REPORT OF ACTING DIRECTOR OF SOCIAL SERVICES
TO: SCRUTINY COMMITTEE
29TH MARCH, 2000
MENTAL HEALTH SERVICES IN CARMARTHENSHIRE
1.1 Shortly after Carmarthenshire came into being in April 1996, the newly-created Dyfed-Powys Health Authority launched its Mental Health Strategy, which seeks to move to localised modern in-patient units, especially for the Llanelli/Ammanford area through the closure of St. David's Hospital. The in-patient units were to be supported by Day Hospitals/multi-agency Community Mental Health Teams (CMHT's) based in the local communities. While these have largely been achieved, with further provision provided in the Towy Valley of the Dinefwr area, the final closure of St. David's Hospital has not yet occurred. Acute in-patient facilities for Llanelli and Ammanford continue to be provided on this site.
1.2 Further, it is now likely that some central facilities for the Pembrokeshire and Derwen NHS Trust will continue to be provided at St. David's Hospital - for example providing specialist rehabilitation care which enables people currently placed outside the area to return and long-term/continuing care for people who are now quite frail with both physical and long-term problems. The eventual reprovision of in-patient acute facilities in Llanelli may take place within the next two years.
1.3 When the Dyfed Powys Mental Health Strategy was launched in 1996, the local authority was very concerned that no funding was likely to flow from the closure/reprovision of health facilities to enable additional community services to be made available. A members working party was set up in June 1996 and made several recommendations to the Dyfed Powys Health Authority resulting from the work undertaken. These recommendations indicated the level and type of provision required to ensure the appropriate level of services in both Health and Social Services. These matters remain partly unresolved, although there has been development as set out later in this report. The Community Mental Health Teams (CMHT) in particular have moved forward in joint working, which continues to develop in order to support people more effectively. Respite and residential services remain relatively under-developed, with child and adolescent services receiving attention through inter-agency planning.
TABLE 1 - Summary Of Health Care And Social Care Service Needs submitted to the Health Authority by the Working Party.
Inpatient emergency and acute admission beds
Social work services (increased numbers of Approved Social Workers)
Inpatient services for the elderly mentally ill
Domiciliary Services (e.g. specially trained Home Care Staff and Support Workers)
Day Hospital Services
Day Care Services
Community based psychiatric and psychology services
Appropriate level of nursing and para-medical staff
Child and adolescent mental health services
Child and adolescent mental health services (social care elements)
Services for mentally disordered offenders
Services for mentally disordered offenders (social care elements)
1.4 Despite the constraints which have prevented the reprovision plans from developing at the pace initially expected, the multi-agency service planning and implementation systems have continued to be led by the Health Authority through their Mental Health Project Manager. This is strongly supported by representatives from the Social Services Department, the Pembrokeshire & Derwen NHS Trust and the Voluntary Sector. Both Health and Social Services give financial and operational support to the voluntary agency, West Wales Action for Mental Health which is a mental health service development agency. This enables two development workers in the County to work closely with other mental health voluntary organisations and service user groups such as the Mental Health Forums. At this stage, the Health Authority retains the lead for strategic mental health planning, while Local Health Groups representatives are closely involved in the joint planning systems.
2. Progress to Date on Social Services Department Provided and Commissioned Services
2.1.1 Annex A (attached) sets out the Social Services role in mental health services.
2.1.2 As will be noted since 1996, some incremental growth in Adult (18-65 years) mental health services has been achieved. In Llanelli, the level of Social Services input to the Community Mental Health Team has increased in line with service need, together with the sustained Day Service provision shared between Wesleyan Hall (Social Services provision), Llanelli MIND and Lynx. Although the Wesleyan Hall model of service, employing a Town Council owned building, has provided an excellent service, its further development, e.g. from 5 to 7 days per week, is constrained by this building. The need to ensure equity in rural areas led to developments in North Carmarthenshire, both to the West (Towy Valley) and to the East. The aim of these developments have been to provide services closer to people's own homes working in local communities.
