Top

Top

Agenda Item No

The Vale of Glamorgan Council

 

Scrutiny Committee (Social Care and Health), 4th January 2016

 

Report of the Director of Social Services

 

Community Mental Health Services for Adults

 

Purpose of the Report

  1. To update Scrutiny Committee on developments in community services for adults with mental health problems in the Vale of Glamorgan.

Recommendation

  1. THAT the Scrutiny Committee notes the content of this report.

Reason for the Recommendation

  1. To inform Scrutiny Committee of developments in community mental health services in the Vale of Glamorgan which will help us to meet increasing public, service user and policy expectations.

Background

  1. At any one time, one sixth of the working age population of Wales have symptoms of mental health problems that by virtue of their nature, severity and duration meet diagnostic criteria and which would be treated if they come to the attention of a mental health professional. The most common of these disorders are depression and anxiety or a mix of the two. There are approximately 6000 emergency admissions to hospital per year in Wales as a result of deliberate self-harm with around 300 deaths from suicide. The overall cost of mental health problems in Wales is estimated at £7.2 billion per year.
  2. People with mental health problems live with reduced opportunities for employment and adequate housing. They are more likely to live in poverty and with multiple health conditions than the general population. The Welsh Health Survey found that, in the Vale of Glamorgan, there are 7574 adults living with two or more mental health diagnoses.
  3. The Time to Change Wales Campaign carried out a survey in 2013 looking at public attitudes toward people with mental health problems. It found some startlingly negative attitudes, including:
  • 1 in 7 people thought that a person with signs of mental illness should be hospitalised;
  • 1 in 4 believed that a person with a mental health problem should not be allowed to hold public office; and
  • 1 in 10 people believed that people with mental health problems are less trustworthy and should not be allowed to have children.
  1. The Vale of Glamorgan Council signed the Time to Change Wales pledge earlier this year, setting out its commitment to supporting people with mental health problems both in the work place and in the community by promoting positive images of mental illness and mental health problems, to reduce the stigma and discrimination that people with mental health problems face every day.
  2. The Interim Policy Implementation Guidance and Standards for Delivering Community Mental Health Services sets out a tiered model of services and places CMHTs at the heart of secondary mental health care in Wales. It states that CMHTs should:
  • receive referrals (at present mainly from primary care);
  • undertake screening assessments;
  • offer a range of more specialist assessments and interventions; and
  • deliver a constructive discharge.
  1. CMHTs work within the secondary mental health sector, providing care and treatment to people with unstable and severe mental health problems. People requiring care and support for mild to moderate and stable severe mental illnesses are routinely managed through primary care and third sector support organisations.

Relevant Issues and Options

  1. Within the Vale of Glamorgan, Social Services staff work in partnership with the Cardiff and Vale University Health Board in three Community Mental Health Teams, working to the GP surgeries in the Central, Eastern and West areas of the County. The staffing comprises:
  • Amy Evans CMHT, Barry

1 Integrated Manager

0.3 Social Work Lead

2.5 Social Workers

6 Community Psychiatric Nurses

2 Consultant Psychiatrists

  • Hafan Dawel CMHT, Penarth

1 Integrated Manager

0.3 Social Work Lead

1 Social Worker

3 Community Psychiatric Nurses

1 Consultant Psychiatrist

  • Western Vale CMHT, Cowbridge

1 Integrated Manager

0.3 Social Work Lead

1 Social Worker

1 Social Work Assistant

3 Community Psychiatric Nurses

1 Consultant Psychiatrist

  1. The Integrated Manager in each CMHT is responsible for ensuring that the teams have systems and staff in place to be able to make emergency, urgent and routine assessments and provide suitable advice, care or treatment to adults with mental health problems in their area. The Integrated Managers are employed jointly by the UHB and the Vale of Glamorgan to deliver this function.
  2. Prior to the introduction of integrated management of the CMHTs, the social work service was co-located with other professionals in team buildings but offered a distinct traditional social work service secondary to health colleague's interventions. We now offer a much more inclusive service to a wider range of the population and support a more person-centred initial assessment, allowing earlier social interventions leading to better outcomes and quicker discharge from services.

Referrals

Each CMHT operates a duty function where two health or social care professionals are available to accept referrals and undertake a screening assessment during office hours. During the first six months of 2015/16, the three CMHTs received an average of 145 referrals each month and undertook an average of 103 assessments. On average, 42 referrals per month were re-directed to other sources of help without a formal assessment.

 

Assessments

Each referral in to the CMHT is prioritised according to the risk and need of the service user. Referrers are requested to telephone the CMHT duty worker when making an emergency or urgent referral. Emergency referrals are offered a face-to-face appointment with two mental health professionals within four hours. Urgent referrals are seen within two days. Routine referrals are provided an appointment within four weeks.

 

By acknowledging that people live within complex social systems that can have an impact on their mental health, the assessments take into account the person's mental health and their social circumstances and aim to provide advice in relation to medical treatment and psychosocial interventions to assist in providing a sustainable recovery. On average, 70% of people referred to a Community Mental Health Team do not require ongoing care coordination after an assessment and short term intervention.

