Snapshot 2
People’s Experiences
of Primary Mental Health
Services in Wales
One year on
Contents
1.
Introductionpage 01
2.
Survey overviewpage 02
3.
Understanding and empathy
4.
Support offered
5.
Waiting timespage 17
6.
Overall accesspage 24
7.
Overall impactpage 28
8.
Case studiespage 32
9.
Conclusions and recommendationspage 39
page 06
page 12
About Gofal Gofal is a leading Welsh mental health and wellbeing charity. We provide a wide range of
services to people experiencing mental ill health, supporting their independence, health,
wellbeing and recovery. We lobby to improve mental health policy, practice and legislation,
and we campaign to increase public understanding of mental health and wellbeing.
Our vision
Good mental health and wellbeing for all.
Our mission
To have a positive, lasting impact in all that we do.
Report author: Katie Dalton
1. Introduction
Getting the right support when we first need it is fundamental
to good health and wellbeing and primary care plays a crucial
role in many people’s lives. We are pleased to present
our second ‘snapshot’ report, which focuses on people’s
experiences of primary mental health services in the year
since the Mental Health (Wales) Measure was implemented.
We would like to thank everyone who responded to the survey
and provided us with case studies. Your experiences are
invaluable and we really appreciate your contributions to this
piece of work. We would also like to thank the many partner organisations that helped us
promote the survey far and wide. Over eight hundred people who accessed primary mental
health services responded to our survey and a number of people provided case studies in
order to illustrate their experiences in more detail.
Overall the results from our survey showed a mixed picture, with some improvements in
GPs’ understanding and empathy; the range of advice, treatment and support offered to
patients; and waiting times for support services. However, other areas showed little or no
improvement.
We recognise that the legislation is still relatively new. It is inevitable that teams and
structures will take time to ‘bed in’ and there is bound to be a period of adjustment as
primary care professionals understand the nature and limitations of the new services.
However, we are also clear that services must continue to develop and improve in order to
deliver the aims and ambitions of Welsh policy and legislation.
In Together for Mental Health the Welsh Government commits to improving access to and
the quality of preventative measures, early intervention and treatment services so that
more people recover. It also seeks to improve the mental health and wellbeing of the whole
population. Primary care is clearly crucial to delivering these aims, but in order to gauge
progress health boards will need to measure the impact of these services on people’s
mental health and wellbeing, as well as collecting process data such as waiting times.
This report includes some encouraging signs. However, the survey results demonstrate
that we still have some way to go to ensure that people’s needs are adequately met
through primary mental health services. Thank you again to everyone who shared their
experiences and participated in this piece of work.
Ewan Hilton
Executive Director, Gofal
1
2. Survey overview
Background
During the autumn of 2013 Gofal undertook a second snapshot survey of people’s
experiences of primary mental health services. This followed a similar survey, which took
place in September 2012, just before the implementation of Part One of the Mental Health
(Wales) Measure.
The purpose of this second survey was to measure any improvements in people’s
experiences since this part of the Measure came into force, as well as to highlight good
practice and areas that require further improvement.
The Mental Health (Wales) Measure
The Mental Health (Wales) Measure is a piece of legislation made by the National
Assembly for Wales, which makes changes and improvements to the assessment and
treatment of people with mental health problems. The Measure received Royal Assent in
December 2010 and was implemented in different stages throughout 2012.
The Mental Health (Wales) Measure has four main parts:
• Part 1: Local Primary Care Mental Health Support Services
• Part 2: Care Coordination and Care and Treatment Planning
• Part 3: Assessment of people who have previously used secondary mental health
services
• Part 4: Independent Mental Health Advocacy
Part One of the Mental Health (Wales) Measure
Part One of the Measure was implemented in October 2012 and aims to:
• improve access to mental health services within primary care settings
• improve outcomes for individuals accessing these services and
• facilitate appropriate and timely referrals to secondary mental health services
It requires that the local mental health partners (health boards and local authorities) agree
joint written schemes for each health board region in Wales. These schemes set out what
services are to be provided, how they are to be provided, by whom, and where, to meet
the legal requirements of Part One of the Measure. These services are known as Local
Primary Mental Health Support Services (LPMHSS).
2
The survey
The survey questions focused on some of the issues commonly raised by the people we
support, as well as the areas that the Measure is intended to address. As a result, we
asked people about their experiences of staff attitudes, access to advice, treatment and
support, and the overall impact of primary mental health services on their mental health
and wellbeing. We also collected case studies about people’s experiences of visiting their
GP to discuss their mental health and the interventions that followed these visits.
Methodology
This report does not pretend to be an academic piece of research, but it does provide a
snapshot of experiences through the lens of the patient. The results should complement
other work, such as health board data collection, Wales Mental Health in Primary Care
Network surveys of GP’s views and the Welsh Government’s formal review of the
Measure.
The second of our three annual snapshot surveys took place during the autumn of 2013,
one year on from the official implementation date for Part One of the Measure. The
survey was available electronically in both English and Welsh through the website Survey
Monkey.
The survey was promoted through a number of local, regional and national networks of
voluntary organisations and support providers, as well as on social networking websites
such as Twitter and Facebook. Gofal also contacted trade unions and a number of large
employers (such as local authorities and health boards) and asked them to promote
the survey to their employees. We purposefully promoted the survey to a wide range of
organisations beyond the mental health sector, in recognition that primary mental health
services are relevant to the broader population.
3
Profile of respondents
Over eight hundred people who had visited a GP to discuss their mental health during the
previous twelve months responded to the survey. These respondents were spread across
the length and breadth of Wales, with the largest numbers of respondents coming from the
Cardiff and Vale (25.0%), Aneurin Bevan (24.2%) and Abertawe Bro Morgannwg (16.1%)
health board areas.
Chart 2a: Health board area
30%
25%
20%
15%
10%
5%
0%
ABM
AB
BC
C&V
CT
HDd
P
The survey also asked people to disclose equality and diversity data.
• The majority of respondents (97.5%) were between the ages of 16 and 65, with
44.3% from the 36-50 age group (Chart 2b).
• More than two thirds of respondents were female (Chart 2c).
• 86% of respondents were heterosexual, with 3.5% identifying themselves as
bisexual, 2.8% as a lesbian or gay woman and 2.0% as a gay man (Chart 2d).
• 30.7% considered themselves to have a disability (Chart 2e).
• 96.9% identified themselves as white when asked about their ethnic origin.
• More than two thirds of respondents were living in an urban area when they
accessed the primary mental health support service (Chart 2f).
