Agenda Item No. 7


The Vale of Glamorgan Council


Scrutiny Committee (Social Care and Health): 7th October, 2013


Report of the Director of Social Services


Community Opportunities for Adults with Mental Health Problems


Purpose of the Report

1.             To update Scrutiny Committee on plans for developing a more responsive range of services providing community opportunities for adults with mental health problems.


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

Reason for the Recommendation

1.             To inform Scrutiny Committee of opportunities for collaboratively developing services that will deliver better vocational and occupational activities for and with adults who have mental health problems.


2.             During September and October 2011, the Cardiff and Vale Mental Health Partnership reviewed adult mental health day, vocational and occupational services across the statutory and third sector.  The review involved consultation with service users and other stakeholders and it was informed by feedback questionnaires, focus groups and reviews of individual care plans.

3.             The review recommended that day services should:

·         promote social inclusion and reduce social exclusion;

·         be recovery focused and promote mental well-being;

·         help people to avoid hospital admission;

·         address the needs of minority groups;

·         increase quality of life;

·         be service-user led;

·         be locally based and part of the community; and

·         build social, leisure, training and employment opportunities.

4.             Since the review, a multi-agency group has set about developing a model describing how daytime vocational and occupational community opportunities should be delivered.  The model is shown in the diagram linked hereto:

Relevant Issues and Options

5.             As part of their Care and Treatment Plan, adults with severe and enduring mental health problems can receive a specialist outreach service from this Directorate. The team consists of one team leader and five FTE outreach support workers; it supports 30 to 40 people at any one time to engage with community facilities, to improve confidence and regain their social roles.  The service is very highly valued by users and carers.

6.             Over the last two years, the service has changed from providing long-term support services, social activities and monitoring with minimal move on from the service (that potentially created unnecessary dependency) to much more dynamic, short-term focussed interventions that aim to build social networks and promote recovery.

7.             The model of community opportunities outlined above places this outreach service within Tier 3 and suggests further steps to consolidate the new approach.  With the support of key stakeholders, it is planned that the Vale Mental Health Outreach Service will amend its operations to:

·         provide outreach for people as part of a Care and Treatment Plan only;

·         offer time limited reablement services with clear deliverable outcomes;

·         work with the University Health Board's day treatment services to prevent hospital admission;

·         link to Tier 2 services such as the Vale Mind projects to provide move on opportunities;

·         provide support to assist residents using supported accommodation to move on to more independent housing at an appropriate time;

·         support adults with co-occurring substance misuse and mental health problems;

·         collaborate with the mental health Occupational Therapy service to inform interventions and lead group-based activities / therapies;

·         monitor progress toward outcomes using validated outcome measurement tools such as the Recovery Star; and

·         develop links with local providers of education, training or employment.

8.             An implication of a more recovery- focused Tier 3 service is that links to Tier 2 and Tier 1 provision will need to be strengthened, enabling people to move through the different levels of support.  Some individuals may benefit from the whole range of services at any one time; for example, they may require support from the local MIND centre while undergoing more intensive therapeutic interventions.

9.             It is accepted that some service users may not be eligible or suitable for the revised Tier 3 service because of the nature of their health and social care needs arising from their enduring mental health problems.  Such individuals should not be excluded from the recovery focussed service at Tier 3, but they may also require other services, as identified by their Care Co-ordinator under their Care and Treatment Plan. Such services are likely to be provided by the Authority under s2 Chronically Sick and Disabled Persons Act 1970 or s29 National Assistance Act 1948. Such services may include the arrangements identified above (i.e. Tier 1 and Tier 2 services) but may also include other services (e.g. domiciliary care at home).

10.        Similar considerations apply to those service users who may receive the services under Tier 3 provision but who may remain eligible for longer term support because of their enduring mental health problems. Such individuals may be eligible for other services, as identified by their Care Co-ordinator under their Care and Treatment Plan. Such services are likely to be provided by the Authority under s2 Chronically Sick and Disabled Persons Act 1970 or s29 National Assistance Act 1948. Such services may include the arrangements identified above (i.e. Tier 1 and Tier 2 services) but may also include other services (e.g. domiciliary care at home).

11.        Community opportunities provided as part of Tier 1 and 2 offer preventative support that aims to promote mental wellbeing in the wider community, encourage positive images of mental health problems thus reducing stigma and provide informal and accessible support options for individuals that otherwise may require secondary mental health services. In other words, the Tier 1 and 2, should be seen as part of the range of services that the Authority provides to meet its obligations under section 2 of the Chronically Sick and Disabled Persons Act 1970 and should be identified as part of a Care and Treatment Plan.

Resource Implications (Financial and Employment)

12.        The re-focussing of the Mental Health Community Outreach Team to offer a short term recovery focussed interventions will be funded within available resources.  The revised provision will offer a more efficient use of resources by encouraging independence and reducing ongoing dependence on services.

Sustainability and Climate Change Implications

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

Legal Implications (to Include Human Rights Implications)

14.         There are no specific legal implications as a result of this report.  The provision of day time activities is dealt with primarily in the National Assistance Act 1948 (S.29), which defines those eligible for non-residential welfare services and gives the Local Authority powers to provide a range of services.  The Chronically Sick and Disabled Persons Act (1970 S.2) places a duty on the Local Authority to provide services including ‘recreational facilities’ and ‘educational facilities’ to those who are eligible under S.29 of the National Assistance Act.

Crime and Disorder Implications

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

Equal Opportunities Implications (to include Welsh Language issues)

16.        By supporting community groups that promote mental wellbeing and a non-discriminatory image of mental illness in the community, these service developments will reduce the perceived stigma that can be a barrier to using mental health services.

Corporate/Service Objectives

17.        Community Leadership:

CL2       Increase customer satisfaction and improve how customers access services by developing more integrated service delivery with our partners and being more innovative in how public buildings are used.

CL4       Explore opportunities for working collaboratively within the Vale and regionally which will lead to improved services for customers, support innovation and deliver savings.

Health, Social Care and Wellbeing:

HCWB2            Promote and support community facilities to offer a wide range of leisure and social activities helping to improve residents’ health and wellbeing.

Policy Framework and Budget

18.        This is a matter for Executive decision.

Consultation (including Ward Member Consultation)

19.        There are no matters in this report which relate to any individual Ward.

Relevant Scrutiny Committee

20.        Social Care and Health.

Background Papers

Community Opportunities Census


Contact Officer

Lance Carver Head of Adult Services and Locality Manager


Officers Consulted

Andrew Cole, Operational Manager - Mental Health


Responsible Officer

Philip Evans, Director of Social Services