Implementing the Mental Health (Wales) Measure 2010 Updated Guidance for Local Health Boards and Local Authorities
ISBN 978 0 7504 6906 7 Crown copyright 2011 WG14368
Contents Page No 1. Introduction 1 About this Revised Implementation Guidance 2 Who should use the Implementation Guidance? 3 Other Supporting Documentation 4 Welsh language services 5 Service user participation 6 Joint working 7 2. Overview Of The Mental Health (Wales) Measure 201 8 Background 9 Part 1 Local Primary Mental Health Support Services 10 Part 2 Care Coordination and Care and Treatment Planning 11 Part 3 Assessments of Former Users of Secondary Mental Health Services 11 Part 4 Independent Mental Health Advocacy 12 3. Funding 13 4. Timescales For Implementation 13 5. National And Local Implementation Programmes 14 Welsh Government National Implementation Support Programme 15 Suggested Actions for Local Health Boards and Local Authorities to consider in developing their own Implementation Programmes 17 Actions for Part 1 of the Measure 17 Actions for Parts 2 and 3 of the Measure 20 Actions for Part 4 of the Measure 23 6. Further Information 25
1. Introduction About this Revised Implementation Guidance 1. This document has been developed by the Welsh Government and is intended to provide further guidance to statutory, independent and voluntary organisations in Wales to support implementation of the Mental Health (Wales) Measure 2010 ( the Measure ). This document replaces the Mental Health (Wales) Measure 2010: Implementing the Mental Health (Wales) Measure 2010 Guidance for Local Health Boards and Local Authorities issued by the Welsh Government in January 2011. 2. This document provides: an overview of the Measure, related subordinate legislation, and guidance which the Welsh Government has issued in relation to the Measure; an outline of the funding anticipated to be available to support the implementation of the Measure; an outline of the Welsh Government s national implementation programme; suggested key actions and timescales for service providers to consider in finalising their Measure implementation plans to ensure their readiness for application of the new legislation on the required dates. Who should use the Implementation Guidance? 3. This guidance has been developed for use by Local Health Boards and Local Authorities, but it may also be of assistance to independent hospitals (and other registered establishments), third sector and voluntary organisations. User groups, carers' networks, managers, clinicians and human resources staff may also find this guidance useful to support them in understanding the nature and implications of the new legislation. Other supporting documentation 4. Organisations may also find it useful to consult the Mental Health (Wales) Measure 2010 itself, and the following attendant subordination legislation and Welsh Government guidance documents in their preparations for implementation of the Measure in their area: a. The Mental Health (Wales) Measure 2010 and accompanying Explanatory Notes 1. b. The Mental Health (Wales) Measure 2010: Explanatory Memorandum, incorporating the Regulatory Impact Assessment 2. 1 http://www.legislation.gov.uk/mwa/2010/7/contents/enacted 2 http://www.assemblywales.org/bus-home/bus-third-assembly/bus-guide-docs-pub/bus-businessdocuments/bus-business-documents-doc-laid.htm?act=dis&id=200768&ds=10/2010 1
c. The draft Mental Health (Regional Provision) (Wales) Regulations 2012 3 *. d. The draft Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012 4 *. e. The draft Mental Health (Secondary Mental Health Services) (Wales) Order 2012 5 *. f. The Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011 6 *. g. The Mental Health (Assessment of Former Users of Secondary Mental Health Services) (Wales) Regulations 2011 7. h. The Mental Health (Independent Mental Health Advocates) (Wales) Regulations 2011 8. i. The National Service Model for Local Primary Mental Health Support Services 9. j. The draft Code of Practice to Parts 2 and 3 of the Mental Health (Wales) Measure 2010 10 *. k. Guidance for Independent Mental Health Advocacy Providers and LHB Advocacy Service Planners 11 *. 5. The Welsh Government will also be publishing Guidance for Local Health Boards and Local Authorities on the Establishment of Joint Schemes for the Delivery of Local Primary Mental Health Support Services early in 2012. A Mapping Report on Existing Primary Mental Health Services will also be published in early 2012. Organisations with duties under Part 1 of the Measure should also have regard to these documents. Welsh language services 6. The Welsh Government is positive about the Welsh language and the benefits of bilingualism. Mental health services in Wales are underpinned by the principle that the Welsh and English languages be treated on an equitable basis. 7. Local Health Boards and local authorities should therefore ensure that their implementation plans reflect this commitment. 3 http://wales.gov.uk/consultations/healthsocialcare/regulations2012/?lang=en 4 http://wales.gov.uk/consultations/healthsocialcare/regulation2012/?lang=en 5 This Order had not been published at the time of publication of this guidance, but will be available on the Welsh Government s website during. 6 http://www.assemblywales.org/bus-home/bus-business-fourth-assembly-laiddocs.htm?act=dis&id=225852&ds=11/2011 7 http://www.assemblywales.org/bus-home/bus-business-fourth-assembly-laiddocs.htm?act=dis&id=221838&ds=9/2011 8 http://www.assemblywales.org/bus-home/bus-business-fourth-assembly-laiddocs.htm?act=dis&id=221840&ds=9/2011 9 http://wales.gov.uk/topics/health/publications/health/guidance/national/?lang=en 10 http://wales.gov.uk/consultations/healthsocialcare/mental/?lang=en 11 http://www.wales.nhs.uk/sites3/docopen.cfm?orgid=816&id=105634 * final versions of this subordinate legislation/guidance was not available at the time of publication of this document. Stakeholders will be informed in the usual way when the final versions have been published. 2
