Mental Health Services in Wrexham
This chapter of the Social Care Plan has been written by the Wrexham Mental Health Planning Group. This consists of representation from Social Services Department (Lead Manager and Team Managers CMHTs’), North East Wales NHS Trust (Directorate Managers), Service Users, Brighter Futures, Local Health Group, Unllais, Wrexham Mind, Consultant Psychiatrist (Directorate Manager), NSF Cymru, and Officers from Planning & Development.
National / Local Strategies
There are a number of strategy developments that will shape the future development of mental health services in Wrexham. These are: -
- Adult Mental Health Services for Wales
- North Wales Strategy for Adult Mental Health
- National Service Framework for Mental Health in Wales
- Health Act 1999 (Flexibilities)
- Health Improvement Programme
- Best Value and Clinical Governance
Copies of these documents can be obtained from Planning & Development Team, Personal Services Directorate, Lambpit Street, Wrexham 01978 292966
Strategic Vision
The Planning Group has agreed the following strategic vision for mental health services in Wrexham that recognises the values that underpin the strategies above:
(a)To ensure good mental health promotion is at the heart of our approach to services.
(b)To educate the public about the effects and treatment of mental illness in order to develop positive attitudes, reduce stigma and incorporate mental health into the wider health, well being and social agenda.
(c)To provide equitable access to mental health services for people of Wrexham in need of mental health services, irrespective of gender, sexuality, disability, race, or social, cultural and religious background.
(d)To actively involve service users and carers in the planning, commissioning, monitoring and delivery of services.
(e)To ensure joint working & good communication between Social Services, Health Authorities and the voluntary and private sectors in order to commission an effective, comprehensive and co-ordinated mental health service which will enable us to provide an efficient, responsive and seamless care package.
(f)To support service users, and their carers in ways which enhance their ability to cope & remain in control of their lives and to promote the integration of service users into all aspects of community life.
(g)To assess the medical, psychological and social needs of service users and carers at appropriate times with reviews at regular intervals.
(h)To provide effective and high quality care based on the best evidence and to include provision for medical, psychological and social needs of service users and carers of people with mental health problems
(i)To protect service users, carers and the public from avoidable harm whilst respecting the rights of users and their carers.
(j)To recruit and retain highly trained staff of all disciplines who are confident in their skills and who have high morale.
(k)To review all aspects of service to ensure best value in clinical governance and such a process should include all relevant stakeholders.
The above highlights the objectives we are striving to achieve both broadly and specifically and will be measured against the principles and aims laid down in the Adult Mental Health Services for Wales in terms of equity, empowerment, effectiveness and efficiency.
Person Centred Planning
Members of the Mental Health Planning Group in 2001/02 undertook a “gap analysis” of mental health services in Wrexham. Because of the multi-disciplinary approach within mental health services, this analysis aimed to identify both social and health issues. This person-centred approach to needs analysis revealed the following: -
1.A Place To Live
There is active partnerships with Local Authority Housing Department, Housing Associations and voluntary Organisations (e.g.: Womens Aid and MIND) to provide a range of housing / tenancy support services. Supported living arrangements are in the early stages of being developed with a new scheme commencing in May 2002. A further scheme is to be set up in September 2002. It is anticipated that the new appointment of a Special Needs Housing Co-ordinator in June 2002, through Flexibility funding, will promote further positive developments.
The Social Services Department and Housing Department are working together to ensure that the “Supporting People” legislation is used to maximise applications for Transitional Housing Benefit to enable people to be supported independently in the future. More information on the ‘Supporting People’ scheme is included in Section 8.4 of the General Information chapter of this Social Care Plan
- Having a Voice
A number of voluntary organisations working in Wrexham provide support and advocacy for service users. However it is acknowledged that information is often not user friendly or available in a wide enough range of styles and formats. There is a need for more user and carer involvement and consultation including the views of people who may be socially isolated such as children with parents who have a mental health problem. It is also acknowledged that further development needs to be done in gaining user and carers views of services.
- Jobs / Occupation
The Local Authority and North East Wales NHS Trust should act as role models with regard to the employment of people with mental health problems. There are currently Work Opportunities schemes provided by Social Services Department but options for people to move on from these are limited & better links are needed between the Social Services Department and Employment Services. It must be recognised that both flexible & meaningful employment options are needed such as job sharing. The provision of a Support Worker to encourage people with mental health problems to participate in voluntary work is acknowledged as being a valued but limited service.
The Work Opportunities Service for people with a learning disability are undertaking a management review of their services in 2002 and this will include reviewing access to Work Opportunities for people with mental health problems.
- Learning
Day Services provide a range of learning opportunities and NEWI have a Disability Liaison Officer to facilitate access courses, however it is noted that often support is needed to enable and encourage people to attend, for example, Project Workers.
