Members’ Research Service: Topic Brief Gwasanaeth Ymchwil yr Aelodau: Papur Byr Mental health Introduction At any one time, as many as 1 in 6 adults in the UK are affected with a mental illness and 1 in 4 people will seek help for mental health problems. During 2004-05, 9 percent of all adults in Wales reported being treated for a mental illness.i In 2001, the Assembly Government made mental health one of its top three health priorities. Adult Mental Health - The provision of adult mental health services is the responsibility of Local Health Boards (LHBs), apart from some specialised services which are commissioned on an all-Wales basis by Health Commission Wales (HCW). The Assembly Government published an adult mental health strategy in 2001 and their approach to mental health provision has been to move away from the large institutional services to community settings, with inpatient and community services provided in appropriate, fit for purpose environments, with people treated in the least restrictive setting possible. These priorities are reflected locally within Health, Social Care and Well-being Strategies. Child and Adolescent Mental Health Services (CAMHS) - The Assembly Government published its 10-year strategy for the improvement of child and adolescent mental health services in 2001. The strategy describes a four-tier concept for CAMHS services, which also provides the basis for how services are commissioned: Tier 1 - primary or direct contact services, commissioned by LHBs. Tier 2 - first-line specialist services provided by professionals from Specialist CAMHS whose primary role is mental healthcare, commissioned by CAMHS Commissioning Networks (CCNs). Tier 3 - second-line specialist services provided by teams of staff from within Specialist CAMHS, some services are commissioned by CCNs and some by HCW. Tier 4 - very specialised interventions and care (including in-patient services), commissioned by HCW. CAMHS provision at all levels and through all agencies is to be reviewed independently over the next 12 months by the Wales Audit Office and Healthcare Inspectorate Wales. Overview of current statutory powers of the Assembly “Health and Health Services” is Field 9 of the Government of Wales Act 2006. The Assembly could, in accordance with the Government of Wales Act 2006, pursue an Order in Council seeking Measure- making powers to enable it to legislate in relation to specific matters connected with mental health. Not all the powers relating to mental health are devolved – those that relate to mental health and the criminal justice system are the responsibility of the Home Office. Given that where treatment has been prescribed by either the courts or the Home Secretary it is a non-devolved issue, the Assembly would need to ensure that the proposed exercise of such powers would interface with both the devolved and non-devolved areas of mental health provision in Wales. Forthcoming EU and UK primary legislation The Mental Health Bill was introduced in the House of Lords on 16 November 2006 and received its second reading in the House of Commons on 16 April 2007. The current Bill has proved controversial having been heavily amended during its passage in the House of Lords. The Health and Social Services Committee scrutinised the Bill In January 2007 and found it to be deeply flawed. EU policy Although the Commission has no competence for health services, it can support national action in the field of public health and facilitate co-operation between Member States. The Commission published a Green Paper on establishing an EU mental health strategy in October 2005, to which the Second Assembly's Health and Social Services Committee responded. The Commission is now drafting a Communication setting out a strategy on mental health which is expected in July 2007. One key objective will be to set a target for suicide reduction in the EU. The strategy will cover a wide scope including promotion of mental health in children and at the work place to better social inclusion of people with mental illness, the protection of their human rights, and the availability of proper policy frameworks.ii MRS070949 April 2007 Key Assembly Government strategy documents and action plans from the Second Assembly: ♦ The Adult Mental Health Strategy, Equity, Empowerment, Effectiveness, Efficiency, Sept 2001.iii ♦ The revised Adult Mental Health National Service Framework (NSF) and Action Plan for Wales, Raising the Standard, were published in October 2005.iv A key action of the revised NSF calls on the Local Authorities and LHBs to promote social inclusion by taking fully into account the needs of people with mental health problems when developing or implementing policies across the range of their responsibilities. ♦ The Child and Adolescent Mental Health Services Strategy, Everybody’s Business, September 2001.v ♦ Chapter four of the NSF for Children, Young People and Maternity Services relates to Children and Young People with Mental Health Problems and Disorders. vi ♦ The Assembly Government’s Mental Health Promotion Action Plan (consultation document), September 2006,vii aims to improve mental health and wellbeing in Wales, reduce stigma and discrimination and promote social inclusion for people experiencing mental health problems. Legacy issues from the Second Assembly Mental health remained one of the Health and Social Services Committee’s priority areas during the second (and first) Assembly. The Committee’s legacy paper highlighted the following high level strategic issues for the attention of the Third Assembly: ♦ The capacity of the NHS and its partners to meet the physical and mental health needs of the population. ♦ Improving health. ♦ Protecting the most vulnerable in the population, i.e. children, disabled and elderly adults. Given the Committee’s view that the current Mental Health Bill before Parliament is deeply flawed, the legacy paper also recommended that a close watch be kept on developments to ensure that the provision for Wales is sustainable and compatible with mental health policy in Wales. Useful links 1. MIND (incorporating MIND Cymru: http://www.mind.org.uk/About+Mind/Mind+Cymru/) is the leading mental health charity in England and Wales http://www.mind.org.uk/ 2. Hafal is the principal organisation in Wales working with individuals recovering from severe mental illness. http://www.hafal.org/english/news.php Further information For further information on any aspect of mental health policy, please contact: Kathryn Potter, Members’ Research Service on ext. 8038 [email protected] i National Assembly for Wales, Welsh Health Survey 2004/05, http://new.wales.gov.uk/topics/statistics/publications/health-survey2004- 05/?lang=en ii European Commission's website on mental health, http://ec.europa.eu/health/ph_determinants/life_style/mental_health_en.htm iii Welsh Assembly Government, Adult Mental Health Services for Wales, Equity, Empowerment, Effectiveness, Efficiency, Strategy Document September 2001, http://www.wales.nhs.uk/publications/adult-health-e.pdf iv Welsh Assembly Government, Raising the Standard, The Revised Adult Mental Health National Service Framework and an Action Plan for Wales, 2005, http://www.wales.nhs.uk/sites3/Documents/438/Raising%20the%20Standard%20%28english%29%2Epdf v Welsh Assembly Government, Child and Adolescent Mental Health Services, Everybody’s Business, Strategy Document, September 2001, http://www.wales.nhs.uk/publications/men-health-e.pdf vi National Service Framework for Children, Young People and Maternity Services, February 2006, http://www.wales.nhs.uk/sites3/Documents/441/EnglishNSF%5Famended%5Ffinal%2Epdf vii Welsh Assembly Government , Mental Health Promotion Action Plan for Wales, September 2006, http://new.wales.gov.uk/docrepos/40382/40382311111/comms/consultations/2006/mental-health-plan-e?lang=en MRS070949 April 2007 .