8. People in Wales should, where possible, be given the option of assessment, treatment and provision of information in Welsh. Within the remit of LHB and local authority Welsh language schemes, all possible steps should be taken to ensure that services are available for Welsh speakers in the language that best meets their individual needs, and that services are suitably developed and supported to be delivered through the medium of English and Welsh. Local Health Boards and local authorities should promote the bilingual services that are already available and increase capacity for providing bilingual services where there is a shortfall of Welsh speaking staff. The onus is on Health Boards and Local Authorities to provide the appropriate service rather for an individual to have to ask for it. Service user participation 9. In keeping with the principles of the Welsh Government s Stronger in Partnership guidance 12, LHBs and local authorities should seek to involve service users, and their representative organisations, in developing implementation plans and establishing arrangements to meet their statutory duties under the Measure. Joint working 10. Successful implementation of the Measure will require LHBs and local authorities to work together to effectively meet their duties under the legislation. It will be important that existing relationships between statutory organisations are effectively utilised and further developed, so as to effectively and efficiently deliver the new requirements whether for local or regional provision. 11. Regulations which would facilitate LHBs and local authorities to develop regional schemes for delivering local primary mental health support services under Part 1 of the Measure (and arrangements for the provision of assessments for former users of secondary mental health support services under Part 3 of the Measure) were introduced for consultation in September 2011. It is anticipated that, if consultation confirms that there is a demand for such arrangements to be put in place, these regulations would be laid before the National Assembly for approval in April 2012 and brought into force shortly thereafter. 12 http://wales.gov.uk/topics/health/publications/health/guidance/strongerpartnership/?lang=en. 3
2. Overview Of The Mental Health (Wales) Measure 2010 Background 12. A Measure - such as the Mental Health (Wales) Measure 2010 - is a piece of law made by the National Assembly for Wales. It has similar legal status to an Act of Parliament. The Measure introduces a number of important changes relating to the assessment and treatment of people with mental health problems in Wales. 13. The Measure is divided into six Parts and two Schedules: Part 1 Local Primary Mental Health Support Services. Part 2 Coordination of and Care and Treatment Planning for Secondary Mental Health Users. Part 3 Assessments of Former Users of Secondary Mental Health Services. Part 4 Mental Health Advocacy. Part 5 General. Part 6 Miscellaneous and supplemental. Schedule 1 Consequential amendments to the Mental Health Act 1983. Schedule 2 Repeals. 14. Further details on Parts 1 to 4 of the Measure, which contain the main legislative requirements relating to mental health service provision, are set out in the following paragraphs, along with information on the subordinate legislation and guidance which has been introduced by the Welsh Government in relation to each of these Parts. Part 1 Local Primary Mental Health Support Services 15. The Welsh Government recognises the crucial role that primary care plays in delivering effective mental health care and treatment. The aim of Part 1 of the Measure is to strengthen that role by ensuring that throughout Wales there will be local primary mental health support services. These will be delivered by Local Health Boards and local authorities in partnership, and it is expected that these services will operate either within, or alongside, existing GP practices. 16. Part 1 of the Measure requires that the following elements be delivered as part of local primary mental health support services: a. comprehensive mental health assessments for individuals who have first been seen by a GP, but for whom the GP considers a more detailed assessment is required (in some cases, individuals may be referred into the primary care service by secondary mental health services); b. treatment, by way of short-term interventions, either individually or through group work, if this has been identified as appropriate following 4
assessment. Such treatment may include counselling, a range of psychological interventions including cognitive behavioural therapy, solution-focussed therapy, stress management, anger management and education; c. provision of information and advice to individuals and their carers about treatment and care, including the options available to them, as well as signposting them to other sources of support (such as support provided by third sector organisations); d. provision of support and advice to GPs and other primary care workers (such as practice nurses) to enable them to safely manage and care for people with mental health problems; e. supporting the onward referral and co-ordination of next steps with secondary mental health services, where this is felt to be appropriate for an individual; 17. These services are aimed at individuals of all ages who are experiencing mild to moderate, or stable severe and enduring mental health problems. 