• The majority of respondents were in full time employment, with less than 20% being
unemployed (Chart 2g). This may be reflective of the survey being primarily available
in an electronic format and the approaches we made to large employers, such as
local authorities and health boards. However, it also demonstrates the importance
and relevance of primary mental health services to the whole population.
4
Chart 2b: Age
Chart 2c: Gender
100%
90%
80%
70%
Prefer
not to say
Male
66+
Female
51-65
Prefer
not to say
60%
36-50
50%
26-35
40%
30%
16-25
20%
0-15
Chart 2e: Do you consider
yourself to be disabled?
100%
10%
90%
0%
80%
70%
60%
Chart 2d: Sexual Orientation
50%
40%
Heterosexual
30%
Bisexual
Yes
No
Prefer not
to say
20%
Lesbian
10%
Gay man
0%
Other
Prefer not
to say
Chart 2g: Employment status
60%
50%
Chart 2f: Location
40%
30%
20%
Urban
area
10%
0%
Rural
area
5
3. Empathy and understanding
The empathy and understanding demonstrated by general practitioners and other
healthcare staff remains a key issue for many people accessing primary mental health
services. We hear examples of good and poor practice from the people we support, as well
as from conversations with members of the public, colleagues, friends and family. It is clear
from their stories and from many of the comments left by respondents to this survey that
attitudes can have a huge impact on people’s overall experience.
General Practitioners
There was a 4.1% increase
in the proportion of people
who selected ‘extremely’ or
‘very’ understanding and
empathetic compared to
the 2012 survey.
Although this indicates a
small improvement, it is still
concerning that over 20%
of respondents felt that
their GP was only ‘slightly’
or ‘not at all’ understanding
and empathetic.
However, it is pleasing to
see that the majority of
respondents rated their GP
in the two most positive
categories.
Chart 3a: How would you rate the understanding
and empathy demonstrated by your GP?
100%
Not at all
understanding
and empathetic
90%
80%
Slightly
understanding
and empathetic
70%
60%
Moderately
understanding
and empathetic
50%
40%
Very
understanding
and empathetic
30%
20%
Extremely
understanding
and empathetic
10%
0%
2012
2013
Table 3b: How would you rate the understanding and empathy demonstrated by your GP
when you discussed your mental health with them?
2012
2013
Extremely understanding and empathetic
23.1%
24.4%
Very understanding and empathetic
30.7%
33.5%
Moderately understanding and empathetic
22.5%
20.1%
Slightly understanding and empathetic
15.4%
15.3%
Not at all understanding and empathetic
8.4%
6.6%
664
520
Number of respondents
6
2012
2013
%
change
53.8%
57.9%
4.1%
23.8%
21.9%
-1.9%
The comments left by many respondents at the end of the survey reflect the data shown in
chart 3b. Their experiences were varied but the attitude of their GP was clearly important
to many people.
“My GP has been incredibly sympathetic and understanding and her attitude
is as important in my ability to cope with the issues as any prescription
medication that was prescribed.”
“My GP’s response was “well, what do you want me to do about it?”
“GP was extremely understanding following diagnosis of PTSD. She was
thorough - remembered history and followed up appointments to ensure
continuation of care.”
“Useless, it’s like I’m not being taken seriously.”
“I have a long standing mental health problem and can always rely on my GP
to listen to my concerns. I use predominantly self management to minimise
symptoms and having a good relationship with my GP is a key part of this.”
“I’m sick of being treated like I’m lying by my doctor.”
“My GP listened and explained how my medication would work very well, he
made me feel that my depression was an illness and not me just being foolish.
He also made me feel as if he was interested and asked me to book a further
appointment for follow up. After the appointment I felt as if I was being
treated well and not pushed aside.”
“I was treated as if my condition was not important.”
“GP fantastic - what he didn’t know about disorder he researched in order to help.”
“Felt judged and as if I was wasting time.”
It is clear that some people have had an extremely positive experience and these GPs
play a crucial part in making patients feel respected and believed. However, local mental
health partners need to ensure that all GPs appreciate the importance of demonstrating
understanding and empathy towards people with mental health problems and treating
them with dignity and respect.
7
Other staff
These results show very little change in the perceived understanding and empathy of other
staff members in primary care. The responses remain less favourable than the comparable
data about GPs’ attitudes.
Table 3c: How would you rate the understanding and empathy demonstrated by other
staff, such as receptionists or practice nurses?
2012
2013
Extremely understanding and empathetic
9.6%
9.0%
Very understanding and empathetic
20.5%
21.3%
Moderately understanding and empathetic
29.2%
27.1%
Slightly understanding and empathetic
21.0%
20.0%
Not at all understanding and empathetic
19.7%
22.5%
664
520
Number of respondents
The importance of the values and
attitudes demonstrated by other
primary care staff should not be
underestimated. Receptionists
are the first point of contact
for most people, whether this
takes place on the telephone or
in person. It is crucial that they
demonstrate understanding and
empathy towards patients, as
failure to do so could discourage
individuals from accessing the
support they need.
Similarly, practice nurses may
well see patients for regular
check-ups or to treat physical
health problems. Their level of
understanding and empathy
could make the difference
between a patient disclosing
their mental health problem or
walking away without the advice,
treatment or support they need.
2012
2013
%
change
30.1%
30.3%
0.2%
40.7%
42.5%
1.8%
Chart 3d: How would you rate the
understanding and empathy
demonstrated by other staff?
100%
Not at all
understanding
and empathetic
90%
80%
Slightly
understanding
and empathetic
70%
60%
Moderately
understanding
and empathetic
50%
40%
Very
understanding
and empathetic
30%
20%
Extremely
understanding
and empathetic
10%
0%
2012
8
2013
A number of respondents left comments about other staff members, including practice
nurses and receptionists. It is important that all staff treat people with dignity, respect,
understanding and empathy, and primary health services should consider the training and
development needs of their whole staff team.
“Practice nurses MUCH more understanding and generous with time than
GPs.”
“Certain receptionists are rude and unhelpful but some others go above and
beyond to help.”
“The receptionists in my GP surgery [...] are appalling. Not very empathetic
at all, they act like they’re doing you a favour when you ring for an
appointment!!”
“Administrative staff at the GP need awareness of needs; administrative staff
at counselling centres were excellent, empathetic without being condescending.
A peer review or training would be helpful for GP admin staff.”
The Welsh Government strategy Together for Mental Health commits to improving the
values, attitudes and skills of staff who provide support services to people with mental
health problems.
