Adferiad Calls for Independent Review into Deaths

Mental health services in Wales are failing people who have a mental illness and who need help and support. Two reports reported in the press last week highlighted some of the problems that are leading to tragic circumstances and unnecessary deaths.

An inquest at Ruthin Coroners Court heard about a series of “gross failures” in the care one of its patients received that led to their death by suicide. Betsi Cadwaladr University Health Board apologised for its failures and said it would make improvements.

A patient absconded from a secure mental health unit and went on to fatally attack their father at the family’s home. An inquest found that failures in the patient’s care had ‘contributed’ to the father’s death. Swansea Bay University Health Board apologised for its failings and said it had put ‘key actions’ in place for improvement.

We frequently hear about instances of poor care and treatment for people living with a mental illness. Report after report has found poor care and treatment planning processes, poor engagement and involvement of people who use mental health services, a lack of involvement and engagement with unpaid carers and family members, a lack of join up between health and social, the list goes on.

Review after review, including those published by the NHS’ own Delivery and Support Unit and Healthcare Inspectorate Wales (HIW), has consistently found and said that Care and Treatment Plans (CTPs) are of poor quality, are not being co-produced, and are not being completed in accordance with primary legislation.

The proposed new mental health strategy does not do enough to identify or detail what actions need to be taken and will be taken to transform mental health services in Wales and ensure they are safe and fit for purpose. There is a conflation between mental wellbeing and mental illness and the determinants of the two are not the same.

We call on the Minister for Mental Health and Early Years to commission an independent review into all the tragic deaths over the last five years where mental illness has been a factor. Can the Minister be confident that the circumstances leading to the two tragedies highlighted earlier won’t happen again in 6 months’ time or beyond. We are not convinced that lessons have been learnt.

Recovery and prudent healthcare in mental health

Models of prudent healthcare for mental health services should focus on two principles:

• That resources are targeted efficiently on moving those patients receiving higher-end (and more expensive) services, where appropriate, into lower-level support services, as this will have the greatest impact in terms of improving people’s lives – and additionally in reducing the cost of their care and treatment
• That intervention is provided at the earliest possible time. Conditions such as schizophrenia and bipolar disorder often require high levels of care and treatment, and by providing this at the earliest possible point we can greatly improve outcomes for people and potentially reduce care and treatment costs

Both the human cost and the financial cost should be considered when developing service models. Recovery-focused services that are co-produced are more likely to result in better outcomes for service users/patients and a reduction in financial cost. Prudent healthcare and value-based principles should be incorporated into all future mental health modelling proposals.

Adferiad’s proposals

1. Make it clear that a priority must be given to providing services for people who are in greatest need
2. Set out clearly the importance of service commissioners and providers planning and delivering services in partnership with people who use services and their carers and families
3. Be measured by how quickly people receive help and how effective that help is in achieving recovery
4. Commit to strengthening people’s rights to care and treatment by tightening the legal requirement for services to deliver on the holistic Care and Treatment Plan mandated in the current Mental Health Measure (This is particularly relevant given the weaknesses in care and treatment planning highlighted by the NHS Delivery Unit and by Healthcare Inspectorate Wales)
5. Make it clear that a person reaching a particular level of care will usually mean that person also meeting the threshold for lower levels of care and support
6. Highlight the vast amount of help and support available across the third sector
7. State clearly and unambiguously that the planning and commissioning of mental health services should be driven by needs determined by what is included in co-produced Care and Treatment Plans
8. Highlight the crucial role that families and carers play in providing support to people living with mental health problems and that this support is reflected in Care and Treatment Plans
9. Set out clearly how it links to existing legislation and addresses whether this legislation needs to be strengthened to ensure its strategic aims are enforced and people’s rights are further protected
10. Highlight the links between mental health and addiction services and the importance of ensuring a joined-up service
11. Commit to piloting in a rural area of Wales a model for mental health services that includes having a single line management structure, a single information system and a single performance management process in place across health and social care within the first 5 years of the new strategy
12. Commit to undertaking a review within the first 5 years of the new strategy to determine whether having larger single mental health teams that incorporate a range of specialist services such as crisis response, home treatment, assertive outreach, etc. can provide better and more responsive services and be more cost efficient