18. The Welsh Government has published a National Service Model to support LHBs and local authorities in developing and delivering their local primary mental health support services. The National Service Model sets out the legislative requirements of Part 1 of the Measure and provides strategic and operational guidance for service planners and providers. 19. It is expected that further guidance will be published by the Welsh Government in early 2012 to provide additional advice to LHBs and local authorities in developing joint schemes for the delivery of local primary mental health support services in their area. In addition, a National Mapping Report of the local mental health services identified during a Welsh Government review, undertaken during 2011, will be issued to provide baseline information and to help identify the changes to existing services or systems which may be required to meet the requirements of Part 1 of the Measure. 20. The Welsh Government has also introduced the draft Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012 under Part 1 of the Measure for consultation. These set out proposals regarding the range of practitioners who may undertake local primary mental health support services assessments, and separately, arrangements regarding access to local primary mental health support services for individuals who are not registered with a GP and/or those who do not have a permanent address in the local authority area. Following formal consultation the final version of these Regulations is expected to be laid before the National Assembly for approval in spring 2012. 5
Part 2 Care Coordination and Care and Treatment Planning 21. Part 2 of the Measure places duties on service providers - Local Health Boards and local authorities in Wales - to act in a coordinated manner to improve the effectiveness of the mental health services they provide to an individual. 22. This Part of the Measure also requires that care and treatment plans be provided for service users of all ages who have been assessed as requiring care and treatment within secondary mental health services. Regulations made under Part 2 of the Measure (the Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011) also prescribe the content and the form of the care and treatment plan which all care coordinators will be required to use. 23. Under the regulations, each care and treatment plan will: a. be developed by a care coordinator in consultation with the service user and mental health service providers (although the plan may be developed without the input of the patient where the outcomes cannot be agreed between all parties); b. be in writing; c. record the outcomes that the provision of mental health services for the relevant patient are designed to achieve; d. list these outcomes, record the services and/or actions that are to be provided to achieve each outcome, including when they will be provided, and state who is responsible for providing the service as well as where it will take place; e. be kept under review and updated to reflect any changes in the type of care and treatment which may be required by the service user over time. 24. These Regulations, which have been laid before the National Assembly for approval, are expected to be made in autumn 2011 and brought into force in June 2012, also set out requirements relating to the appointment of care coordinators and the making, reviewing and revising of care and treatment plans. A national care and treatment plan template, which mental health service providers will be expected to adopt, will also be published. 25. To support implementation, a series of learning resources have been produced by the University of Lincoln on care coordination and care and treatment planning. These resources will be rolled-out to service providers in spring 2012 and will also be available online. 26. A further piece of subordinate legislation, the draft Mental Health (Secondary Mental Health Services) (Wales) Order 2012, will be published by the Welsh Government for consultation in. This Order will provide clarity for service providers as to what services and treatments are to be considered as secondary mental health services for the purposes of Parts 2 and 3 of the Measure, in light of the existing definition at section 49 of the Measure. The Order will also provide that certain services from other parts of the UK are to be considered as 6
secondary mental health services for the purposes of some sections in Part 3 of the Measure. Part 3 Assessments of Former Users of Secondary Mental Health Services 27. The aim of this Part of the Measure is to enable eligible adults who have been discharged from secondary mental health services, but who subsequently believe that that their mental health is deteriorating to such a point as to require such care and treatment again, to refer themselves back to secondary services directly, without necessarily needing to first go to their general practitioner or elsewhere for a referral. 28. Part 3 of the Measure requires that Local Health Boards and local authorities have arrangements in place to receive self-referrals of this kind, and to undertake timely assessments. 29. Regulations which set out the length of time an individual will be eligible for such an assessment following their discharge from services (3 years from the date of discharge) and arrangements for dealing with requests where the individual s place of usual residence is disputed were agreed by the National Assembly for Wales in October 2011. 30. A draft Code of Practice to Parts 2 and 3 of the Measure has been published for consultation by the Welsh Government. This Code contains guidance for local authorities, Local Health Boards and their staff in relation to their functions under Parts 2 and 3 of the Measure, to which they will be required to have regard when undertaking their functions. The Code will also provide information to patients, their families, carers and advocates on Parts 2 and 3 of the Measure. 