

I think I might have mentioned before that my partner Graham Brand works for the Big Lottery Fund (aka BIG) based in Newtown. Well, today one of the projects funded by the BLF - Time to Change Wales  - had a major day of campaigning around the stigma associated with mental distress.

"24 hours in which to start conversations about mental health, raise awareness and share the message that mental illness is nothing to be ashamed of, neither is talking about it. Sometimes it's the little things we do that make a big difference - like having a chat over a cuppa, sending a text or inviting someone out. And on Time to Talk Day we’re encouraging people to do just that. In fact, we're hoping to spark a million conversations, and we want your help to do that."

The day is called Time to Talk, and if I'm quick I might actually finish posting this blog before midnight on 6 February! There certainly has been a lot of talk about mental health today, both in the more traditional media and social media (check out these giant cups!). Tweets have been pouring in, telling us what people in organisations - large and small - have been talking about.

Whilst we have engaged in a bit of a debate on this blog around the approach taken by the Time to Change project the campaign goes on, of course! We would still like to challenge the underpinning theme of the campaign, that 1 in 4 people experience mental distress. We still strongly believe that any one of us could experience emotional trauma at any time - who knows what lies around the corner for any of us? We don't like the word "illness" either, preferring to use that of "distress"... but these arguments are out there for all to see. So today I will just highlight what happened in Newtown, and hundreds of other workplaces across the UK, and... in the end... readers have to make up their own minds. 

In the Newtown Big Lottery Fund office staff set up a Pledge Wall for Time to Change Day, and Lisa Powell sent through some photographs and a couple of paragraphs describing how they approached the day:

Today was Time to Talk day which is backed by Gofal, MIND Cymru and Hafal, and in the BIG office in Newtown we supported this campaign to get 1,000,000 conversations going about mental health throughout the UK and hopefully help put an end to the stigma surrounding mental health.

We had a pledge wall in the kitchen so people could make pledges about things they could do to be more aware of mental health, or conversations they could have with friends or anyone they know who suffers from a mental health illness. Basically anything that can be done to support the issues surrounding mental health. There were tea and biscuits too so people could sit and have a chat about their experiences or their exposure to this subject. There were leaflets about how to start conversations about mental health and facts and myths about it too. There were also posters put up around the office to remind people but also with facts and statistics on them about the amount of people who are affected by this.

Time to Talk had a big social media campaign, and backing from the Health Minister and celebrities who have been diagnosed with mental disorders. As well as having big and small organisations plus anyone who wants to talk about this subject, then we can all end the stigma surrounding this illness that affects 1 in 4 people.

"I pledge to continue to listen." One of the pledges on the Big Lottery Fund Pledge Wall.

Did you listen to anyone talk about their mental health today?

Hearts and Minds

Yesterday I drove down through sun and snow flurries to the Royal Welsh Showground near Builth Wells. I was attending an event organised by Powys teaching Health Board (PtHB) to look at the future of mental health services in Powys. The “vision” for future services was developed during late Autumn 2012, and very much informed by feedback from people who use services and their carers at the time. I posted about that here. Then it was christened Hearts and Minds, and included information not just about the vision but how services would be delivered – you can link to more information here.

So, yesterday it was the turn of staff providing services (for the health board, social services, the voluntary sector and other agencies) to say what they thought. There were about a hundred people in total, including (in a bit of a mini A-Z of professions) advocates, nurses, occupational therapists, psychiatrists, social workers, support workers and police officers. And many of them spoke very passionately about their views, and some key themes emerged throughout the day.

Facilitator Dr Les Rudd, of the Centre for Mental Health Services Development, introduced the morning session which started with a series of presentations to inspire and set the mood. 

Jo Mussen

Vice Chair of PtHB, Jo Mussen, spoke first, about the need to give the people of Powys the best possible mental health services that we can, taking into account the many challenges and opportunities that face us. She also referred to the “incredibly vibrant Third Sector” which went down well with some of my colleagues.

Ian Hancock and Les Rudd

Then Ian Hancock gave us a Scottish viewpoint. He has turned round mental health services in the Dumfries & Galloway region in just three years. It is very similar to Powys in many ways, with its rural geography and a population of 147,000 (Powys approx. 133,000). His approach as the General Manager appears to have been both innovative and brave, and the Powys staff were clearly very impressed by the achievements he described.

