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The Welsh Measure AMHPA Conference - May 2013

CPMCA LTD. The Welsh Measure AMHPA Conference - May 2013. A summary of the Mental Health (Wales) Measure 2010 & Issues for Practice. Chris Pearson – May 2013. Purpose of the Measure. CPMCA LTD.

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The Welsh Measure AMHPA Conference - May 2013

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  1. CPMCA LTD The Welsh MeasureAMHPA Conference - May 2013 A summary of the Mental Health (Wales) Measure 2010 & Issues for Practice Chris Pearson – May 2013

  2. Purpose of the Measure CPMCA LTD • Current mental health law is set out in the MH Act 1983. This provides a framework for the compulsory hospitalisation and treatment of certain people with a mental disorder. • Only a very small minority of people with mental health problems need this compulsory treatment. The great majority of people with mental health problems seek treatment on a voluntary basis. • The new Measure deals with accessing and receiving care and treatment within primary and secondary mental health services.

  3. Statutes Supporting The Measure Mental Health (Secondary Mental Health Services (Wales) Order 2012 Welsh Government Policy Implementation Guidance on Local Primary Mental Health Support Services and Secondary Mental health Services for the purposes of the Mental Health (Wales) Measure 2010 Guidance for the local health Boards and Local Authorities on the Establishment of Joint Schemes for the Delivery of Local Primary Mental health Support Services February 2012. Code of Practice to Part 2 & Part 3 of Mental Health (Wales) Measure 2010 – (note: Munjaz (2011). CPMCA LTD

  4. CPMCA LTD The 4 broad intentions of the Measure are: • PT 1: To provide assessment of a person’s mental health and, where appropriate, provide treatment for their mental ill-health within primary care. The Measure places a statutory duty on Health Boards and Local Authorities to develop and deliver local primary mental health support services across Wales.(Commenced October 2012) • PT 2: To improve the effectiveness and coordination of mental health services by creating statutory requirements regarding care and treatment planning and care coordination. (Commenced June 2012)

  5. CPMCA LTD The 4 broad intentions of the Measure are: • PT 3: To require secondary mental health services to have arrangements in place to enable people they have discharged to refer themselves directly back to the service if they believe their mental health is deteriorating significantly, without having to first go to their GP or elsewhere for a referral. (Commenced June 2012) • PT4: To extend the provision of Independent Mental Health Advocate (IMHA) support, which prior to the Measure was only required for patients subject to the longer-term sections of the Mental Health Act, now available to all those patients detained under the Act and those who are admitted to hospital on a voluntary basis. (Commenced January 2012 for short term sections & April 2012 for informal patients)

  6. CPMCA LTD 1. Local Primary Mental Health Support Services: • The aim of Part 1 of the Measure (Sections 1-11) is to strengthen that role by ensuring that throughout Wales there will be local primary mental health support services. These will be delivered by Local Health Boards and local authorities in partnership, and it is expected that these services will operate either within, or alongside, existing GP practices • Sets out who can assess -See the Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012

  7. CPMCA LTD 2. Care Coordination & Care & Treatment Planning: • Part 2 of the Measure (Sections 12-18) places duties on service providers - Local Health Boards and local authorities in Wales - to act in a coordinated manner to improve the effectiveness of the mental health services they provide to an individual. • It also requires that care and treatment plans be provided for service users of all ages who have been assessed as requiring care and treatment within secondary mental health services.

  8. 2. Care Coordination & Care & Treatment Planning: CPMCA LTD • Regulations made under Part 2 of the Measure (the Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011) also prescribe the content and the form of the care and treatment plan which all care coordinators will be required to use.

  9. CPMCA LTD 2. Each care and treatment plan will: • be developed by a care coordinator in consultation with the service user and mental health service providers (although the plan may be developed without the input of the patient where the outcomes cannot be agreed between all parties); • be in writing; • record the outcomes that the provision of mental health services for the relevant patient are designed to achieve; • list these outcomes, record the services and/or actions that are to be provided to achieve each outcome, including when they will be provided, and state who is responsible for providing the service as well as where it will take place; • be kept under review and updated to reflect any changes in the type of care and treatment which may be required by the service user over time.