31. As mentioned at paragraph 26 above, the draft Mental Health (Secondary Mental Health Services) (Wales) Order 2012, will be published by the Welsh Government for consultation in. This Order seeks to ensure that people who have previously received certain secondary mental health services in other parts of the United Kingdom, but who are currently usually resident in Wales, receive the same right to request an assessment as individuals who have previously received secondary mental health services delivered in Wales. Part 4 Independent Mental Health Advocacy 32. Evidence suggests that advocacy can lead to an improved experience of mental health services for individuals, including the potential for advocacy to create choice, improve involvement in decision making, and promote access to a range of different services. 33. Part 4 of the Measure introduces an expanded statutory scheme of independent mental health advocacy, both for patients subject to compulsion under the Mental Health Act 1983, and for those in hospital voluntarily. 34. The Measure amends the Mental Health Act 1983, so that Independent Mental Health Advocates (IMHAs) will be available to the majority of patients detained under the Mental Health Act 1983, including those patients detained under 7
sections 4 and 5(2) and 5(4) of that Act 13. In addition, Part 4 of the Measure expands the IMHA service to individuals receiving care and treatment in hospital for a mental health problem who are not detained under the Mental Health Act 1983, but are voluntary (or informal) patients. These patients sometimes require help from an advocate during their stay in hospital, but such services may not always be available. The Measure will create statutory duties to ensure such help and support is available for all inpatients. Such advocacy will assist inpatients in making informed decisions about their care and treatment, and support them in getting their voices heard. 35. Subordinate legislation has been made by the National Assembly under this Part of the Measure. The Mental Health (Independent Mental Health Advocates) (Wales) Regulations 2011, set out requirements relating to the provision of IMHA services, appointment and independence requirements for advocates, and who the IMHA may visit and interview in undertaking their role. 36. In addition, the Welsh Government has issued detailed guidance designed to provide LHBs and independent mental health advocacy services with advice in planning and providing the expanded IMHA service in Wales. A series of support events were also delivered to advocacy providers across Wales by Action for Advocacy during 2011, and new City and Guilds learning resources have been introduced for advocates delivering the IMHA service in Wales who are working towards the Independent Advocacy Qualification. 13 Section 4 provides for an emergency order that lasts up to 72 hours; it is made by an approved mental health professional based on one medical recommendation. Section 5(2) is referred to as the holding power of a doctor or approved clinician; it can only be used in respect of an inpatient who wishes to leave the hospital, but whom the doctor or approved clinician considers needs to be detained for assessment or treatment. The power lasts up to 72 hours. Section 5(4) is a similar power which may only be instigated by certain qualified nurses, and lasts for a maximum duration of 6 hours. 8
3. Funding 37. The Welsh Government is providing additional funding to services to support pre-implementation work. Local Health Boards and local authorities will also receive annual recurring funding to support the delivery of the Measure policies on the following basis: 38. It is expected that funding of 3.5m per annum will be provided to LHBs from 2012/13 onwards to assist them and their partner local authorities in the provision of local primary mental health support services under Part 1 of the Measure. Funding will be distributed to LHBs in accordance with the Welsh Government s standard LHB discretionary allocation formula. It is expected that 75% of the funding will be made available in 2012/3 and the full amount annually thereafter. All allocations will be subject to Ministerial approval. 39. Part 2 of the Measure - care coordination and care and treatment planning - will reinforce and give legal weight to existing guidance, rather than creating any additional requirements. Therefore, no additional funding will be provided by the Welsh Government in relation to this Part of the Measure. 40. Nor is it anticipated that any significant costs would be incurred by local authorities or LHBs under Part 3 of the Measure in respect of secondary mental health assessments. Whilst it is imperative that record keeping systems are in place which will ensure that the entitlement to, and outcome of, assessments are recorded and communicated as appropriate to other health or local authority partners (i.e. the patient s GP, housing or welfare services), it is not anticipated that Local Health Boards or local authorities would require any additional administrative or ICT capacity to achieve this. For example, existing patient record systems may be updated to include additional information relating to an entitlement to future assessment, or to update records to include the details of any subsequent assessments which are requested and/or undertaken. 41. It is possible that on occasions individuals may request an assessment in an area other than that where they are usually resident, in which case LHBs and local authorities would be required to employ existing patient record management/transfer systems or protocols. LHBs and local authorities will be required to notify patients of their entitlement to future assessment in writing (including information on how to make a request for assessment in future if required) and it is anticipated that this could be incorporated into existing discharge planning procedures without incurring any additional costs. 42. To support Part 4 of the Measure the expanded independent mental health advocacy scheme the Welsh Government has provided LHBs with an additional 1.4m per annum from 2012/13 onwards. This will supplement the current annual funding of 0.6m which is currently provided to LHBs for the existing IMHA service. LHBs were notified of their uplifted annual allocations in June 2011. 9
