Overview
Many people underestimate the impact mental health conditions can have on individuals, society and the economy as a whole. At any given time, one person in six is experiencing anxiety or depression, and mental illness accounts for up to a third of all illnesses in the UK.
The total cost to the UK of mental health conditions runs into tens of billions of pounds a year, due to loss of earnings and associated treatment and welfare costs. But the cost to an individual can be a lot greater; left untreated, mental health conditions can result in unemployment, homelessness, the break-up of relationships and suicide.
Welsh Government Strategy for Mental Health
Together for Mental Health is the 10-year strategy for improving the lives of people using mental health services, their carers and their families in Wales which started in 2012. This strategy is currently being reviewed by Welsh Government and the NHS executive.
At the heart of the strategy is the Mental Health (Wales) Measure 2010, which places legal duties on health boards and local authorities to improve support for people with mental ill-health. The Measure introduced local primary support services for lower level problems and ensures all people in specialist mental health care have holistic care and treatment plans, rights to re-access assessment when discharged and rights to advocacy for people who are in hospital.
Together for Mental Health is supported by 3 year delivery plans, which aim to take forward improvements in mental health and wellbeing in Wales, as well as in mental health services. The delivery plan focuses on areas such as dementia, perinatal mental health and improving mental health care in general hospitals.
Work is ongoing to improve child and adolescent mental health service (CAMHS) provision with the NHS leading a programme of work Together for Children and Young People. This aims to improve access to CAMHS and develop new services following Welsh Government investment.
Service Description
Mental Health Care Professionals
Mental health conditions can be complicated to treat as they can impact on a wide range of issues, such as housing, employment, relationships and physical well being.
Due to this, there are a number of different mental health care professionals, each with their own specialised expertise; some of which are outlined below.
GPs
Your GP will often be your first point of contact with the mental health services. It is estimated that people with emotional or psychological conditions make up between a quarter and a third of a GP's workload.
GPs can make an initial assessment of a mental health condition, prescribe medications such as anti-depressants, and arrange referrals to other services and treatments, such as counselling if necessary. For many people the support of their GP is enough to manage their mental health.
Primary Mental Health Support Services (PMHSS)
Each local authority in Wales will have a local Primary Mental Health Support Service whose key purpose is to provide:
- mental health assessments for a person who has first been seen by a GP who thinks that a more detailed assessment is needed.
- short-term interventions (i.e. treatment), either individually or through group work. The type of intervention could include counselling, a range of psychological interventions, family work, online support, stress management, bibliotherapy and education.
- onward referral and the co-ordination of next steps with secondary mental health services.
- support and advice to GPs and other primary care providers (such as practice nurses) to enable them to safely manage and care for people with mental health problems.
- provision of information and advice to individuals and their carers about interventions and care – for example support provided by third sector organisations and help to access them.
The GP can arrange a referral to the PMHSS and sometimes this will also be done by a mental health professional working in Community Mental Health Teams.
Community Mental Health Nurse (CMHN)
A community mental health nurse (CMHN), sometimes known as a community psychiatric nurse or CPN is a registered nurse with specialist training in mental health. Some are attached to GP's surgeries or community mental health centres while others work in psychiatric units.
CMHNs have a wide range of expertise. They can provide counselling, offer advice and support to people with long-term mental health conditions and administer medication.
Some CMHN's specialise in treating certain people, such as children, older people, or people with a drug or alcohol addiction.
Clinical psychologists
Clinical psychologists are health professionals who specialise in the assessment and treatment of mental health conditions using psychological interventions (or talking treatments). They often work in combination with other mental health care professionals in multi- disciplinary teams.
Psychiatrists
Psychiatrists are qualified medical doctors who have done further training in treating mental health conditions. Psychiatrists are not just based in hospitals but can have close links with GP's surgeries and community mental health centres.
Counsellors
Counsellors are individuals who have been trained to provide talking therapies that aim to help people cope better with both their life and their mental health condition. Most counsellors specialise in a specific type of therapy, such as cognitive behavioural therapy (CBT).
Psychotherapists
Psychotherapists have a similar role to counsellors, but they usually have more extensive training, and are also often qualified psychologists or psychiatrists. Psychotherapy tends to be a longer and more intense process than counselling.
Occupational therapists
Occupational Therapists in mental health provide training, support and advice to help someone to reach their maximum level of function and independence for day- to day living, including personal independence, communication skills, self-confidence, employment, social and leisure activities and interpersonal relationships.
Social workers
Social workers are often a bridge between mental health services and the wider social services provision. They can provide advice on practical issues such as finances and welfare benefits, housing options, independent living support and education or training opportunities.
Approved Mental Health Professional (AMHP)
An approved mental health professional (AMHP) is a Social Worker, Mental Health Nurse, Occupational Therapist or Psychologist who has completed additional comprehensive and specialist training in order to be approved by the Local Authority and to fulfil designated functions under the Mental Health Act(MHA) (1983). Their functions can include arranging an assessment of whether a person needs to be compulsorily admitted to hospital as part of their treatment (sectioned).
An AMHP is also responsible for ensuring that the human and civil rights of a person being detained under the Mental Health Act are respected and upheld. For more information on the Mental Health Act see the section below about hospital care.
Community Mental Health Teams (CMHTs)
Community mental health teams (CMHTs) work to help people with complex mental health conditions, such as schizophrenia or bipolar disorder (manic depression).
They aim to provide the day-to-day support a person might need to live independently in the community.
Crisis Resolution and Home Treatment Teams (CRHTTs)
Crisis resolution and Home Treatment teams (CRHTTs) treat people with mental health conditions who are currently experiencing an acute and severe psychiatric crisis, which without the involvement of the CRHTT, could lead to an admission to hospital. Examples of an acute psychiatric crisis includes a psychotic episode or a suicide attempt.