- Carers
A range of voluntary organisations in Wrexham provides support for carers. However, there is a gap in the range and choice of respite care available within Wrexham, particularly emergency respite. It is acknowledged that statutory bodies need to actively involve carers in the planning of care and support and to offer Carers Assessments to all carers.
- Health
Primary Care (First Access Team) and Secondary Care (Community Mental Health Team) services link to other professionals who support health care needs. People who suffer mental health problems also suffer from poor physical health and are more prone to life threatening illnesses due to poor diet, lifestyle and long term effects of psychiatric medication. To address this, the Local Health Board initiative, “Hearts and Minds”, enables people with mental health problems to have a full medical screening through their General Practitioner. However gaps exist in providing a person-centred approach for specialist outreach work in a number of areas, including the ability to support vulnerable and high-risk people in the community at times of crisis.
There is no appropriate in-patient unit for seriously disturbed adolescents or for those adolescents requiring compulsory assessment/treatment under the Mental Health Act 1983.
There are difficulties for people with Learning Disabilities to access mental health services and vice versa.
- Planning for Life
An assessment of need is central to any person centred approach. Assessments must be completed for each service user and it is essential that each user of the service feel "heard” and has good advocacy to enable them to do so.
It is felt that sound foundations are in place to enable users to be at the centre of care planning and this will be enhanced by the adoption of the Care Programme Approach within Community Mental Health Teams. However, more work is needed to enable a seamless transition from children’s to adult services. It is important to continue to involve and consult with users and carers in relation to planning, monitoring and delivery of services.
To assist with planning for life, an integrated Community Mental Health Team for people with mental health problems is needed to enable people to access services easily. As the Care Programme Approach is about multi-disciplinary working within Teams, any training on the role of team members is facilitated in the same way. The Social Services Department and North East Wales NHS Trust have accessed ‘Flexibilities’ funding to provide joint training and aid the process of integrated team working.
- Money / Income
The specialist service provided by the Social Services Department’s Welfare Rights Unit has enabled users to access a range of entitled benefits. Voluntary Organisations in Wrexham supplement this work (see ‘Summary of services available for people with mental illness in Wrexham’) by offering benefit support and advice.
- Support In Daily Living
There is a range of services available to support and assist people to remain in their own homes. However there are no local respite residential care for people with mental health problems. Although the Social Services Department has an Out of Hours Emergency Duty Team, there is no joint Social Services Department and North East Wales NHS Trust 24 hours Crisis Service.
- Leisure & Social Activities
The Social Services Department, Independent and Voluntary Sector provide Day Services to support and encourage people to take up new leisure interests.
- Information
It is agreed that there are pockets of good practice across Wrexham with regard to information but this would benefit from being better co-ordinated, more accessible and targeted. The Social Services Department is working in partnership with others to develop a Communications Strategy for the people of Wrexham.
The Community Mental Health Teams and Primary Care First Access Team in Wrexham have an outmoded data information system. This will be addressed during 2002 – 2003 through the proposed replacement of the Adult Services Management Information System and the development of unified Referral and Assessment documentation for all adult services.
12.Keeping Safe
Community Mental Health Teams in Wrexham have formal arrangements in place with North Wales Police around protecting vulnerable adults with mental health problems.
The Social Services Department has a responsibility to provide support and care to people most vulnerable in the community. The Department has in place procedures to respond to adult abuse effectively, in conjunction with other relevant agencies. The Council is committed to raising awareness of abuse and protecting vulnerable adults.
Statistical and Budgetary Information
The following graphs illustrate the allocation from within the Mental Health Services budgets for 2001 – 02 and 2002 - 03 to particular service areas. It will be noted that for 2002 – 03, the total budget has been increased by £131,237 from £1,494,733 to £1,625,970. This represents an increase of nearly 9%.
Within this overall increase, the ‘Community Care’ budget heading has increased by over £64,000. This is an increase on the previous year’s budget for Community Care of almost 32%. The amounts included in all of the other budget headings for 2002 – 03 have increased. Some of the increases have been relatively low (less than 1%), whereas others have increased by almost 10%. However, the division of the overall budget has remained fairly constant.
Within Mental Health Services budget Professional Services comprise a much larger element than is found with other service user groups. This reflects the pattern of service delivery, that is, through social workers providing on-going support to service users.
