Monday 7 June 2010

Aberystwyth Mon Amour

The “Road to Recovery” led to Ceredigion last Friday and the microbus parked on the sea-front in Aberystwyth to spread the word about recovery, mental health legislation, and the future of services for people with a serious mental illness in Wales. These three issues are connected: there is an opportunity in Wales, in spite of the impending cuts in public spending, to put mental health services on a new footing which genuinely empowers people with serious mental illness and their families. The ambition must be to revolutionize the approach to delivering services by making individual care plans the paramount driver for policy and resources in place of the traditional top-down commissioning.

At the core of the proposed Mental Health Measure (Welsh law) is the legal right to an individual care plan for everybody who needs secondary mental health services – the Measure can prescribe the content and format of those care plans and if we get the regulations right they should set out how individuals can as of right work towards their recovery by taking action on all the areas of life which together can rebuild mental health. There is an excellent precedent for this in the Welsh Code of Practice for the Mental Health Act which prescribes nine areas which must be covered in care plans, namely medical treatment, other forms of treatment including psychological interventions, personal care and physical well-being, housing, work and occupation, training and education, finance and money, social/cultural/spiritual, and parenting or caring relationships.

Of course if those responsible for mental health services treat these care plans as bolt-ons to traditionally-commissioned services then they will have missed the point: all secondary mental health services should be subordinate to and justified by individual care plans – this is hardly rocket science because how can any mental health service be needed if it doesn’t feature in those individual care plans?

The jury’s out on whether the Assembly Government will follow through the logic of the Measure and insist that Local Health Boards and Councils work towards commissioning all mental health services in response to analysis of individual care plans. A further ambition should be to enable individual service-users to choose where they get their services from, whether that is through the bureaucratic Direct Payments system or (preferably) a new streamlined mechanism covering health as well as social care.

Ceredigion is special for me as my family were cattle dealers in Tregaron until my grandfather took holy orders and went off to minister to the handful of Anglicans holding out in Nonconformist Ammanford (he was a leading proponent of antidisestablishmentarianism). Hafal's Company Secretary Nicola Thomas hails from Adpar just North of the Teifi and we frequently hear mutterings of discontent from staff about the impossibility of any slack being cut on financial control because of senior management's county of origin: but, to borrow Millwall FC's unofficial motto, "Everybody Hates Us, We Don't Care".