REPORT OF ACTING DIRECTOR OF SOCIAL SERVICES

TO: SCRUTINY COMMITTEE

29TH MARCH, 2000

MENTAL HEALTH SERVICES IN CARMARTHENSHIRE

REF:

 

1. Introduction.

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.

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.

4. Conclusion

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.

ANNEX A

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

 

Ammanford CMHT

1 ASW

Llandeilo/Llandovery

1 ASW

&

Carmarthen Town

Newcastle Emlyn

0.5 ASW

Rehab

1

ASW

Whitland/

St Clears Carmarthen Town

2 Homefinders/

(Homemakers covering the area)

 

1 Support Worker

   

1 ASW

B. COMMISSIONERS OF SERVICES

VOLUNTARY SECTOR PROJECTS RECEIVING FUNDING