The Welsh Assembly Government’s Review of Secure Mental Health Services has identified key objectives for service improvement in Wales. The report, which sets out the strategic vision for secure mental health services with 33 recommendations and is designed as a strategy for 10 years, recommends that:
• The whole workforce across all agencies delivering secure mental health service needs to reform and expand
• No one in acute distress from an ‘active serious mental disorder’ should be held in prison
• Service users and their carers should influence more directly the development and delivery of services
• Reliance upon high and medium secure care could be safely minimised through the establishment of additional low secure inpatient facilities and bespoke community services.
Key objectives proposed by the report include:
• The establishment of an all Wales Mental Health Board with responsibility for unified strategic planning
• The development of dedicated low secure and step down services within the NHS, Local Authorities and voluntary sector
• The development of new Mental Health Crisis Resolution Services and Mental Health Assessment Centres.
The report is now being circulated for a 16 week consultation process.
During the production of the report Hafal, Wales’ principal charity working for people with serious mental illness, undertook focus groups and surveys to elicit the views of service users with first-hand experience of secure care.
Penny Cram, Hafal’s Criminal Justice Lead Officer, said: “Following their input into the Assembly Government’s research our clients welcome what is a fair and measured report. We feel that our concerns have been listened to and acknowledged in the report which includes valuable recommendations for service improvement.
“We agree with the recommendation that no one in acute distress from an active serious mental disorder should be held in prison – although we would go further and say that prison is an inappropriate environment for anyone with a serious mental illness.
“Our clients know from experience that new low secure services are required so that patients can be supported to make the transition back to the community. A more efficient and effective system would also place a focus on earlier intervention before admission to secure care and on an improvement in aftercare and resettlement programmes.
“We believe that the report is a significant step in the right direction, clearly identifying the problems in the current system and offering practical solutions. But for these solutions to work we will need to see significant investment in mental health services.”
The Review of Secure Mental Health Services follows the publication of Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system which has recommended key reforms. Examining the treatment of mentally disordered offenders in Wales and England Lord Bradley recommends:
• Access to liaison and diversion services for all police custody suites and courts
• Improved screening and identification of people with mental illness at police custody suites and at reception into prison
• The use of community sentences as safe and positive opportunities for offenders with a mental illness
• Mental health training for all probation staff and the judiciary
• The refocusing of in-reach mental health teams on providing services for those with serious mental illness
• A new minimum target for the NHS of 14 days to transfer a prisoner with acute, severe mental illness to an appropriate healthcare setting
• The creation of new Criminal Justice Mental Health Teams to support the police and courts to divert people with a serious mental illness.
Lord Bradley’s report does not cover Wales formally but during his research he did include a visit to Wales to discuss issues with stakeholders and has expressed his hope that Wales “will find the issues I have raised of use”.