2.1.3 The Whitland/St. Clears area continues to require development, an aspect which is being addressed in conjunction with the Pembrokeshire and Derwen NHS Trust.
2.2 Services for People who are Elderly and Mentally Infirm
Work has been undertaken in partnership with Dyfed Powys Health Authority to agree a strategy for the care of elderly mentally ill/infirm people across a range of settings. Within the Social Services Department, this will entail building on the successful work undertaken at Y Bwthyn in Llanelli with the intention of replicating similar work elsewhere in the County. The review of day services also offers the opportunity to consider how the needs of vulnerable elderly people who are developing mental infirmity can be met. The aim is to ensure that Social Services and National Health Services dovetail, with the Health Services meeting the needs of people who are more challenging. This strategy will also require development of a range of complementary services from the voluntary and independent sector, involving carers and organisations such as the Alzheimers Disease Society. This will present opportunities for joint commissioning and will be taken forward through the Local Health Groups, Health Authority and the Local Authority.
3. Future Developments
3.1 Service Developments - Social Services Department
3.1.1 Both the Business Plan/Performance Plan 2000/01 and the Social Care Plan have identified the need to continue to develop local authority services, acknowledging that they are currently under-resourced when set against national patterns of service and spending. These plans focus on the assessment and statutory duties carried out within the Area Mental Health Teams as part of the multi-agency Community Mental Health Teams. This will require the development of two Senior Social Work Practitioner posts, to support staff and supervision arrangements in line with action already taken in Adult Services teams. The continuing need for training and professional update requires a dedicated training post to sustain good practice, which will be shared with substance misuse services.
3.1.2 At the same time, the partnerships with the voluntary agencies (listed in Annex A) to maintain a range of 7 day per week activities will be strengthened, as indicated in the Business Plan.
3.1.3 There is a continued commitment from the Department to consultation with service users and carers, which will take place within the multi-agency planning framework, including mental health forums.
3.2 Strategic Guidance
The National Assembly draft Strategies for Mental Health Services for Children and Young People; and Elderly Mentally Ill/Infirm People are shortly to be launched and consulted upon. At the same time, the all-Wales Mental Illness Strategy has been reviewed and is being relaunched. These strategies will inform local planning on service standard setting and the level and range of services to be provided. Meeting their objectives will require links across local authority departments and the Corporate Strategy so that the national priorities, such as Social Inclusion and Employment, are realised for very vulnerable people, who may be subject to stigma and other social inequality.
3.3 Legislative Changes
At the same time, proposals for the reform of the Mental Health Act 1983 are likely to bring both opportunities and challenges. Operationally, major changes in statute require considerable extra work both in staff training and in informing the public.
Mental Health Services have been acknowledged as a high priority for all statutory authorities in this area for some time. The continued shift in resources to mental health within the local authority will be necessary if services are to meet need. While the national agenda is setting the required priorities and standards, it will be up to the local stakeholders to rise to this challenge. However, in order to do so, the support of members and the general public will be crucial.
This document was first introduced to inform the Multi-Agency Planning Groups
CARMARTHENSHIRE COUNTY COUNCIL
SOCIAL SERVICES DEPARTMENT
MENTAL HEALTH SERVICES
The Social Services Department has two main roles in this service.
A. DIRECT PROVIDERS
The Social Services Department have a duty to appoint enough Approved Social Workers (ASW's) to fulfil their obligations under the law (the Mental Health Act, the NHS and Community Care Act and the National Assistance Act primarily) and to provide assessment of needs, input to care planning and support, where appropriate. Approved Social Workers also work in other teams where people experience mental disorder. These include teams working with elderly people and people with learning disability. Although line management rests elsewhere, their initial and continued training and practice development is the responsibility of the Senior Principal Officer (Mental Health). Within mental health services, in order to provide services effectively, the social workers are based in the multi-disciplinary Community Health Mental Health Teams (CMHT's) with their Health Trust colleagues. These are located throughout Carmarthenshire as follows :-
1. ADULTS 16 YEARS - 65 YEARS
1.1 Llanelli CMHT - 13 Goring Road
Social Services element
Team Manager (Malcolm Evans)
(supported lodgings etc)
Wesleyan Hall Day Services
Malcolm Evans is also responsible for Wesleyan Hall Day Services through Sue Daniels and Jackie Lewis the Supervisors. Everyone in the CMHT may refer to Wesleyan Hall.