Due to the nature of their work, CRHTTs offer extended hours service, and people are often referred to them via A&E Departments or the police service.
The CRHTT will aim to support and treat a person in the community where possible This can be in a person's own home, in dedicated crisis houses or a hostel, or in a day service centre.
CRHTTs are also responsible for planning follow-on support and treatment with other mental health services once the crisis has passed in order to prevent a further crisis from occurring.
Early Intervention in Psychosis Services (EIPs)
Psychosis is a term that is used to describe a mental condition where someone is unable to distinguish between reality and their imagination. An episode of psychosis is usually caused by an underlying serious mental health condition such as schizophrenia or bi-polar disorder, or as a result of drug or alcohol abuse.
The early intervention by the psychosis services (EIPs) is designed to work with people aged 18-35 who have experienced their first episode of psychosis. In the past, it could take up to two years after the onset of psychotic symptoms before someone started receiving treatment and help.
Now, the EIPs focuses on the early detection and assessment of psychotic symptoms and then provides support and counselling in order to treat the underlying causes.
Early intervention can often be crucial because it is during the first few years that people with psychotic symptoms are at greatest risk of harm; both to themselves and to others. Also, the earlier a serious mental condition is treated, the better the long-term outcomes tend to be for a person’s recovery
Mental health facilities
Outpatient clinics
Most people living with a mental health condition can be treated on an outpatient basis, meaning they will not have to stay in a hospital or psychiatric unit.
Treatment can take place at a dedicated community mental health centre, a day clinic that operates out of the local hospital, or in some larger GP surgeries.
Hospital care
People can agree to an admission to hospital if their psychiatrist recommends that this is the best could of care and treatment.
People can also be compulsorily admitted and detained in a hospital under the Mental Health Act. This law says that somebody can only be compulsory detained in a hospital for the assessment and treatment of a mental disorder, such as schizophrenia, and detention is necessary:
- in the interests of their own health,
- in the interests of their own safety, and/or,
- for the protection of other people.
A person who is detained in hospital under the Mental Health Act has a right to appeal their detention through an application to the Hospital Managers and/or the Mental Health Review Tribunal. The hospital has a duty to explain to a person their rights and how they can appeal. All people being treated in hospital will only stay as long as is absolutely necessary to assess and treat the mental disorder and for discharge support plans to be put in place when needed.
Regional secure units
Regional secure units are medium-security psychiatric units. They are used to treat:
- people who have been admitted by the courts under the Mental Health Act,
- people who have been transferred from prison under the Mental Health Act, and
- people transferred from an ordinary hospital ward because it is felt they need to be treated in a more secure setting.
Secure hospitals
Secure hospitals are high-security hospital used to treat people held under the Mental Health Act who are thought to pose a significant risk of harm to the public. There are three secure hospitals covering England and Wales: Ashworth, Rampton, and Broadmoor.
How to use it
GPs and counselling
If you are concerned about your mental health, you should first visit your GP. GPs, in combination with counsellors, can successfully treat some less complex mental health conditions such as mild to moderate depression, anxiety, and some eating disorders.
Your GP will be able to prescribe any medicines that are needed to help with your symptoms and also to refer to a counsellor.
An increasing popular type of therapy for a wide range of mental health conditions is cognitive behavioural therapy (CBT).
CBT is based on the assumption that most unwanted thinking patterns, and emotional, and behavioural, reactions are learned over a long period of time. The aim is to identify the unhelpful thinking that is causing the unwanted feelings and behaviours and then to learn to replace this thinking with more realistic and balanced thoughts.
A course of CBT therapy can last between 5 to 10 weekly sessions, with each session lasting between 30 and 60 minutes.
A number of interactive software programmes are now available that take a person through the work that a CBT therapist might do.
Here is a short guide to help young people prepare to talk with their GP about self-harm and suicidal experiences.
Specialist mental health care
If following a detailed assessment you are identified as having a more serious mental health condition that requires access to specialised mental health services you will be supported by services to develop an agreed care and treatment plan. This applies to anyone in specialist care in hospital or in the community.
Care and Treatment Planning
This ensures that people of all ages within secondary mental health services receive an individual Care and Treatment (CAT) plan. This plan is holistic and should cover up to 8 areas of life according to individual need.
Care Co-ordinators, will be appointed, and will ensure that CAT plans are informed by the personal outcomes of the service user and their carers.
Mental health services will focus on the recovery model of care and treatment and the active involvement of service users in individually tailored CAT Plans and must be reviewed regularly.
Care coordinator
Your care coordinator will provide your first point of contact between yourself, and the various health professionals involved in your treatment. They are also able to explain how the different services are responding to your different needs, while relaying any concerns or questions you may have to the appropriate person
Ideally, your care coordinator should be somebody you feel comfortable talking to and being with, and can be a social worker, occupational therapist, or community mental health nurse.
While you may have some choice about who becomes your care coordinator, it may not be possible in all cases.
Reviews
As your personal needs may change over time it is important that your care and treatment is reviewed on a regular basis.
During a review, yourself, your care coordinator, and other professionals involved in your care will meet to discuss your progress and to discuss whether your care plan needs to be changed to better meet your needs.
It may be possible to hold a review at your house, or in a neutral place, such as a community centre.
You can bring a friend or relative to a review for support if you wish.
Some people prefer to bring an advocate to their review. An advocate is somebody who will represent your views and interests during the review process.
Advocates can be voluntary, such as mental health charity workers, or professional, such as lawyers. Your care coordinator should be able to tell you what advocacy services are available in your local area.