Together for Mental Health - High Level Outcomes
a. The mental health and wellbeing of the whole population is improved.
b. The impact of mental health problems and/or mental illness on individuals of all
ages, their families and carers, communities and the economy more widely, is better
recognised and reduced.
c. Inequalities, stigma and discrimination suffered by people experiencing mental health
problems and mental illness are reduced.
d. Individuals have a better experience of the support and treatment they receive and
have an increased feeling of input and control over related decisions.
e. Access to, and the quality of preventative measures, early intervention and treatment
services are improved and more people recover as a result.
f. The values, attitudes and skills of those treating or supporting individuals of all
ages with mental health problems or mental illness are improved.
9
Impact on overall experience
Many of the comments and case studies contained within this report demonstrate the
importance of understanding and empathy. However, to illustrate this point further we
have compared the answers that people gave in response to the questions about access
and impact, depending on the GP’s perceived level of understanding and empathy. The
following graphs show the difference between the experiences of the people who had a
‘slightly’ or ’not at all’ understanding and empathetic GP and those who had an ‘extremely’
or ‘very’ understanding and empathetic GP.
Chart 3e: Did you manage to access the advice,
treatment and/or support services you needed?
Slightly or not at all
understanding and
empathetic GP
Yes
Mostly
Partly
Extremely or very
understanding and
empathetic GP
No
0%
20%
40%
60%
80%
100%
Chart 3f: Did the services you accessed through primary
care lead to improved mental health and wellbeing?
Slightly or not at all
understanding and
empathetic GP
Yes
Mostly
Partly
Extremely or very
understanding and
empathetic GP
No
0%
20%
40%
10
60%
80%
100%
The differences between the results are stark. In answer to the question about whether the
respondent was able to access the advice, treatment and support they needed, there was
a difference of 41.0% between the proportions of people who answered ‘yes’ or ‘mostly’,
depending on how understanding and empathetic the GP was perceived to be. In answer
to the question about the impact on people’s mental health and wellbeing there was a
difference of 42.0%.
Charts 3e and 3f both highlight the importance of understanding and empathy when
people visit a GP to discuss their mental health. The lack of understanding and
empathy demonstrated by some staff members may indicate a presence of stigma and
discrimination, which could be impacting on whether people are getting the support
they need. We welcome several health boards’ commitments to tackling stigma and
discrimination by signing the Time to Change Wales organisational pledge. However, local
mental health partners must continue their work to improve understanding and empathy
and to ensure that people are treated with respect and dignity.
Recommendations
• Local mental health partners should ensure that primary mental health workers and
all relevant staff participate in the Part One training curriculum that was developed by
NLIAH to support the implementation of the Measure.
• Local mental health partners should ensure that GPs and other primary care staff
attend training to increase their awareness and understanding of mental health
problems.
• Local mental health partners should (continue to) promote Time to Change Wales
across their services and encourage GP practices and LPMHSS to engage with the
campaign to tackle stigma and discriminations.
• Welsh Government should require local mental health partners to routinely measure
and report on patient experiences of the empathy, understanding, values and
attitudes demonstrated by GPs and other primary care staff towards people with
mental health problems.
11
4. Support offered
One of the intentions of the Mental Health (Wales) Measure was to improve access to a
range of services, as well as to broaden primary health care professionals’ knowledge
of alternative support routes. In our 2012 survey we were disappointed to see such low
proportions of people offered anything other than prescription medication. We were
particularly concerned that only 34.8% of respondents felt that they had been offered
advice and information.
This year’s survey results show some real improvements, with 65.1% of respondents
being offered advice and information (an increase of 30.3%). The proportions of people
offered a further assessment, referral to another service and signposting to another
service also increased by between 9.1% and 11.4% (Table 4a).
In response to a request from health care professionals we adjusted the question
regarding psychological therapies and split it into ‘CBT’ and ‘other talking therapy/
counselling’. Overall 11.7% more respondents were offered CBT or another talking therapy
compared to the previous survey (some were offered both). These figures are really
positive and we hope to see further improvements in next year’s survey.
There were slight increases in the proportions of people being offered books on
prescription and physical activity. However, the percentages remain fairly low and we
would welcome further increases in our 2014 survey results. Books on prescription and
physical activity can be helpful options for people who are facing lengthy waiting times to
access other support services such as talking therapies.
Table 4a: Were you offered any advice, treatment and/or support?
2012
2013
% change
A further assessment
15.9%
27.3%
11.4%
Advice and information
34.8%
65.1%
30.3%
Befriending
1.8%
1.7%
-0.1%
Books on prescription
7.8%
11.3%
3.5%
Physical activity
6.5%
7.9%
1.4%
Prescription medication
62.8%
71.6%
8.8%
Psychological therapies
24.5%
36.2%*
Cognitive Behavioural Therapy
16.2%
Other talking therapy
28.3%
11.7%
Referral to another service
13.5%
22.6%
9.1%
Signposting to another service
5.8%
15.3%
9.5%
Another form of support
6.3%
8.5%
2.2%
No support was offered
13.5%
11.9%
-1.6%
Number of responses
882
722
* The proportion of people who were offered CBT and/or another talking therapy
12
Chart 4b: Were you offered any advice, treatment or support?
80%
70%
60%
50%
40%
30%
20%
10%
0%
2012
2013
Despite the improvements, prescription medication is still the dominant offer and several
people complained that their GP seemed too quick to prescribe medication rather than
consider alternative or additional support options.
“Too quick to hand out medication”
“I felt that my GP was too fast in giving medication”
“Too quick to prescribe antidepressants”
“GPs have been far too quick to just put me on medication rather than discuss
other options.”
“GPs quick to offer prescription meds but slow to offer counselling or cognitive
therapy.”
13
Medication may be appropriate for many patients but it is clear that people would like to be
offered alternative treatments and therapies or at least the opportunity to discuss a variety
of options.
“In my experience, most of the GPs I’ve visited have had a very good empathy
and understanding of mental ill health. I think however they are very
limited in the support/treatment they can offer patients. They can give
general advice about how to manage your wellbeing and provide prescriptions
to medication, but I think there is still a serious lack of other available
treatments.”
“I have suffered depression since the birth of my son 15 years ago and only
ever been offered anti depressants, I think I would benefit from counselling or
a gym referral but it has never been offered.”
“I wish instead of medication I could have got counselling or another type of
therapy instead.”
“My doctor is lovely and very understanding of my on-going condition;
however, he advocates a medical approach only, and has tried to dissuade me
from more holistic treatments. He will not refer me to the primary mental
health service, despite being asked to do so.”
“I asked about cognitive behavioural therapy but I was told it wasn’t
available.”
“I would really have appreciated the opportunity to gain access to therapy
services or counselling. Having used these services in the past through a
different health board when I was living elsewhere, I found it to be the most
beneficial in dealing with depression. Using prescription drugs alone does not
deal with the route of any problem. I wouldn’t mind being on any waiting
list for the service, but the knowledge that I had that opportunity and was
waiting for support, would be helpful.”