4. Timescales for Implementation 43. It is expected that the provisions of the Measure will be brought into force during 2012. Commencement will be staged as follows: The statutory duties around Part 1 of the Measure, concerning local primary mental health support services, will commence on 1 October 2012. Parts 2 and 3 of the Measure, relating to care and treatment planning and care coordination within secondary mental health services, and assessment of former users of secondary mental health services, will commence on 6 June 2012. Part 4 of the Measure - the expansion of the independent mental health advocacy scheme under the Mental Health Act 1983 - will commence in two phases: the first phase (for compulsory patients which will include those patients subject to sections 4 or 5 of the 1983 Act) will commence on 3 January 2012. The second phase (for informal inpatients) will commence on 2 April 2012. 44. These timescales, which were agreed by the Minister for Health and Social Services in July 2011, are slightly later than those which were indicated in the Welsh Government s original implementation guidance. They are designed to ensure that services are able to effectively plan and prepare to meet the duties which will fall to Local Health Boards and local authorities under the new legislation, and are non-negotiable. 10
5. National And Local Implementation Programmes 45. It is essential that thorough preparations for successful implementation of the Measure provisions are made and put into practice at a local or regional level, as appropriate, by LHBs and local authorities. 46. The Welsh Government has developed a national programme of actions to support implementation at an all-wales level. In addition, Local Health Boards and local authorities should undertake their own implementation planning so that they are in a position to meet the statutory requirements of the Measure when these come into force in 2012. Welsh Government National Implementation Support Programme 47. This national programme will help to ensure that the Welsh Ministers are able to meet their responsibilities under the Measure, including the making of all the necessary subordinate legislation within the relevant timescales. The programme also aims to provide support and guidance to LHBs and local authorities. 48. The expected timetable for the next twelve months of the Welsh Government s national implementation support programme is set out below: Date September 2011 September October October 2011 January 2012 November 2011 January 2012 March 2012 January 2012 Action Publication of a National Service Model for Part 1 of the Measure Consultation on the draft Mental Health (Regional Provision) (Wales) Regulations 2012 Anticipated National Assembly approval of the Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011; the Mental Health (Assessment of Former Users of Secondary Mental Health Services) (Wales) Regulations 2011 and the Mental Health (Independent Mental Health Advocates) (Wales) Regulations 2011 Consultation on the draft Code of Practice to Parts 2 and 3 of the Mental Health (Wales) Measure 2010 Consultation on the draft Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012 Consultation on the draft Mental Health (Secondary Mental Health Services) (Wales) Order 2012 Publication of updated Implementing the Mental Health (Wales) Measure 2010 Guidance to LHBs and Local Authorities document Publication of guidance for LHBs and local authorities on developing and agreeing schemes for the delivery of local primary mental health support services 11
January 2012 January 2012 April 2012 April 2012 May 2012 May 2012 Publication of mapping report on existing primary mental health services, with a view to supporting service reconfiguration and redesign, where required Publication of learning resources to support the successful implementation of care coordination and care and treatment planning under Part 2 of the Measure and train the facilitator sessions with LHBs and local authorities Publication of final Code of Practice to Parts 2 and 3 of the Mental Health (Wales) Measure 2010 Anticipated National Assembly approval of the Mental Health (Regional Provision) (Wales) Regulations 2012 Anticipated National Assembly approval of the Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012 Anticipated National Assembly approval of the Mental Health (Secondary Mental Health Services) (Wales) Order 2012 Suggested Actions for Local Health Boards and Local Authorities to consider in developing their own Implementation Programmes 49. Below are details of those matters which the Welsh Government suggests that LHBs and local authorities consider to ensure that they are in a position to meet the statutory duties placed on them by the Measure at the relevant commencement dates. The following are not intended to be exhaustive lists, but rather prompts for further consideration in developing local or (potentially) regional arrangements. Actions required for Part 1 of the Measure 50. In order to meet their statutory duties under Part 1 of the Measure, all Local Health Boards and local authorities in Wales will