 

Mental Health Act Assessments

The Vale of Glamorgan operates a rota of Approved Mental Health Professionals (AMHPs) to provide functions required under the Mental Health Act 1983. This includes ensuring that the local authority has sufficient numbers of AMHPs available at all times to undertake Mental Health Act Assessments of people requiring emergency care. Some people may need to be detained in hospital for a period of assessment and treatment on a compulsory basis, in the interests of the person and/or the public.

 

During the first six months of 2015/16, the Vale of Glamorgan AMHP service undertook 89 Mental Health Act assessments and made 65 applications for compulsory detention in hospital.

 

Interventions

Through working with allied health professionals, other local authority departments and third sector organisations, the Vale of Glamorgan CMHTs support people to live independently through recovery-focused care and treatment. The majority of people using mental health services will be offered care and treatment by a consultant psychiatrist and a social worker or Community Psychiatric Nurse. The role of the social worker in the team is to:

  • support people to regain their role within their family, community;
  • assist them to make constructive changes to their lives and behaviours that promote mental wellbeing and reduce the potential for further deterioration.

This can be achieved through direct psychosocial interventions such as mindfulness, Cognitive Behavioural Therapy and family support alongside robust risk assessments.

 

The Vale of Glamorgan Assistant Social Worker and Community Support Workers have worked alongside the CMHT Care Co-ordinators to develop a service to meet a long standing often overlooked need. There is much evidence to show that mental illness and the effects of medication can have a significant impact on a person's motivation and ability to maintain a healthy lifestyle. Indeed, we know that people living with a chronic serious mental illness have a life expectancy of less than 10 to 20 years when compared with the general population. To meet this need, we have developed and set up healthy lifestyle groups that support people into a more healthy diet and exercise.

 

A small proportion of adults with mental health problems will require additional support to maintain their independence and wellbeing. The Vale of Glamorgan currently supports 8 adults with mental health problems in residential care homes and 45 through the provision of domiciliary care in their own homes. We do not currently support anyone in a Nursing Home as we have developed very robust mechanisms for highlighting people's need for Continuing Health Care. It is noteworthy that the majority of people receiving commissioned care through the CMHTs are older people who have had a life-long, serious mental illness often with other complex physical conditions.

 

However, we are very clear that residential care for adults with mental health problems is not seen as the end of the road. Instead, we work with residents and providers to encourage move on from care homes into more independent living. One example of this is where the team supported a long standing care home resident into Extra Care. Despite his initial anxiety about this move, Extra Care has provided the person-centred support that has enabled a much improved quality of life.

The Vale of Glamorgan CMHT also supports and supervises 24 adults with severe mental health problems who are restricted under Part 111 of the Mental Health Act 1983, which is concerned with people involved in criminal proceedings or under sentence.

Resource Implications (Financial and Employment)

  1. By working together to promote mental wellbeing and preventing mental illness, we have reduced the financial cost of mental ill health in the Vale of Glamorgan. As shown in Appendix 1, mental health services in the Vale of Glamorgan have a long history of supporting people to maximise their independence and to minimise the use of commissioned Community Care spending. When comparing our total spends on Adult Mental Health against the Welsh Government figures of the number of adults with two or more psychiatric diagnoses, the Vale of Glamorgan is by some distance the lowest spender on adult mental health in Wales.
  2. We have achieved this through:
  • Close scrutiny and review of community care provision;
  • Working closely with Vale of Glamorgan Housing Department in the development and maintenance of innovative solutions to provide an alternative to residential care; and
  • Working with the UHB to ensure people with eligible needs are supported to access continuing healthcare funding.

Sustainability and Climate Change Implications

  1. More effective and responsive services do provide opportunities to reduce waste and duplication.

Legal Implications (to Include Human Rights Implications)

  1. There are no specific legal implications as a result of this report.

Crime and Disorder Implications

  1. There are no crime and disorder implications as a direct result of this report.

Equal Opportunities Implications (to include Welsh Language issues)

  1. The Cardiff and Vale Community Mental Health Service provides the same high level outcomes for people of all ages, aims to reduce stigma and promote equality of life chances for all.

Corporate/Service Objectives

  1. HSCW8: Establish integrated social care and health assessment and care management teams for all adult services in partnership with the Cardiff and Vale University Health Board.
  2. Directors' report priority: Progress work on the review of Community Mental Health Services with our partners and service users and their families, to inform the future development of community services.

Policy Framework and Budget

  1. This is a matter for Executive decision.

Consultation (including Ward Member Consultation)

  1. There are no matters in this report which relate to an individual ward.

Relevant Scrutiny Committee

  1. Social Care and Health.

Background Papers

Contact Officer

Lance Carver, Head of Adult Services / Locality Manager.

Officers Consulted

Andrew Cole, Operational Manager - Mental Health.

Responsible Officer:

Philip Evans, Director of Social Services.

 

Share on facebook Like us on Facebook