14
It is important to consider why people are not being offered alternatives to prescription
medication. Some of the reasons may include:
• Some GPs may not feel confident or competent to offer advice because they do not
have specialist mental health expertise or do not have access to information and
support to enable them to do so.
• Some GPs may believe that they have given advice and information, but their
patients do not feel as though they have received this support.
• Some GPs may feel forced to prescribe medication because waiting times for other
services are lengthy or they believe that there are no alternative support options
available to their patient.
• Some GPs may be unaware of alternative local support services or they may not
have the confidence in these services to refer patients to them.
Part One of the Measure includes a duty to provide information and support to primary
care practitioners. This should lead to an improvement in the knowledge and awareness
of the range of support services available to patients, which should translate into more
options being discussed and offered to people with mental health problems. As health
boards and local authorities continue to implement the Measure they should ensure that
this is being delivered and is not being lost due to a focus on other aspects of Part One.
We cross referenced the type of advice, treatment and support offered to respondents
with their answer to the question ‘Did the services you accessed lead to improved mental
health and wellbeing?’ There was clear variation between those offered only medication
and those offered medication along with advice and/or another form of support. The results
indicate that medication by itself is less effective and that advice, information and other
forms of support can make a positive difference to an individual’s outcome.
Chart 4c: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
Medication only
Yes
Mostly
Medication + advice and
information
Partly
No
Medication + advice and
information + another form of
support
0%
20%
40%
15
60%
80%
100%
There was also a difference in outcomes between those offered CBT and/or another
talking therapy and those you were not offered this type of support.
Chart 4d: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
Not offered CBT or
other talking therapy
Yes
Mostly
Partly
Offered CBT and/or
other talking therapy
No
0%
20%
40%
60%
80%
100%
Overall, we would like to see a higher proportion of respondents being offered a wider
variety of support options. Without discounting the medical expertise of primary care
staff, people are experts in how they feel and we believe that they should be given choice
and control over their treatment and support options. We would also like to see a further
increase in the proportion of people being offered advice and information. This should be
the bare minimum offered to every patient with mental health problems who visits their GP.
Recommendations
• In line with the Measure, local mental health partners should ensure that appropriate
information and support is provided to GPs and other primary care staff, so that they
are better informed and more confident about offering a range of advice, treatment
and support options.
• Local mental health partners should work to increase primary care practitioners’
awareness of alternative support services in the community and encourage general
practices to positively engage with third sector organisations and other providers of
these services.
• Local mental health partners should continue to explore opportunities and take
action to reduce waiting times for assessments and support services such as talking
therapies.
• Local mental health partners should encourage the promotion of schemes such as
Books Prescription Wales and exercise referral, which patients can utilise while they
are waiting for other services such as talking therapies.
• The social model and a holistic, whole person approach to mental health and
wellbeing should be taught within the training that GPs receive pre-qualification.
16
5. Waiting times
We asked respondents about their experiences of waiting times for both assessments and
other support services. This has been an issue for many people over a number of years
and one of the aims of Part One of the Measure is to reduce waiting times and therefore
improve outcomes. Waiting times are also being recorded and monitored by local mental
health partners and the Welsh Government.
Waiting times: assessments
Waiting times for assessments
appear to have improved very slightly,
however we recognise that the sample
size is small. Bearing in mind that
the Measure received royal assent in
December 2010 it could be argued
that services should have been set up
and ready to go from October 2012.
However, we understand that some
primary mental health teams were
not fully operational by this time. We
also know that there has been a high
demand for the new service, which
will have undoubtedly increased
pressure and affected waiting times.
Table 5a: How long did you have to wait to
receive the assessment?
2012
2013
Up to 2 weeks
16.4%
17.9%
2-4 weeks
21.2%
23.2%
1-2 months
25.7%
24.7%
3-4 months
13.7%
13.2%
4-6 months
10.2%
8.4%
Over 6 months
12.8%
12.6%
226
190
No. of respondents
Chart 5b: How long did you have to wait to receive the assessment?
Up to 2 weeks
2012
2-4 weeks
1-2 months
3-4 months
4-6 months
2013
Over 6 months
0%
20%
40%
60%
17
80%
100%
The initial Welsh Government target, which was set in April 2013 (half way through the
timescale for this survey data) was for 80% of people to receive their assessment within
56 days. Our table shows that 65.8% of respondents told us that they had received their
assessment within two months. From October 2013 the target was changed to 80%
of people to receive their assessment within 28 days; however this was after the data
collection period for this survey. More recent figures collected by health boards for the
Welsh Government appear to show a more positive reduction in waiting times, with the
majority of people being seen within 28 days. We hope to see this improvement reflected
in next year’s survey data when the system has had more time to ‘bed in’.
Table 5c: How long did you have to wait to receive the assessment?
2012
2013
% change
Up to 2 weeks
16.4%
17.9%
1.5%
Up to 4 weeks
37.6%
41.1%
3.5%
Up to 2 months
63.3%
65.8%
2.5%
226
190
No. of respondents
Although the sample size is relatively small, when waiting times are cross referenced
with outcomes the pattern is almost identical to last year’s results. The point at which the
lines cross is approximately four weeks for both the 2012 and 2013 data (Chart 5d). This
indicates that accessing an assessment within a month is extremely important for people’s
mental health and wellbeing and that the Welsh Government was right to reduce the target
to 28 days.
Chart 5d: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
100%
90%
Yes / Mostly
(2013)
80%
70%
Partly / No
(2013)
60%
50%
Yes / Mostly
(2012)
40%
30%
20%
Partly / No
(2012)
10%
0%
Less than
2weeks
2-4
weeks
1-2
months
3-4
months
4-6
More than
months 6 months
(Waiting time for assessment)
18
Waiting times: support services
The following figures show
the length of time that
respondents had to wait to
access support services.
These waiting times
appear to have improved,
particularly in relation to the
proportion of people being
seen within four weeks.
However, it is disappointing
to see that 34.7% of
respondents reported that
they had to wait longer than
two months and 23.6%
reported that they had to wait
longer than four months.
Table 5e: How long did you have to wait to access the
support service?
2012
2013
Up to 2 weeks
17.4%
24.6%
2-4 weeks
17.4%
20.2%
1-2 months
24.8%
20.5%
3-4 months
14.8%
11.1%
4-6 months
7.4%
7.8%
6-12 months
9.4%
8.2%
Over 12 months
8.7%
7.6%
310
781
No. of respondents*
*The 2012 survey collected an answer for each respondent. The
2013 survey collected an answer for each support service offered.