need to agree schemes for the delivery of local primary mental health support services in all local authority areas (or regions, if regional provision arrangements under the proposed Mental Health (Regional Provision) (Wales) Regulations 2012 are in force). This work may include an element of restructuring and refocusing of existing services and/or establishing new services, and will require significant partnership working between local authorities and LHBs. 51. Schemes should set out how the partners will work together to deliver the five core functions of local primary mental health support services required under Part 1 of the Measure in each local authority area, or region, and any other services the partners intend to deliver as local primary mental health support services in addition to the required elements. The Welsh Government recognises that some aspects of schemes may be aspirational in nature, and may include elements which are intended to be developed or introduced as part of the service at a future date (If this approach is adopted, the scheme must make clear which aspects/elements are aspirational). It is also recognised that schemes may evolve over time, with further versions of a scheme being produced as services expand or develop. 12
However, schemes must set out how the five core functions of local primary mental health support services are to be delivered from the outset of the scheme. This means identifying the treatments which are to be made available, and securing the provision of local primary mental health support services in accordance with section 2(1) of the Measure) In addition, schemes should include: i. clarification of the extent to which each of the partners is responsible for providing the local primary mental health support services (i.e. who will deliver what ); ii. iii. iv. identifying the treatments (known as "local primary mental health treatments") which are to be made available in the local authority area(s) (i.e. the therapies, approaches, interventions which the service will deliver) arrangements for ensuring that the local primary mental health support services are provided in accordance with the scheme; arrangements for recording agreement of the scheme in writing, including changes or subsequent versions of the scheme; v. clarification in respect of whether the scheme allows for primary mental assessments to be available in respect of individuals to whom section 8 (1) of the Measure applies and, if so, specifying the descriptions of the staff working in secondary mental health services who can refer such an individual for assessment; vi. arrangements for ensuring that practitioners who conduct primary mental health assessments satisfy the eligibility criteria set out in the Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012, including any requirements relating to skills, experience or training. 52. In developing schemes and establishing services, partners should take into account the requirements of the Mental Health (Primary Care Referrals and Eligibility to Conduct Primary Mental Health Assessments) (Wales) Regulations 2012 and the Mental Health (Secondary Mental Health Services) (Wales) Order 2012. 53. Further detailed guidance on the preparation and suggested content of schemes will be provided in the Guidance for Local Health Boards and Local Authorities on the Establishment of Joint Schemes for the Delivery of Local Primary Mental Health Support Services, which will be published in early 2012. 54. The Welsh Government recommends that agreed schemes be in place by May 2012. 55. In order to ensure that LHBs and local authorities are not in breach of their statutory duties under Part 1 of the Measure, local primary mental health support services must be operational from 1 October 2012. 13
56. The following timetable is provided as a suggested guide to the key actions and timescales LHBs and local authorities may wish to consider in developing and delivering their own implementation plans: Date By By onwards onwards onwards March 2012 April 2012 April 2012 May 2012 May 2012 April September 2012 Action Appointment of LHB Primary Care Implementation Leads to support the work required to establish the local primary mental health support services Local project management arrangements in place with all key interests represented Establish dialogue with local GPs and GP bodies to ensure that strong relationships develop between the new services and the general practitioner services that they will be supporting Establish dialogue with third sector organisations to ensure that all local services are taken into account in the development and delivery of the new service model Publicity and awareness raising materials developed and disseminated Local/regional service model(s) agreed to confirm, inter alia: the pattern of local service delivery, ensuring that local primary mental health support can operate within, or close to GP settings; arrangements for delivery of services to additional persons (i.e. those not registered with a GP and/or not usually living within the local authority area), including, where relevant, appropriate arrangements for local primary mental health services to be delivered in prisons. Analysis of required staffing for Part 1 services in terms of skills, experience and numbers, and required posts identified Part 1 schemes included in the Children and Young People s Plan for the local authority area (see section 11 of the Measure) Job descriptions for primary care practitioners evaluated and grades assigned Local schemes (including regional schemes) agreed and in place for all local authority areas or regions Processes for recruitment of additional staff required to deliver Part 1 services in place 14