  10. 3 – Assessments of Former Users of Secondary Mental Health Services : CPMCA LTD • The aim is to enable eligible adults who have been discharged from secondary mental health services, but who subsequently believe that that their mental health is deteriorating to such a point as to require such care and treatment again, to refer themselves back to secondary services directly, without necessarily needing to first go to their general practitioner or elsewhere for a referral. • Part 3 of the Measure (Sections 19-30) requires that Local Health Boards and local authorities have arrangements in place to receive self-referrals of this kind, and to undertake timely assessments.

  11. 4 – Independent Mental Health Advocacy: CPMCA LTD • Evidence suggests that advocacy can lead to an improved experience of mental health services for individuals, including the potential for advocacy to create choice, improve involvement in decision making, and promote access to a range of different services. • Part 4 of the Measure (Sections 31-40) introduces an expanded statutory scheme of IMHA both for patients subject to compulsion under the Mental Health Act 1983, & subject to sections 4,5(2), 5(4), 135 (1) 135(2) and 136 and informal patients.

  12. Key Challenges – PART 1 Part 1: Scheme and Code and a County Model framework sets out what is within Primary Care with a single point of access managed daily by a County Manager. Issues arising local level are IT system compliance, record keeping, e-referrals Meeting timescales for assessments (28 days) and recording Not all Primary Care professionals are co-located with GP surgeries CPMCA LTD

  13. Key Challenges – PART 1 Huge rise in first year referrals when PCMHT set up in 2010/11 in Wrexham – 54% increase. 2011/12 from 1,000 to 4,000. Geographical Borders in Wales– Responsibility to assess person if GP in host area but person lives in another LA. If patient lives in LA ‘A’ in Wales but GP is in LA ‘B’ then it will be LA ‘A’ to assess. More complex with Part 2 patients!! Part 1 should be aimed at an ageless service includes – PCMHT, Memory Service, Psychiatric Liaison, Criminal Justice (liaison to courts/police stations), Veteran Service, Prescribed Medication Service. CAMHS will retain their own services but have challenges around long waiting lists and need to reconfigure services. Implementation funding infrastructure across BCU HB area was £810k across Adult/CAMHS services for additional staff and 3rd Sector. CPMCA LTD

  14. Key Challenges – PART 2 Sets in place Care and Treatment Plan which must ensure recording outcomes that must include (not limited to) achievements in at least one area set out in s.18(1) of Measure. All C&TP must be in place for users in Secondary Care by 6 June 2013 and had a review in past year. Legal challenge if not completed and in breach of Measure. Geographical challenges: Changes to that within Part 1, Part 2 Responsibility to provide Care & Treatment Plan if residency in Wales but placed outside and residency rules apply. If LA in Wales has S117 responsibilities for resident placed outside Wales, Measure still applies. CPMCA LTD

  15. Key Challenges Part 2 Operational Framework set in place to ensure consistency across BCU HB/LAs. Some Councils operate generic older people services so unable to collate/aggregate number supported under the Measure, those subject to Review. Service to older people mental health needs significant structure changes and resources in Primary/Secondary Care services. LD, in or out? IT systems not compatible across 6 LAs CPMCA LTD

  16. CPMCA LTD Parts 3 & 4 Challenges • No real risks/challenges but • Will test out systems to record when person received service previously • Will be a source of information about users experiences but note the Measure revokes IMHA (Wales) Regulations 2008.

  17. CPMCA LTD References: • “Implementing the Mental Health (Wales) Measure 2010”. Updated Guidance for Local Health Boards and Local Authorities. December 2011 • The Mental Health (Wales) Measure 2010 and accompanying Explanatory Notes. • The Mental Health (Wales) Measure 2010: Explanatory Memorandum, incorporating the Regulatory Impact Assessment.

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