The hallmark of a civilised society

Mental health services in Wales are still failing many vulnerable young people

LAST year I read evidence to the Assembly’s Children and Young People Committee on behalf of a teenage girl who had been placed on a male psychiatric ward while in local authority care.

Before going into care she had been abused and lost a close family member, but she was considered to be out of control. Instead of bereavement counselling and the support of the right health services, she was pushed from one secure mental health unit to another, often hundreds of miles from her home. She was too unwell to appear in front of the committee but wanted everyone to know what she had gone through to stop it happening again.

Sadly, however, it hasn’t stopped happening. The first ever report published collectively by Healthcare Inspectorate Wales, the Wales Audit Office, Estyn and Care and Social Services Inspectorate Wales – shows that mental health services in Wales are still failing many vulnerable young people.

One of its key criticisms was the inappropriate use of adult mental health wards for “significant numbers” of children and young people because of insufficient emergency beds and inadequate assessment for young people, particularly out of hours.

Other findings in this 109–page report are just as damning. In Wales there are no specialist services for under fives unlike other parts of the UK, access to specialist mental health services for children depend on where you live and specialist teams in many parts of Wales are struggling to provide services at all.

Many services, it found, are not child-friendly and transition arrangements from child to adult services are simply “not good enough”.

Though it acknowledged that some recent improvements had been made, it also specifically criticised the Welsh Government for being unclear in how policy should be implemented and for providing limited support and guidance to organisations that provide services locally.

Despite these failings and 16 recommendations to improve the way services are planned and provided, health minister Edwina Hart dismissed the report as “out of date”, although it drew on evidence from 2007 to as recent as August 2009. Although Mrs Hart’s press team excluded that particular phrase in a later statement, the health minister has still not committed specifically to the report’s demand for a six-month action plan to address the clear gaps that exist in vital services.

Dismissing the findings of independent organisations whose only aim to is to highlight bad practice in order to make things better appears to be a symptom of why improvements are not being made fast enough in Wales.

Two weeks ago, the Welsh Government seemed equally keen to absolve itself of any responsibility for serious failings in the case of the death of Father Paul Bennett. An independent review published by the Healthcare Inspectorate Wales (HIW) two weeks ago found that although Father Paul’s death could not have been predicted, the chances of it happening could have been significantly reduced if several opportunities to treat the person who killed him had not been missed.

Its finding was that if Geraint Evans had received a full psychiatric assessment after a self-harming incident, a diagnosis of psychosis could have been made and appropriate treatment given, reducing the likelihood that he would have committed an act of violence.

Despite these clear failures, the Welsh Government chose only to highlight the first part of HIW’s report and that “his mental state was never known fully known to any medical services”. There was no acknowledgement or apology that this was because the services meant to protect him had simply failed him, and his victim.

Those on the frontline know what the challenges are today. One GP I spoke to said that links between primary care and secondary care are still a major issue. There are still long waiting times for treatment, such as cognitive behavioural therapy, and inequalities all across Wales in the provision of specialist services.

A senior source with knowledge of CAMHS services also told me that while adult mental health services are already underfunded, children and adolescent services are the ultimate “Cinderella” service. The lack of proper structures for children’s mental health services and poor communication between agencies means that mental health wards often become “dumping grounds” for those who cannot easily be treated.

The Welsh Government estimates that more than 40 per cent of young people have recognisable risk factors. Up to 25% may experience a more severe or persistent mental health disorder. The need is clear, yet how many of these are still slipping through the net?

Last month an inquest heard that a 17-year-old A-level student from Mid Wales hanged himself because he was so afraid of the voices in his head telling him to kill people. Rather than risk that horror he decided he was better off dead himself. Despite being on course for university, this teenager was suffering alone as a result of a potentially serious, but treatable, mental illness that no one had picked up.

In pursuing his cause to bring mental health legislation to Wales, Conservative AM Jonathan Morgan said he believed that mental health reform was the “last great social reform for our country” and vital if we are to call ourselves a civilised society. Preventing tragic and unnecessary deaths in our young people is surely a hallmark of such a society.

Today, he reaches a key point in his campaign. His proposed LCO, which will be debated in the Assembly before being passed to Westminster for the final time, will help change the way in which mental health services are designed and delivered in Wales.

It will give the Assembly the ability to enshrine in law a right to assessment and treatment in a therapeutic setting before compulsion becomes the only safe option, as well as a right to independent advocacy.

This will undoubtedly help to end the current approach of planning services around whether someone’s need meets a service’s criteria, rather than building services around the specific needs of the individual.

On Monday England took a step in this direction by publishing its innovative new strategy on mental health, New Horizons.

Increasing job opportunities for people with mental health conditions and helping employers to support those with difficulties are part of a new vision to enhance mental services and address some of the wider social implications. A new network of mental health co-ordinators will be available in every Jobcentre Plus district and occupational health advice lines are being set up to give small businesses advice on how to keep their employees in work.

Measures such as these will not only help identify those in need of support but will de-stigmatise mental ill health by giving everyone a responsibility for addressing it.

‘Life-threatening conditions like cancer or heart disease prompt sympathy and understanding. But mental health is all too often shrouded in mystery, stigma or simply forgotten, said health secretary Andy Burnham.

The Assembly Government insists that mental health is already one of its key health priorities and that key recommendations in last month’s report have already formed the basis of government policy. ‘Speed of access to services and staff numbers have increased in the last two years,’ a spokesman said.

‘Waiting times for specialist services have fallen by almost 10 per cent, with nine in 10 new cases seen within the target time.

‘Specialist nurse numbers have increased by 15 per cent, the number of clinical psychologists has more than doubled, and the number of mental health workers in primary care have almost doubled with specialist training courses rolled out for frontline staff.’

Despite this, ministers have to face the fact that four major organisations concluded last week that “the scale of the task ahead in developing comprehensive and effective services is considerable.”

They, and many on the frontline, believe there is much the Assembly Government can do with its existing powers.

Better legislation in Wales has the potential to make a vast improvement to services, but the willingness of ministers to accept that they can do better with what they’ve already got will go a long way.