April September 2012 April September 2012 April September 2012 April September 2012 April September 2012 April - spetemb2012 April September 2012 Appropriate referral mechanisms developed for GPs, and (where applicable) practitioners in secondary mental health services, to refer individuals to the new services Education and awareness raising for GPs and other referrers underway Signposting mechanisms agreed, building upon existing local and national services, including those provided by the third sector or voluntary organisations, to ensure accurate information and effective systems to allow patients and their carers to be signposted to other support services Establishment of effective arrangements to support advice and information on mental health and mental health services being given to GPs and their staff Effective links developed between local primary mental health support services and secondary mental health services to accommodate referrals into/from both services, to ensure that service users (of either service) are seen quickly and that duplication of effort is minimised Development of systems for appropriate and timely clinical and management supervision to support primary mental health workers Develop and put in place suitable clinical governance, performance management and budgetary control structures to support and monitor the operation of the local primary mental health support services 1 October 2012 Delivery of local primary mental health support services commences Actions required for Parts 2 and 3 of the Measure 57. In order to meet their statutory duties under Part 2 of the Measure, LHBs and local authorities will be required to ensure that, from 6 June 2012, care coordinators are appointed and care and treatment plans provided for all relevant patients (i.e. those within secondary mental health services in Wales) in accordance with the requirements of that Part of the Measure, the Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011 and the Code of Practice to Parts 2 and 3 of the Mental Health (Wales) Measure 2010. 58. In order to meet their statutory duties under Part 3 of the Measure, LHBs and local authorities will be required to ensure that, from 6 June 2012, arrangements are in place to facilitate the assessment of former users of secondary mental health services, in accordance with the requirements of that Part of the Measure, the Mental Health (Assessment of Former Users of Secondary Mental Health Services) (Wales) Regulations 2011, the 15
Mental Health (Secondary Mental Health Services) (Wales) Order 2012 and the Code of Practice to Parts 2 and 3 of the Mental Health (Wales) Measure 2010. 59. The following timetable is provided as a suggested guide to the key actions and timescales LHBs and local authorities may wish to consider in developing and delivering their own implementation plans: Date By By January 2012 By January 2012 January 2012 onwards By March 2012 By March 2012 Action The identification of an individual with responsibility for reporting and overseeing implementation of Part 2 and Part 3 on behalf of Local Authorities and Local Health Boards for each LHB area. This may also involve the establishment of multiagency implementation groups. Development of implementation plans to help provide assurance of being prepared for commencement. Engage with Information Technology providers to ensure that electronic and other case record management systems are updated to meet the requirements of Part 2 of the Measure, including use of the new prescribed care and treatment plan. Engage with Information Technology providers to develop or amend electronic and other case record management systems, so that discharge from secondary mental health services is clearly recorded (so as to assist determining future eligibility) Roll-out of the new learning resources for care coordination and care and treatment planning, to ensure that existing and prospective care coordinators are clear about their functions and duties under Part 2 of the Measure. Draft arrangements for the carrying out of assessments and the making of referrals under Part 3 of the Measure in anticipation of the making of Regional Provision Regulations. These arrangements should allow for disputes regarding determination of usual residence to be effectively and quickly resolved. Develop and agree formal processes for appointing care coordinators, including temporary appointments for LHBs and local authorities that meet the requirements of the Measure and adhere to the Code of Practice to Parts 2 & 3. This is likely to cover the identification of which organisation is responsible for appointment, any agreements for appointing care coordinators that are employed by another organisation and consideration of skills, experience and training in appointing an appropriate care coordinator. 16
Date By April 2012 By April 2012 By April 2012 By April 2012 By April 2012 By May 2012 By May 2012 By May 2012 By May 2012 By May 2012 Action Adapt existing referral systems within secondary mental health services in line with the locally agreed arrangements for the making of referrals under Part 3 of the Measure Consider the information needs of existing service users, future service users and carers in relation to the new statutory care and treatment planning processes of the Measure. Agree and set local timescales for completing and delivering care plans after a person becomes a relevant patient and also for completing and delivering care plans following review. It will also be necessary to ensure there are agreed processes for audit against such standards. Ensure that there is a process for ensuring that any relevant patients without a care plan upon commencement are provided with a care and treatment plan in accordance with the transitional arrangements set out in the Care Coordinators and Care and