1.2 Carmarthen and Ammanford CMHTs
North Carmarthenshire is a little more complicated with several small CMHTs covering the former Carmarthen Dinefwr area. A designated social worker may lead for a particular location or speciality but may work anywhere in the whole area as need arises.
Team Manager - Tegwyn Price
(based at Wellfield Resource Centre, Carmarthen)
St Clears Carmarthen Town
(Homemakers covering the area)
1 Support Worker
Day Services Provided directly from the Community Mental Health Team
Rainbow Club - Carmarthen - Financial support and some staff input.
Rainbow Club - Llandovery - Staff input and financial support.
All of these services are responsible to the Senior Principal Officer, Mental Health (Jill Lewis).
2. ADULTS 65 YEARS AND UPWARDS
Within this category are many people who have Mental Health Problems
2.1 Llanelli - Adult Services Teams including 1 EMI Specialist ASW.
There are also other Approved Social Workers in this team including those who provide a service at the General Hospital.
Domicilary day services and residential care in town and outlying areas, especially Y Bwthyn.
2.2 Ammanford - Adult Services Team
Domicilary day services and residential care in town and outlying areas including :
Domicilary, day services and residential care.
2.3 Carmarthen - Adult Services Team
Including 1 EMI Specialist Social worker who is an ASW. There is also another ASW in this team.
Domicilary day services and residential care in town and outlying areas to include St Clears.
3. OUT OF HOURS SERVICES
Outside of office hours Monday - Friday and over weekends/Bank Holidays there is always a social worker who can offer advice and, where necessary, arrange services including access to an Approved Social Worker.
B. COMMISSIONERS OF SERVICES
This includes individual packages of care including residential care based needs; direct funding and support for funding via the Welsh Office. This includes support to many of the established mental health focused voluntary organisations in Llanelli, Carmarthen, Ammanford and Newcastle Emlyn. This support is well established and will develop subject to available finance.
The Strategic Objectives and the purchasing plans are published annually in the Social Plan - this records what we are trying to do, what we have been able to do and what has occurred as a result.
The outlying rural areas of the County, such as Llandovery and Whitland/St. Clears and Laugharne, also require further development so that people are able to receive appropriate services in their own communities.
VOLUNTARY SECTOR PROJECTS RECEIVING FUNDING
Schedule of Voluntary Sector Mental Health Facilities Receiving Funding from Carmarthenshire County Council Social Services Department
This schedule briefly describes the range and distribution of facilities being funded by Social Services in the voluntary sector.
Llanelli: MIND Befriending Scheme
Lynx Silk-Screen Printing Project
Llanelli MIND Centre
Alzheimers Disease Society
Carmarthen/Dinefwr: Carmarthen MIND Centre
Ammanford Support Centre
Newcastle Emlyn: HUTS - Workshop
Llangadog: ACES - Young Person's Group
Carmarthenshire-wide: Arts Care
Welsh Office Mental Illness Strategy - Support to People with Disabilities
The Welsh Office has continued to make 50% grants to voluntary organisations and Social Services Departments for out-of-hours and crisis services to people with severe/long-term mental illness. The Social Services Department funds the other 50% and after 31st March, 2001, is expected to pick up the full cost. The Social Services Department is therefore continuing its commitment to the voluntary sector in addition to developing its own services.
The organisations benefiting from this are:
· Carmarthen MIND
· Llanelli MIND
· Ammanford Support Centre
· HUTS - Sheltered Workshop, Newcastle Emlyn
· ACES Day Activities, Llangadog