Chart 5f: How long did you have to wait to access the support service?
Up to 2 weeks
2-4 weeks
2012
1-2 months
3-4 months
4-6 months
6-12 months
2013
Over 12
months
0%
20%
40%
60%
19
80%
100%
In April 2013 the Welsh Government set a target that 90% of people should receive an
intervention within 56 days of having their mental health assessment. Our data indicates
that 65.3% of respondents accessed the support service within two months. Again, more
recent health board figures indicate that much larger proportions of people are being seen
within two months, and we hope that next year’s survey results reflect this. However, it is
important to point out that the Welsh Government target relates to people moving through
the Local Primary Mental Health Support Services, whereas our data also includes people
who have been referred directly to support services by their GP.
Table 5g: How long did you have to wait to access the support service?
2012
2013
% change
Up to 2 weeks
17.4%
24.6%
7.2%
Up to 4 weeks
34.8%
44.8%
10.0%
Up to 2 months
59.6%
65.3%
5.7%
Up to 4 months
74.4%
76.4%
2.0%
226
190
No. of respondents
The comments left at the end of the survey reflect people’s discontent with waiting times.
Some people had a very positive experience and accessed support in a timely manner but
the majority of comments were critical. A number of people complained that they had to
wait several months to access services such a counselling and some felt forced to access
private counselling due to the lengthy waiting times.
“The service was very good and was quicker than I expected.”
“My doctor was very helpful and I was impressed by the speed of action
taken. The counselling service was a useful tool which helped me to consider
myself in my busy family life.”
“I was put on the waiting list for counselling about 8 months ago, but haven’t
yet come to the top of that waiting list!”
“Still waiting for counselling after 7 months”
“Still waiting to be seen. It has been way over 6 months. Given up now.”
“I was referred to CBT/Counselling in May 2013 following a diagnosis of
PTSD and as of 16th Sept 2013 I have had no contact from the Counselling
agency despite my GP requesting contact on two further occasions.”
20
“Waiting lists for CBT are far too long. You cannot be expected to wait 6
months when you need immediate support?”
“I asked to speak to the GP counsellor. After 2 months I received a letter to
thank me for my enquiry and say there was a 40+ week waiting list. I am
still waiting. This is non-sensical. If a mental health issue is of such severity
that it warrants NHS counselling, waiting a year for an appointment can
only be detrimental. [...]The other option I was given was a private counselling
organisation who were able to see me within a week but at a cost of £40 /
hour.”
“I ended up going to private counselling and paying for it because my wait for
NHS counselling was too long.”
“The waiting list was too long so I now pay for my counselling privately.”
“The only comment is because my treatment was going to take longer than 6
weeks I had to go a private counselling service myself, which is proving quite
costly.”
“The waiting list was too long so I now pay for my counselling privately.”
A number of comments also indicated that some GPs are choosing whether or not to refer
people for talking therapies based on the length of waiting times for these services. This
is an issue that we have also heard from some GPs who are hesitant to refer because of
the associated waiting times. This is clearly a problem if services such as talking therapies
would be the most appropriate and effective form of treatment for the patient.
“I was told that there was too long a waiting list for CBT which was why she
prescribed medication. No other option was offered.”
“I was told that no counsellors are available for 6 months so it wasn’t worth
bothering”
“My GP told me that she could refer me for counselling/CBT but that the
waiting lists were quite long so instead I am using a private (non-NHS)
therapist. Paid for myself.”
21
The following figures and chart plot the waiting time for support services against answers
to the question ‘Did the services you accessed through primary care lead to improved
mental health and wellbeing?’. Unsurprisingly and in line with last year’s survey results
there is a clear trend, with a higher proportion of people answering ‘yes’ or ‘mostly’ the
more quickly they were able to access support services.
Table 5h: Did the services you accessed through primary care lead to improved mental
health and wellbeing?
Under 2
weeks
2-4
weeks
1-2
months
3-4
months
4-6
months
6-12
months
Over 12
months
Yes
36.6%
32.4%
24.3%
28.8%
21.3%
21.6%
18.8%
Mostly
21.1%
22.9%
27.0%
24.2%
12.8%
11.8%
6.3%
Partly
25.2%
23.8%
27.9%
28.8%
40.4%
33.3%
35.4%
No
17.1%
21.0%
20.7%
18.2%
25.5%
33.3%
39.6%
100%
100%
100%
100%
100%
100%
100%
Chart 5i: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
100%
90%
80%
70%
No
60%
Partly
50%
Mostly
40%
Yes
30%
20%
10%
0%
Under 2
weeks
2-4
weeks
1-2
months
3-4
months
4-6
months
(Waiting time for support)
22
6-12
months
Over 12
months
We also plotted the same data in the following line graph, along with the data from last
year’s survey. The 2012 results showed that outcomes worsened after a waiting time
of approximately one month. The 2013 results are similar, with the two lines coming
within 5% of each other at approximately one month. After approximately four months
the proportion of people answering ‘yes’ or ‘mostly’ drops sharply. This strongly indicates
that people are most likely to benefit from an intervention that they can access within four
weeks. If we consider that 34.7% of respondents had to wait longer than two months it is
clear that a sizeable proportion of people see their outcomes affected by lengthy waiting
times.
Chart 5j: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
100%
90%
Yes /
Mostly
(2013)
80%
70%
Partly /
No (2013)
60%
50%
40%
Yes /
Mostly
(2012)
30%
20%
Partly /
No (2012)
10%
0%
Under 2
weeks
2-4
weeks
1-2
3-4
4-6
6-12 Over 12
months months months months months
(Waiting time for support)
Recommendations
• Local mental health partners should continue to explore opportunities and take
action to reduce waiting times for assessments and support services such as talking
therapies.
23
6. Overall access
In addition to questions about attitudes, support offered and waiting times, the survey also
asked respondents whether they managed to access the advice, treatment and/or support
services they needed. Unfortunately, the results show a 5% decrease in the proportion of
people answering ‘yes’ or ‘mostly’ to this question.
Table 6a: Did you manage to access the advice, treatment and/or support
services you needed?
2012
2013
Yes
37.0%
30.6%
Mostly
17.4%
18.7%
Partly
20.4%
24.1%
No
25.2%
26.6%
2012
2013
54.4%
49.3%
% change
5.1%
45.6%
50.7%
It is disappointing that half of all respondents felt that they couldn’t answer ‘yes’ or ‘mostly’.
It is clear from answers to the previous questions and the comments people left at the
end of the survey that many are not being offered the advice or support services they
were looking for and others found that lengthy waiting times led to them seeking support
privately or through employee assistance schemes.