Treatment Planning (Wales) Regulations 2011. Ensure there is a system in place to ensure that all existing care and treatment plans are reviewed and updated to meet the requirements of Part 2 of the Measure in accordance with the transitional arrangements set out in the Care Coordinators and Care and Treatment Planning (Wales) Regulations 2011. Ensure all patients eligible for care and treatment planning under Part 2 including out of area patients are identified. Ensure there is a mechanism in place for responding to service user or carer requests for a review to take place in accordance with the Care Coordinators and Care and Treatment Planning (Wales) Regulations 2011and the Code of Practice. Develop and agree discharge procedures to ensure that the requirements to provide written information to discharged patients in accordance with Parts 2 and 3 of the Measure will be met upon commencement. Ensuring secondary mental health service staff understand when/how service users should be provided with information about eligibility, and how to respond when such a request for assessment is made Ensure that any information-sharing arrangements with other secondary mental health services are updated to 17
Date By May 2012 By May 2012 By May 2012 By May 2012 By June 2012 By June 2012 Action take account of the need to provide or obtain information about eligibility under Part 3 when an individual (previously not known to local services) presents. Ensure the organisation has a mechanism for recording occasions where relevant patients have received secondary mental health services which were commissioned by the LHB or Local Authority as the responsible mental health service provider, but provided by another agency/organisation (e.g. in an independent hospital in England) Consider revisions to existing audit tools to accommodate the new provisions of Part 2 of the Measure, associated subordinate legislation and the Code of Practice Be assured that effective systems are put in place to support review and revision of care plans, in line with the intended relevant subordinate legislation, and appropriate recording systems are utilised to enable compliance to be monitored Ensuring arrangements are in place to provide written reports to service users within 10 days of an assessment having taken place under Part 3. Ensure standardised information materials are in place in LHBs and local authorities for provision to patients being discharged from secondary mental health services explaining eligibility under Part 3, and the local arrangements for accessing such assessments All relevant patients to have eligible care coordinators in place in accordance with the Care Coordinators and Care and Treatment Planning (Wales) Regulations 2011 Actions required for Part 4 of the Measure 60. In order to meet their statutory duties under Part 4 of the Measure, LHBs will be required to ensure that, from 3 January 2012, arrangements are in place to notify qualifying compulsory patients of their entitlement to support from an IMHA and facilitate requests for support in a timely manner. From 2 April 2012 LHBs will be required to ensure that arrangements are in place to notify qualifying informal patients of their entitlement to support from an IMHA and facilitate requests for support in a timely manner. 18
61. The following timetable is provided as a suggested guide to the key actions and timescales LHBs and local authorities may wish to consider in developing and delivering their own implementation plans: Date By onwards onwards By By By March 2012 By April 2012 Action Identification of potential qualifying informal and detained patients in each LHB area, and where such patients are located (i.e. NHS and private hospitals, mental health units and wards, and registered establishments) Programme of awareness-raising for staff within hospitals, units and registered establishments, regarding the role and functions of IMHAs, as well as how to contact IMHA service providers Development of appropriate patient information leaflets and posters, which explain the independent mental health advocacy scheme and how to contact IMHAs, and distribution to all relevant inpatient settings LHBs and IMHA providers to have developed and produced new patient information leaflets/posters etc explaining expanded IMHA scheme and wider range of qualifying patients New or revised IMHA contract arrangements agreed in all LHB areas and arrangements for the provision of expanded IMHA service by independent advocacy provider(s) in place Developing robust engagement protocols for all relevant hospitals and registered establishments (including working with the relevant managers of registered establishments) where IMHA-qualifying patients may be located Recruitment, induction and training of new IMHAs for expansion of service to sections 4 and 5 patients complete Ensuring that there are suitable facilities within all relevant hospitals/units/wards for IMHAs to meet with qualifying patients Recruitment, induction and training of new IMHAs for expansion of service to informal inpatients complete All IMHA providers expected to have attained Action for Advocacy Quality Performance Mark 19
6. Further Information Further information on the Mental Health (Wales) Measure 2011 and the national implementation programme is available from: Mental Health Legislation Team Welsh Government Cathays Park Cardiff CF10 3NQ Telephone: 029 2082 3294 Email: mentalhealthlegislation@wales.gsi.gov.uk Further information in relation to Part 1 of the Measure can be obtained from: Barbara Bowness Primary Care Lead, Mental Health (Wales) Measure National Leadership and Innovation Agency for Healthcare Innovation House, Bridgend Road, Llanharan CF72 9RP Telephone 01443 233333 Email: Barbara.bowness@wales.nhs.uk 20