Richard Bundy from Gofal

After Ian came Richard Bundy of the mental health and wellbeing charity Gofal. He described a service which has “bucked a few trends in Wales” – the Crisis House in Cardiff. The house is an alternative to hospital, with the average length of stay at 7 days. Some of Richard’s stats said it all really, with 95% of people using the house rating it as good or excellent, and 80 – 90% consistently returning home rather than going to hospital. There is more about the project here.

Stephen Hunter, Assistant Medical Director of Aneurin Bevin Health Board (providing mental health services in Mid and parts of South Powys), had sent recommendations which Carol Shillabeer (Director of Nursing) delivered in his absence.  There were some interesting points here, including the need to:

• Consider more cross-sector working (again identifying the Third Sector as a real asset), but involving other organisations too such as Job Centres, social and care services, and other people who are regularly out in the community even (postmen came in for a mention several times).
• Focus on supporting GPs and practice staff to care more for people experiencing mental distress.

The rest of the day was taken up with workshop sessions looking at what a good service would look like for adults, older people, and younger people, in the following three areas:

1.    Community services, primary and secondary care.

2.    In-patient services (crisis and accommodation services).

3.    New services/innovation.

Some of the key themes which I picked up on:

• Services are very different in different parts of Powys. There is certainly something of a postcode lottery going on here. (Services are currently provided by three different out-of-county health boards).
• Everyone wants it made simpler. The police often have to pick up the pieces when the mental health service providers have closed for the day. They would like to see “one procedure, one place, one pathway” for hospital admission, for example.
• More training in psychological therapies is urgently needed – it was suggested this could be “joint” training involving many agencies.
• What can the Third Sector provide? Exploring this topic could form a whole day in itself! (Supported housing and counselling being just two suggestions I picked up on – and the need to “think outside the box”).
• It is crucial to build confidence around mental health issues with other areas of health, eg: health visitors, district nurses and community hospitals. And Third Sector of course! “Mental health is everyone’s business”, as one person said.

Carol Shillabeer and Harold Proctor

So, it was a really interesting and useful day all in all. Harold Proctor, (Planning and Performance General Manager Mental Health and Learning Disability – phew, some job title!), who is leading much of the work for PtHB around transforming mental health services, tells us that this event is the beginning. So, watch out for more updates and events to follow once a proposed new model of services has been put to PtHB in April.

As someone said, summing up towards the end – “we have only just lit the torch paper today… this is very much the start.”

PS: And… did I mention the Third Sector…?!  

Mental Health First Aid - good news and bad

It's Monday, the start of the week, I'm going to begin on a positive note! I did a Mental Health First Aid course in 2009 with Mid Powy Mind - and particularly as I was relatively new to the mental health sector it was brilliant. Just what I needed at the time. 

It seems loads of other people have also now received their training - according to a Welsh Government report today - 10,000 people across the country as a whole:

The course teaches people about mental health problems and gives them the skills they need to help people in crisis. It covers common mental health issues including alcohol, drugs and depression, crisis first aid for suicidal behaviour, first aid for anxiety and panic attacks, and other issues such as self-harm.

You can read more, including Health Minister Lesley Griffiths' comments on the course, here.

So far, so good. 

Monday ticks away by, and during my lunch break whilst browsing the BBC news website, I notice another important report, this time from the mental health charity Gofal. 

It starts - "Gofal is calling for improvement in healthcare workers and GPs' attitudes to mental health problems in Wales." The survey of 1083 people also found unacceptable waiting times for treatments, and a high level of drug prescribing for people experiencing mental distress.

The first question which comes to my mind is - I wonder if all these health care workers and GPs have been on the Mental Health First Aid course? And if not, why not? Because the Gofal survey implies that there are still a huge number of people out there, many working professionally in the health sector, who urgently need this training.

But ..... even the bad isn't all bad, hopefully. Together for Mental Health, the Welsh Government's new strategy for mental health across Wales, was published last month, and Mental Health First Aid is to be a priority:  "... the highly successful Mental Health First Aid programme will continue helping people to recognise the signs and symptoms of someone with mental health problems." Doubtless those 1083 people Gofal surveyed would really hope so.

Meanwhile, you can find out more about Mental Health First Aid courses here.

If you have been on the course we would really like to know what you thought of it, so please let us know.