Agenda Item No 7
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 16th January, 2017
Report of the Director of Social Services
Community Mental Health Services
Purpose of the Report
- To update Scrutiny Committee on developments in community services for adults with mental health problems in the Vale of Glamorgan.
- THAT the Scrutiny Committee notes the content of this report.
Reasons for the Recommendations
- 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.
- 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 and around 300 deaths from suicide. The overall cost of mental health problems in Wales is estimated at £7.2 billion per year.
- People with mental health problems live with reduced opportunities for good well-being outcomes including employment and adequate housing. They are more likely than the general population to live in poverty and with multiple health conditions. The Welsh Health Survey found that, in the Vale of Glamorgan, there are 7574 adults living with two or more mental health diagnoses.
- 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.
- 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
- Within the Vale of Glamorgan, Social Services staff work in partnership with the Cardiff and Vale University Health Board (UHB) in three Community Mental Health Teams, working to the GP surgeries in the Central, Eastern and West areas of the local authority area.
- An 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.
- Prior to the introduction of integrated management of the CMHTs, the social work service was co-located with the other relevant professionals from the NHS in team buildings. However, it tended to be a rather distinct and traditional social work service which was on offer, 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.
- 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 2016/2017, the three CMHTs received an average of 126 referrals each month and undertook an average of 121 assessments. On average, 5 referrals per month were re-directed to other sources of help without a formal assessment. Compared with last year, this is a reduction in referral numbers and an increase in the number of assessments completed. It would appear that fewer inappropriate referrals are now being received.
- Each referral to the CMHT is prioritised according to the risk and needs 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.
- 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 2016/2017, the Vale of Glamorgan AMHP service undertook 82 Mental Health Act assessments and made 64 applications for compulsory detention in hospital. This activity resulted in 72 admissions to hospital as a number of individuals were admitted without the need for compulsory detention.
- 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 Community Support Workers work 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 10 to 20 years lower that the general population. To meet this need, we have developed and set up healthy lifestyle groups that support people with diet, nutrition and exercise. The Community Support Workers also run a well-attended Football Group that encourages fitness as well as social interaction.
- 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 14 adults with mental health problems in residential care homes and 27 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 should not be 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 the Golau Caredig Extra Care facility. 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 22 adults with severe mental health problems who are restricted under Part III of the Mental Health Act 1983 (which is concerned with people involved in criminal proceedings or under sentence).
- The partnership arrangements for mental health services with Cardiff and Vale UHB require continued oversight and involvement. The condition and suitability of the Amy Evans building which accommodates the central Vale CMHT is a significant issue. The social services directorate has enlisted the support of health and safety advisors within the council to support progression of remedial works. The head of adult services has attended a number of Cardiff and Vale UHB estates meetings to discuss these matters. Resolution of the issues with the building remains problematic. It is evident that the building is not fit for purpose and that an alternative should be sought.
- In response to increasing referral demands, a community review of the service began in 2015. It was intended to:
- explore potential alternative models of delivering screening and assessment activity;
- review the use of the existing buildings; and offer a range of more specialist assessments and interventions; and
- ensure a resilient and responsive service is in place. deliver a constructive discharge.
A programme implementation steering group has been set up. The review will be taken forward through this group and a number of work streams. The first newsletter describing this arrangement is attached at appendix 1.
- A joint management arrangement for the social work element of CMHTs and for strategic oversight has been in place with Cardiff Council, through appointment of an Operational Manager post which covered both local authority areas. A similar arrangement was in place for learning disabilities services. There have been clear benefits but also some problems which mean that this arrangement will be brought to an end, at least in the medium term. A proposal to create an Operational Manager post covering both areas of responsibility solely for the Vale of Glamorgan is being considered. This is not to rule out development of a regional service in the future but it is considered that, having a post concentrating only on the issues for the Vale of Glamorgan, will benefit and facilitate discussions with UHB partners regarding future arrangements in both Mental Health and Learning Disabilities Services.
Resource Implications (Financial and Employment)
- By working together to promote mental wellbeing and supporting people to maximise their independence we have been able to minimise the use of commissioned Community Care spending.
- 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
- More effective and responsive services do provide opportunities to reduce waste and duplication.
Legal Implications (to Include Human Rights Implications)
- There are no specific legal implications as a result of this report.
Crime and Disorder Implications
- There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
- 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.
- This service is consistent with the Council's Corporate Plan, Well- being Outcome 4: An active and Healthy Vale. Mental Health Services support the delivery of the following Corporate Objectives:
- Encouraging and Promoting Healthy Lifestyles
- Safeguarding those who are vulnerable and promoting independent living
Policy Framework and Budget
- This is a matter for executive decision.
Consultation (including Ward Member Consultation)
- There are no matters in this report which relate to an individual ward.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Lance Carver, Head of Adult Services / Locality Manager.
Andrew Cole, Operational Manager - Mental Health.
Philip Evans, Director of Social Services.