Chart 6b: Did you manage to access the advice,
treatment and/or support services you needed?
2012
Yes
Mostly
Partly
No
2013
0%
20%
40%
60%
80%
100%
One respondent outlined her experience of being referred to the primary mental health
support service. She was very happy with her interaction with her GP but felt let down
by the local primary mental health support service, which did not offer the support she
needed.
24
“My GP was excellent in listening and providing information but there were
limited options available to her in being able to refer me for the support
I need (psychological services). My experience of LPMHSS was extremely
disappointing. There was a lengthy assessment process, over the phone,
which resulted in being offered leaflets about local services. It was really
disheartening to go through such a process of getting your hopes up, waiting
and talking through intimate details of your mental health problems only
to be offered this, especially as in my case none of the services offered were
particularly relevant.”
It is likely that this contact was recorded as a successful intervention, with the patient
being referred for an assessment within the target time and having received information
and support. However, the patient did not receive the support she wanted and the
intervention did not therefore have a positive impact on her mental health and wellbeing.
This demonstrates the importance of recording patients’ views and outcomes as well as
more process driven data such as waiting times.
The comments that people left at the end of our survey picked up a number of other issues
that prevented people from accessing the advice, treatment and support they needed.
Out of hours
A number of respondents commented on the limitations of some services only being
available during normal working hours. Local mental health support services are supposed
to ensure early intervention and prevent people’s health from deteriorating. When the
£7.2billion that mental health problems cost the Welsh economy includes the cost of
absenteeism and presenteeism it is clear that keeping people well and in work should be
a priority. Over 60% of respondents to this survey were in full time work and the following
comments indicate that services need to be flexible enough to meet the needs of working
people.
“Most classes/courses/groups are not [available] outside of normal working
hours, so when you feel vulnerable etc. and are trying to hold it together and
remain in work, you can’t really go to regular ‘treatment’ groups if they […]
happen in working hours.”
“I found it difficult to properly access as I work normal office hours so could
not make use of anything like CBT or counselling.”
“I have recently started reducing my dose myself, as I don’t have the time to
go to and from the doctors, which have limited opening times.”
25
Welsh language
Some respondents commented on the lack of Welsh speakers working in mental health
services, particularly in the provision of talking therapies. This is extremely concerning,
especially in the context of mental health services, where the ability to express emotions
and discuss sensitive issues in the patient’s language of choice is of paramount
importance.
Talking about mental health can be extremely difficult in someone’s first language, never
mind in their second or third. A lot of people are worried or scared about talking to a health
professional about this issue and it is important that they feel confident and comfortable
that they can express themselves, their feelings and experiences in their first language.
“Need more professional Welsh speakers in the industry in Wales. Or to be
informed of ones that are available. It’s much easier to talk about personal
issues in your mother tongue in any country. It took me 14 years to find a
Welsh speaking counsellor through the NHS.”
“More Welsh speakers are needed in the profession.”
“There was no Welsh service available at all. I felt this would have made me
feel a lot more comfortable when discussing my worries and my feelings.
I asked for Welsh support in advance but no Welsh medium support was
available.”
Accessibility
It is vital that people are able to access support services regardless of whether they are
disabled or not. The Books Prescription Wales scheme is an important support option
for many people, especially for those waiting several weeks or months for access to
psychological therapies. It is crucial that these are accessible.
“I couldn’t have the books as [they are] not [available] in large print!!! I’m
partially sighted, and was not happy RE: disability awareness. I felt a bit like
if I said I needed large print I was meant to sort it myself as part of recovery,
but really, that shouldn’t be the case...”
26
Recommendations
• Local mental health partners should ask patients who were referred to LPMHSS
whether they were able to access the advice, information and support they required,
and if not, what else could the service have done to meet their needs.
• Local mental health partners should assess whether they have enough out of hours
provision to meet the needs of people who work full time.
• Local mental health partners should assess whether they have enough services
available through the Welsh language to meet the needs of local people, paying
particular attention to the provision of talking therapies.
• Welsh Government should ensure that national schemes such as the Books on
Prescription Scheme are accessible to disabled people throughout Wales, including
those with sight or hearing loss problems.
27
7. Overall impact
These results were also disappointing, with a smaller proportion of people reporting
improved mental health and wellbeing as a result of accessing primary mental health
services. This could be attributed to a number of factors we have already highlighted
in this report, such as people being unable to access the services they required and/
or the attitude of their GP. External factors such as the economic climate and increased
employment pressures could also be having an impact on people’s wellbeing and their
ability to respond positively to treatment and support.
Table 7a: Did the services you accessed through primary care lead to improved
mental health and wellbeing?
2012
2013
Yes
25.5%
20.9%
Mostly
16.3%
16.3%
Partly
26.6%
26.8%
No
31.6%
36.0%
2012
2013
41.8%
37.2%
% change
4.6%
58.2%
62.8%
However, we remain concerned with the proportion of people answering ‘partly’ or ‘no’ to
this question. It is arguably the most important question in the survey and it is concerning
that we are not yet seeing an improvement. The figures should at the very least be holding
steady rather than going backwards. There may well be an increase in activity but there
also needs to be an improvement in outcomes. We believe that a question of this nature
should be asked beyond the life of this project as part of the data collection associated
with Together for Mental Health. These are the very services that meet the needs of the
general population and should be contributing to the strategy’s high level outcome ‘The
mental health and wellbeing of the whole population is improved’.
Chart 7b: Did the services you accessed through primary care
lead to improved mental health and wellbeing?
2012
Yes
Mostly
Partly
No
2013
0%
10%
20%
30%
40%
50%
28
60%
70%
80%
90%
100%
Consistency and continuity
A number of respondents in the 2012 and 2013 surveys raised the issue of not being
able to see the same GP during each visit. This often means that people have to repeat
their experiences and history several times, which can be distressing for many people
with mental health problems. It also means that people are faced with inconsistencies in
attitude, expertise and treatment. If a patient needs to see the GP again, we believe that
the GP should book follow-up appointments with the patient, rather than expecting them to
navigate the surgery’s booking system which could lead to them seeing a new doctor.
“difficult to see the same doctor each time you visit and different doctors have
different degrees of expertise or experience with mental health issues”
“Each time I visited the GP I was seen by a different doctor and this meant
my treatment was inconsistent”
“Part of the problem with my surgery is the lack of consistency in approach
across all the GPs (you never see the same one so a consistent approach is
needed)”
“The quality of service is very dependent on the individual GP.”
“the knowledge of different GPs is highly variable. I’ve had a couple of very
empathetic and supportive GPs and several who have had a profound lack of
understanding.”
