Welsh mental health charity Hafal has welcomed the Proposed Mental Health (Wales) Measure which was laid in the Table Office of the National Assembly yesterday, and which will be introduced by the Health and Services Minister Edwina Hart in plenary today.

The proposed Measure places duties on Local Health Boards and local authorities in Wales in relation to assessment of mental health and treatment of mental disorder, and in relation to independent mental health advocacy for qualifying patients.

Hafal is quoted in the Explanatory Memorandum for the Measure under the "Purpose and intended effect of the legislation" as follows:

Organisations have reported the informed views of service users who point to the importance of receiving early assessment and treatment for mental ill health: "...clients and carers know from experience that if a person receives early treatment for their mental illness they are much less likely to become so ill that they need compulsory treatment" (Hafal, 2007).

Hafal Chief Executive Bill Walden-Jones said: "The central value of the proposed Measure is that it provides people receiving secondary mental health services with a legal right to a care plan. Our clients know from experience that when a comprehensive care and treatment plan is in place there is a greatly improved prospect of recovery. We are delighted that the proposed Measure recognises the importance of care planning, and we hope that reference will be made to the Welsh Mental Health Act Code of Practice for Wales which provides an obvious legal precedent for which areas of life should be covered in a care plan.

"Though there is a great deal to commend in the proposed Measure we believe there is one issue that needs to be addressed: it is essential that there is a legally fixed timescale between initial referral by a GP and the creation of a care plan for those who are assessed as requiring secondary mental health services. Our Members are aware that it is vitally important to create a care plan as soon as possible to prevent patients from becoming even more unwell, and to move forward as positively and effectively at the earliest point."

When he proposed the Mental Health Legislative Competence Order Jonathan Morgan AM said that the most convincing piece of evidence for why reform is so long overdue came from Hafal service user and now staff member Lee McCabe. Speaking about the proposed Measure Lee said: "This is a historic moment for service users in Wales which will be seen as a turning point in providing key rights to patients with serious mental illness.

"Anyone who has had a serious mental illness will welcome the day when service users have a legal right to a comprehensive care and treatment plan as this is such an important step towards recovery. Having a legal right to a care plan will prevent many people from becoming so unwell that they need to receive compulsory treatment, which is such a destructive and anti-therapeutic experience. But we will need to make sure that the regulations set out very clearly which areas the care and treatment plan covers to ensure it is as effective as possible."

Hafal's response to detailed aspects of the Measure is as follows:

1. To provide assessment of a person's mental health and, where appropriate, provide treatment for their mental ill-health within primary care, by placing a statutory duty on Health Boards and Local Authorities to deliver local primary mental health support services across Wales.
The Welsh Assembly Government recognises the crucial role that primary care plays in delivering effective mental health care and treatment. The aim of the proposed Measure is to strengthen that role so that throughout Wales there will be local primary mental health support services. These will be delivered by Health Boards and Local Authorities in partnership, and it is expected that these services will operate alongside existing GP practices.

Hafal response: This will give consistency to primary care services though we would like the Measure to include provisions to ensure that people are fast-tracked through to assessment if they need secondary mental health services. We will also need to ensure that new duties at primary care level do not detract from the resources required for secondary mental health services.

2. To create statutory requirements around care and treatment planning and care coordination for all persons receiving care and treatment within secondary mental health services.

The proposed Measure will require there to be a care and treatment plan for all service users aged 18 and over who have been assessed as requiring care and treatment within secondary mental health services.

Hafal response: This is the most important element of the Measure. It is vital that the regulations developed under the Measure are prescriptive to ensure that consistent, holistic and recovery-focused care plans are created for all qualifying patients.

We have an ideal precedent for this in the Welsh Code of Practice for the Mental Health Act which made it a requirement for patients subject to the Mental Health Act to have a comprehensive care plan covering the following areas: Medical treatment; Other forms of treatment including psychological therapies; Personal care and physical well-being; Accommodation; Work and occupation; Training and education; Finance and money; Social, cultural and spiritual; Parenting or caring relationships.

This practice was extended widely in May 2009 when the Health and Social Services Minister issued guidance stating that the requirements set out in the Welsh Code of Practice for the Mental Health Act "should be used as good practice for all enhanced care plans".

3. To require secondary mental health services to have in place arrangements to ensure the provision of timely access to assessment for previous service users.

This will enable individuals 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. Health Boards and Local Authorities will be required to have arrangements in place to receive self-referrals of this kind, and to undertake timely assessments.

Hafal response: This is welcome as it will help to avoid the problem of patients having to start through the system repeatedly (the "revolving door").

4. To extend the group of ‘qualifying patients' under the Mental Health Act 1983 entitled to receive support from an Independent Mental Health Advocate (IMHA), so that all patients subject to the formal powers of that Act are able to receive IMHA support if they request it.

The Mental Health Act 1983 currently enables patients subject to the longer-term sections to receive help and support from an IMHA. Such IMHAs are not currently available to those patients on the shorter-term, emergency sections of the Act. This proposed Measure will provide that these patients can receive IMHA support if they wish. The expansion of the IMHA scheme in this way will ensure that all individuals subject to the 1983 Act are able to receive independent help and support from an advocate if they wish to.

Hafal response: This is an important corrective which will ensure that people who are subject to the Mental Health Act but do not have a right to advocacy under the Act will now have that right.

5. To enable all patients receiving care and treatment for mental health problems in hospital to have access to independent and specialist mental health advocacy.

Many patients receiving care and treatment in hospital for their mental health problems 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. This proposed 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.

Hafal response: This major extension of advocacy to all inpatients is proportionate and will provide an important right to many people who have a serious illness but are not subject to the Mental Health Act.

To read the proposed Measure go to: http://www.assemblywales.org/bus-home/bus-legislation/bus-leg-measures/business-legislation-measures-mhs-2.htm

The Mental Health Act 1983: Code of Practice for Wales can be downloaded at: http://www.assemblywales.org/bus-home/bus-guide-docs-pub/bus-business-documents/bus-business-documents-doc-laid.htm?act=dis&id=96162&ds=9/2008.

The areas of the care plan defined in the Code include: Medical treatment; Other forms of treatment including psychological therapies; Personal care and physical wellbeing; Accommodation; Work and occupation; Training and education; Finance and money; Social, cultural and spiritual; Parenting or caring relationships.

To read a BBC Wales news story on the Proposed Measure please visit: http://news.bbc.co.uk/1/hi/wales/8580317.stm