Tuesday 10 August 2010

Time Limits

Further discussion with stakeholders confirms the view that the key to achieving an effective Mental Health Measure (Welsh law) now lies principally in ensuring that the subsidiary regulations and guidance have strong, prescriptive content giving real rights to patients to get their needs met. That's why the current consultation on the draft guidance on the Care Programme Approach is so important because it will form the basis of the Measure's regulations and guidance (see this post).

Nevertheless the impending opportunity to amend the Measure itself is important and three key priorities are emerging relating to Part 2 of the Measure covering people receiving secondary mental health services...

Patients would like to find a compromise on the question of time limits. They are concerned to see time limits for the periods both from referral by a GP for assessment for secondary mental health services to that assessment being carried out, and from recognition as a "relevant patient” (receiving secondary mental health services) to the completion of the required care plan. Our suggestion is to put on the face of the Measure a requirement for subsidiary guidance to provide timescales for different levels of urgency (for example, it could prescribe a very urgent timescale for those who have quite evident psychotic symptoms) on the basis that the timescales in the guidance would not be absolute but could be challenged in law if unreasonably not adhered to (actually we understand that this requirement to provide guidance on timescales might best fit under Part 5 of the Measure though the effect is to strengthen the substance of Part 2).

It would be reassuring to see in the Measure itself a requirement that the regulations in relation to the required care plan under Part 2 of the Measure should cover the nine "life areas" already prescribed in the Mental Health Act 1983 Code of Practice for Wales, as follows: Finance and Money; Accommodation; Personal care and physical wellbeing; Training and education; Work and occupation; Parenting or caring relationships; Social cultural and spiritual; Medical treatment; Other forms of treatment including psychological interventions.

On the face of the Measure we would also like to see the option for the Minister to prescribe a format for care plans become a requirement. It seems inconceivable that several different formats for care plans should be developed across Wales and our experience with local CPA plan formats is that they have tended to become lengthy and bureaucratic. This was born out by the Government's own study of CPA in Wales. The problem is not one of local services trying to make formats easy for themselves but, on the contrary, vast documents were produced with the best intentions but in practice making life difficult for both patients and practitioners.

We have shared our thoughts with key AMs and third sector colleagues and I will let you know how things proceed. Meanwhile everywhere I go I encounter active interest and practical suggestions from patients and families who have high expectations of the Measure as a platform for a new era in mental health services. If you have a view please don't hesitate to contact us (details here).

My gratuitous time-related picture features the incomparable star of the silent era Harold Lloyd (yes, you've guessed it, his great grandparents came from here). See the nerve-jangling stunts of this Welsh-American immortal from "Safety Last" (1923) here.