There also appears to be an inconsistency in referral routes, with some people being
referred to the LPMHSS to be assessed and offered support, and others being referred
directly by their GP to services such as counselling. It appears that some areas have fully
incorporated support services into their LPMHSS and others still retain services within
individual surgeries, to which GPs can refer directly.
The freedom for local services to make this choice may mean that they are better
equipped to meet local need. However, it should not lead to patients having inequitable
or poor experiences. For example, there may be differences in support options or waiting
times, depending on whether someone is referred through the LPMHSS or directly to the
surgery’s counsellor. The waiting times of those referred directly will not be captured in the
Welsh Government’s data if they sit outside of the LPMHSS.
29
In line with topical discussions about prudent health care it is also important that
referrals to the LPMHSS are appropriate. Part One of the Measure is supposed to give
more information and support to GPs and this should lead to them having much more
confidence to offer advice, information and support. It may be that some patients are more
appropriately supported by their GP with regular appointments over a period of time, rather
than referred onwards. We know that some GPs do this very well, but others may feel less
confident to do so. This is why the information and support to GPs is a crucial element of
Part One of the Measure.
Join up between services
In addition to the comments about attitudes, services offered, waiting times and
access, respondents raised a number of points about the lack of joined up working or
communication between different parts of health and social care services.
“There is a total lack of cohesion from GP through to Social Services and the
NHS. Absolute shambles and totally distressing.”
“There had been no clear communication between GP and psychiatrist
regarding my partner’s mental health problems which is not satisfactory. The
GP did not know how to manage him in the surgery and did not know how
to regulate his medication. I think this is appalling and could be easily rectified
by clear communication between disciplines.”
“the system is so fragmented, different referrals from different people [...]
Individuals great but system design is fragmented and results in duplication.
She did not want to keep discussing it over and over again with different
people. As always with NHS there is little joining up.”
“no joint working with GP and psych teams.”
“The communication between my local GP practice, CMHT and hospital
Mental Health Unit are poor and disorganised at best. Also, my physical and
mental health problems are dealt with separately, rather than treating me
holistically.”
30
Some concerns were also raised in relation to people being caught between primary and
secondary services, a possible unintended consequence of the Measure. It is important
that health boards are mindful of such situations and people regarded as no longer
requiring secondary services are able to access appropriate support from primary care
teams.
“For over a year now, I have been passed from pillar to post, being discharged
from each service along the way before receiving any help, and ending up back
at square one. My case was too severe for employee wellbeing counsellors, but I
was discharged from the community mental health team as I was not deemed
severe enough (ie suicidal) at that moment in time. I kept being advised I
could pay privately, despite my bad financial problems.”
Recommendations
• The Welsh Government should establish a mechanism to understand whether
primary mental health support services are having a positive impact on people’s
mental health and wellbeing.
• Where appropriate GPs should book a follow up appointment with the patient to
ensure that they see the same doctor and do not have to repeat their history or
experiences.
• Local mental health partners should identify inconsistencies in application of primary
mental health support services and whether these are delivering different outcomes
for patients or are justified as a way of meeting local needs.
• The Welsh Government, health boards and local authorities should work to improve
integration and communication between health and social care.
31
8. Case studies
We collected a series of case studies to complement the survey data, provide more indepth accounts of people’s experiences and further demonstrate the impact that attitudes,
support options and waiting times can have on people’s mental health and wellbeing.
The majority of these case studies are written by individuals who have accessed primary
mental health services, using their own words to describe their personal experiences and
views. Two of the case studies are written by support workers on behalf of the individuals
concerned.
Case study
Mental health problem:
Anxiety, low mood, loss of appetite, feelings that I can no longer cope,
trouble with sleeping, a tight knot feeling in my stomach, and suicidal
thoughts.
Response from GP and/or LPMHSS:
The GP was very sympathetic and showed empathy whilst listening to me
talk about how I was feeling. The GP encouraged me to speak openly and
in depth about my mood and thoughts. The GP was able to identify that
there were mental health problems and diagnosed me with anxiety, and
depression. The GP gave me a questionnaire to complete about my thoughts
and feelings, scored this at the end and explained the scoring process. The
GP referred me to the CMHT, prescribed citalopram lower dose and asked
me to return next week to see him. This was done on a weekly basis until I
was placed on the maximum dosage after 4 weeks.
I was seen within a day of expression of these thoughts and feelings and the
CMHT saw me within 4 weeks of the referral.
What would have improved the experience?
Nothing. I was seen quickly and promptly and was dealt with in an
empathetic way.
32
Case study
(Completed by support worker on behalf of the individual)
Mental health problem:
Visit was for various reasons including heightened symptoms of depression
and anxiety.
Response from GP and/or LPMHSS:
The individual initially approached her GP in April 2013 who gave good
advice about mental health but was unable to alter medication for reasons
that were explained to her. A referral was made to the primary care mental
health service and the purpose of the referral was clearly explained to the
individual. This referral had to be chased up by the GP and assessment of
need was carried out approximately 6 weeks after referral.
An assessment of need was carried out in June 2013 by a primary care
mental health nurse. The assessment was carried out in an understanding
and empathetic manner, however the presence of a student which the
service user was not informed of until she entered the assessment room did
not help the service user to relax or feel comfortable in the assessment.
An outline program of treatment was explained to the service user at the
end of the assessment. The options were book prescription, bereavement
counselling, new pathways counselling, mindfulness course and a medication
review with a psychiatrist. The options were explained to the service user
and she was given time to make a decision. The service user informed the
service within 1 week that she would like to accept all options apart from
the new pathways counselling.
To date (October 2013) none of these treatments have commenced. The
individual is still waiting for the treatment.
What would have improved the experience?
Not having to wait so long to receive treatment. The individual concerned
has been waiting for four months following an assessment that she found
incredibly challenging. She disclosed information about her past and current
circumstances which was incredibly difficult for her to discuss. This led to
the individual feeling she had laid herself open but not been taken seriously.
Offering services/treatment that took account of physical disabilities and the
limitations this may place on the individual’s ability to access treatments.
33
Case study
Mental health problem:
Eating disorder for approximately 15 years but I have previously self
managed, rather than seeking professional help.
Response from first GP:
I went to GP for repeat prescription for the contraceptive pill. My BMI was
higher than it should be and the GP told me to lose weight – half a stone by
my next appointment. The GP was unaware of my eating disorder history –
I had never talked to a health professional about it.
I told my GP about my eating disorder but she had no real response,
empathy or understanding. The GP didn’t demonstrate any knowledge
about eating disorders and did not offer to talk about it further. I was only
offered the opportunity to see a nurse about a diet plan to reduce my BMI.
My mental health was ignored.
