CONWY COMMUNITY MENTAL HEALTH SERVICES REVIEW CYCLE TWO REPORT FOR MENTAL HEALTH PROJECT TEAM Report for Stakeholder Reference Group And Conwy and Denbighshire Adult Mental Health and Social Care Partnership Board May 2010 SITUATION Mental Health Services were not included in the original Burns Review or the Conwy Local Health Board (CLHB) report on services at the Llandudno Hospital site. However, Betsi Cadwaladr University Health Board (BCUHB) decided that including mental health services in the review would provide an opportunity to build on the work of the 90 Day Project and develop recommendations for the delivery of mental health and social care services in Conwy. BACKGROUND 2.1 Stakeholder Reference Group 24 th March 2010 Five options were presented to the Stakeholder Reference Group (SRG) on 24 th March (See SBAR Report Cycle 1). The stakeholders were consistent in their recommendation of an alternative option to those presented in the SBAR. The alternative option which was proposed, was for a specialist ageless service for organic mental illness, e.g., dementia, and a specialist ageless service for functional mental illness, e.g., depression, anxiety and schizophrenia. There was also comment that the whilst the management arrangements for adult mental health and social care services fall under the remit of the Conwy and Denbighshire Adult Mental Health and Social Care JJ. 06 05 10 1
Partnership Board, the responsibility for services for older adults is outside the current remit of the Partnership Board. It was also commented that because of the different arrangements for management of adult and older people s services, communication may have been more effective across adult health and social care services. Stakeholders also expressed concern that the mental health workstream did not fit comfortably with the Llandudno Hospital review. Mental health services had not been included in the original Burns Review or the subsequent CLHB Report. The focus of mental health services is to provide care within the community, and the association with a review of services on a hospital site may present a conflicting perspective. Stakeholders wanted to see local services, and there was some concern that services should not be centralised in one location. However, it was clarified that the service delivery issue would be separate from the location of the teams. There were some positive comments that the review of the site presents an opportunity to re-locate mental health teams, working with the Local Authority to maximise the Canolfan yr Orsedd and Bodnant sites. 2.2 Subsequent Feedback Subsequent feedback was received from the Betsi Cadwaladr Community Health Council. The CHC recommended that as mental health had not been part of the original review and there was some anomaly in including a community based service in a review of services provided at a hospital site, the mental health workstream should be considered outside the Llandudno Hospital Project. The CHC also recommended that as there is inconsistency in service models and quality across the BCU area, a wider review is undertaken of mental health services. No other feedback has been received since the SRG meeting on 24 th March. ASSESSMENT The Core Project Group met on 12 th April. The group considered the recommendations of the CHC, and also the recommendations of the SRG of an alternative model for distinct ageless organic and functional services from the SRG. JJ. 06 05 10 2
The Core Project Group considered the benefits and risks of the CHC recommendations that the mental health workstream is removed from the Llandudno Hospital review. The recommendation of the Core Project Group was that the mental health workstream should remain within the Llandudno Hospital review. This was for two reasons: i) the potential for capital investment associated with the site, which may enable the co-location of community mental health teams. The resultant efficiencies could be used to enhance front line services. ii) the need to ensure that the mental health needs of the general hospital population are integral to service planning. The Core Project Group also recommended that as the previous 90 Day Cycle had developed a clinical strategy for North Wales, which set a clear direction for mental health services, the challenge is now in local implementation of those priorities. The Core Project Group considered the alternative service model put forward by the SRG in the context of the Equalities Bill and the Royal College of Psychiatrists position statement: Age Discrimination in mental health services: making equality a reality. A copy of the Royal College of Psychiatrists position statement has already been distributed to members of the Stakeholder Reference Group with the record of discussion of the first meeting of the Reference Group, held on 24 th March. Both the Equalities Bill and the Royal College of Psychiatrists position statement require services to be age-appropriate, and acknowledge that meeting older people s mental health needs requires skill and expertise, best met by specialist services. The Core Project Group recommended that two options are put forward to the next SRG meeting on 26 th May for further discussion. Option 6 Three model approach: Specialist services for organic mental illness, irrespective of age JJ. 06 05 10 3
adults under 65 with functional mental illness older adults with functional mental illness Option 7 Two model approach: Specialist services for older adults, including functional mental illness and organic mental illness (all ages) adults under 65 with functional mental illness The Stakeholder Reference Group also recommended that the service delivery issue should be separate from the location issue. This means that if administrative bases were co-located on one site, services would still be provided from a range of locations within the community. Adopting either of these options would have management and service organisation implications, in particular for the Local Authority Social Services and the Adult Mental Health and Social Care Partnership Board, which would need to be worked through. These proposals were presented to the Project Board on the 20 th April. The Project Board agreed that the mental health workstream should remain within the scope of the Llandudno Hospital Review, although acknowledging that for mental health services, the focus will be on enhancing community based services, e.g., adopting a hub and spoke approach. The Project Board also supported the proposal to present the two additional options (as outlined above) to the stakeholder reference group at its next meeting on 26 th May. The Project Board also recommended that the provision of Psychiatric Liaison services at Llandudno Hospital be included in the mental health workstream. RECOMMENDATIONS 4.1 That the Stakeholder Reference Group debates the two options outlined above and identifies a preferred service model. Cycle 3 will investigate the feasibility of that preferred Option and consider the operational and partnership implications in further detail. JJ. 06 05 10 4
4.2 That the Conwy and Denbighshire Adult Mental Health and Social Care Partnership Board receives the report and is fully engaged in the process through the Stakeholder and Core Groups. JJ. 06 05 10 5