Priority Areas For Development
From the over arching strategic objectives outlined above, the Planning group have identified and agreed the following key objectives as priority areas for development to ensure that the strategic objectives within the vision statement are achieved. For each of these key priorities, objectives have been developed
Objectives
- For this to be recognised and developed as a key role of the First Access team
- To link with the health promotion responsibilities of the Local Health Boards when they are formed
- To strengthen links with Primary Health Care Teams through Hearts & Minds and First Access Team
- To work closely with voluntary organisations to ensure a high level of public information is available in Wrexham
- Establish a baseline of current access to services
- Develop an action plan to address issues arising from baseline assessment
- Work closely with Primary Health Care Teams to ensure appropriate referrals to the range of mental health services
- Explore, through use of Health Act Flexibilities, integrated provision of Community Mental Health Teams (CMHTs)
- Adopt Care Programme Approach within CMHTs' to ensure that users and carers are at the heart of the care planning process
- Ensure close links across service areas / planning forums to facilitate seamless service provision e.g. learning disability, transition
Explore, through use of Health Act Flexibilities, integrated provision of Community Mental Health Teams (CMHTs')
Adopt Care Programme Approach within CMHTs' to ensure that users and carers are at the heart of the care planning process
Ensure close links across service areas / planning forums to facilitate seamless service provision e.g. learning disability, transition
- Undertake a full review of work opportunities / day services in consultation with all stakeholders
- Continue to develop supported housing options / tenancy support for service users
- Explore ways of extending services / developing new services which will enable service users to be supported in the community
- Explore resource implications and identify funding sources / options
Annexe A
Summary of services available for people with mental illness in Wrexham
Service mapping has shown the following services to be available for people with mental health problems, and their carers, in Wrexham County Borough:
Advance / Provides appropriate formal advocacy for anyone who is affected by mental health problems. Aims to promote the rights of individuals and raise awareness of the needs of people affected by mental health problems. Service is based at 3 Belmont Road in Wrexham. / 01978 354737
Advance Brighter Futures / Voluntary organisation providing a wide range of support services including advocacy; outreach and drop in & resource centres; special interest support groups; information service; a Patients Council and co-ordinates User representation in the planning implementation and monitoring of mental health services.
Advance Brighter Futures - Belmont Road Partnership House / Belmont Road offers support, information and recreational facilities to people who are affected by mental health problems in Wrexham. The House is open during the weekday, weekends and during holiday periods. / 01978 310247
Bridges / A Local Authority Work Scheme, providing work-related activities for people with mental health problems. / 01978 366858
Brighter Futures / Is a user led organisation for people whose lives are affected by mental health problems. / 01978 313560
01978 356789
Centre 67 / A day centre operated by social services providing a range of activities for people with mental health problems. It is open 7 days a week plus 2 evenings. / 01978 264344
Coed Celyn Rehabilitation Unit / An NHS North East Wales Trust in patient facility for people suffering serious mental illness which provides support to help rehabilitate clients to fulfil their potential to live in a community setting. / 01978 313105
Community Advice and Listening Line (C.A.L.L) / An advice and listening line covering the whole of Wales for people. / 0800 132737. (Helpline)
01978 132737 (Office)
Community Mental Health Teams / A multi-disciplinary team who provide support to people with enduring mental health problems. The teams comprise of professionals and direct support staff from social services and health who work in close liaison with other agencies. / 01978 355783
Elmbridge / A Local Authority Work Scheme, providing work-related activities for people with mental health problems. / 01978 366858
First Access Team / A new team set up in November 2001. Staff from Social Services and the NHS NEW Trust health working together to support the health of people with mild to moderate mental health problems. The team works closely with Primary Care. / 01978 356703
Focus / A Local Authority Work Scheme, providing work-related activities for people with mental health problems. / 01978 366858
Housing – Aids and Adaptations / Wrexham CBC Development Services Directorate can provide advice and assistance on renovation and disabled facilities grants / 01978 292566
Llwyn-y-Groes / An NHS North East Wales Trust in patient facility providing 24 hour care and treatment for adults suffering from serious mental illness. / 01978 291100
Masquerade / A Local Authority Work Scheme, providing work-related activities for people with mental health problems. / 01978 366858
National Schizophrenia Fellowship Cymru - Break-a-way / Provision of a range of choices & opportunities for short breaks in response to the expressed needs of carers & families coping with the everyday effects of enduring mental health problems / 01978 310936
National Schizophrenia Fellowship Cymru - Dolen / Provides support to families and carers through a family Support Worker based with CMHT Wrexham. / 01978 355783
National Schizophrenia Fellowship Cymru - Wrexham Outreach Tenancy Support / A pilot project that provides support to tenants with mental health problems. / 01978 310936
Stepping Stones / Offers group work and individual counselling to adult survivors of childhood sexual abuse. / 01978 354759
Unllais / A development, information & training agency which provides support to the voluntary sector, service users & cover organisations working in the field of mental health. / 01352 718058
Wrexham Mind / Provision of information, health promotion, counselling & support. Also operates a supported housing project. / 01978 366155
Wrexham Relate / Counselling agency specialising in relationships. Provides services to adults, either as couples or individuals. / 01978 265028
1