I went back to see the same GP and had lost weight. I was weighed and
then congratulated for losing weight. However, the GP didn’t check whether
I had lost the weight in a healthy way. I was only there for a few minutes.
The GP seemed indifferent to the fact that I have an eating disorder.
What would have improved the experience?
An offer to talk about it and some effort to engage with me about what my
experience had been and why it had manifested itself. The GP could have
offered me information, advice or counselling but did none of these things.
Response from second GP:
I visited a different doctor as the previous one had left the practice. Again, I
visited the GP for a repeat prescription. I had previously lost two and a half
stone but had since put weight on. I was concerned about going over the
recommended BMI.
I told the GP about my eating disorder and discussed my concerns. The
GP responded by saying “Do you want to tell me more about where that
came from?” which was a huge improvement from my last experience with
a GP. She listened and offered to refer me to an eating disorder specialist,
counselling or other therapies. She also gave me diet advice.
I felt empowered because I was able to tell my story and still feel in control
about what to do next. The GP was supportive and talked to me about my
established support mechanisms and friends. She acknowledged that my
eating disorder was real – as opposed to my previous experience, when the
GP made me feel like I wasn’t believed.
34
This GP seemed to appreciate my own knowledge, insight and
understanding of my emotions and triggers – she treated me as an expert
in my own health but didn’t shy away from her responsibility in terms of
offering help and expertise.
I decided not to take up the support yet, but know the door is open. The
GP told me to come back if I wanted to access any of the treatment and
support services that had been discussed. The most important thing was
the GP’s attitude towards me and that left me feeling more positive about
my mental health.
What would have improved the experience?
Nothing.
Case Study
(Completed by support worker on behalf of the individual)
Mental health problem:
The service user had experienced mental health issues for many years and
has a diagnosis of depression. He had recently become homeless and was
feeling low in mood and very suicidal. He wasn’t eating or sleeping and had
planned a way to end his life. He visited the GP for help and advice.
Response from GP:
The service user stated his GP has very little understanding of mental health
issues and the effect it has on people. He felt his GP was not very empathic
towards him and didn’t understand how low he felt. The GP did however
refer him to the crisis team where he was seen and discharged the same day.
The service user then went back to the GP as he felt his medication wasn’t
helping him and he was still feeling suicidal. The GP didn’t really listen
and informed him to stop smoking cannabis; this left the service user not
wanting to return to see his GP. The negative experience this person left
then feeling unable to return to see his GP, and he ended up registering with
another GP.
What would have improved the experience?
If they were listened to and referred to appropriate services. If staff had
more experience of mental health issues and how this impacts of people’s
lives. This was a vulnerable gentleman that was homeless and suffering with
his mental health and he felt let down by the GP and mental health services.
35
Case study
Mental health problem:
Anxiety.
Response from GP and/or LPMHSS:
The GP was very understanding and empathetic, he quickly referred me
to Community Mental Health Team for alternative treatments, medication
was altered in the short term until this appointment was scheduled. It took
around a month before I was assessed by CMHT and therapy began shortly
after this. The GP requested that I made a follow up appointment to see how
I was progressing.
What would have improved the experience?
Nothing.
Case study
Mental health problem:
Anxiety
Response from GP and/or LPMHSS:
My GP was excellent in listening and providing information but there were
limited options available to her in being able to refer me for the support I
need (psychological services).
My experience of PMHSS was extremely disappointing. There was a lengthy
assessment process, over the phone, which resulted in being offered leaflets
about local services. It was really disheartening to go through such a process
of getting your hopes up, waiting and talking through intimate details of
your mental health problems only to be offered this, especially as in my case
none of the services offered were particularly relevant. As a result, I have
had to pay for private counselling.
What would have improved the experience?
Being able to access psychological therapies through the NHS.
36
Case study
Mental health problem:
Anxiety, stress, depression.
Response from GP and/or LPMHSS:
The first Doctor assured me I “wasn’t mad”. I burst out in tears. I knew
something was wrong but didn’t know what and that comment didn’t help.
Looking back I now think I had a breakdown that led to stress, anxiety and
major depression. All conditions that make you fear the worst and look for
hidden meanings in what people are saying. So that comment wasn’t wise
or kind.
By the time I’d changed to my third Doctor I found one who is incredible
- caring, understanding; just brilliant. But whilst ill, I shouldn’t have the
added stress of finding the right doctor. All doctors should treat mental
illness with the respect they treat physical illness and the patients with the
care and compassion they clearly so desperately need.
I was initially written off work for 6 weeks and referred to the practice’s
CPN. But I was told it would be at least 6 weeks until I saw her - so was
the expectation I’d see her whilst in work? How was I supposed to get
better without help (this was before I was on medication)? So I was left
to stew, worry and feel abandoned for 6 weeks without any contact or
support, frantically trying to help myself but misguidedly just digging myself
into a bigger hole. I’ve been off over a year now and I can’t help but think
that if I’d had prompt help when I first asked for it [..] then I wouldn’t have
got this ill or suffered quite so much.
When I finally saw the CPN she didn’t offer any useful advice, didn’t seem
to care. Once I’d seen her a few times and hadn’t improved she told me I
should go on medication. I said I didn’t want to go down that route unless
I absolutely had too, and what were the other options? She said giving out
medication was her job. So with no other choice I took it. I’ve now tried 5
different kinds and they either haven’t worked or the side effects have been
too crippling. A while after I asked about the Book Prescription scheme I
had heard about and she looked at me gone out [in an odd or confused way]
and said she could prescribe books if I really wanted... not really selling it.
The nurse who did my blood tests checked with me that I was happy they
had done enough so I “didn’t go away and self harm”. A terrifying thought
to someone who had never self harmed and never wanted to, who was
scared and didn’t understand what was happening to her mind and body at
that moment.
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Case study
Mental health problem:
Decline in mental health due to family situation.
Response from GP and/or LPMHSS:
GP was extremely helpful, signposted and referred to relevant agencies such
as Cruse and CMHT for further treatment and support. GP made me feel
very comfortable and able to discuss my issues in full without making me
feel I was taking too long. GP had a full understanding of the issues and did
not have an issue with asking me about suicide thoughts or plans. GP was
very empathetic. GP prescribed medication, explaining what it was, how
this would affect me and also how long it would take to enter my system
and begin to work. A referral was made straight away and I had assessment
within a month.
What would have improved the experience?
In this circumstance the GP could not have improved the experience. I
came away from the appointment feeling like I had been listened to and
that support was finally being put in place with regards to the specialist
counselling/treatment I needed.
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9. Conclusions and recommendations
The survey results indicate improvements in some areas but it is clear that there is
still some way to go. We did not expect to see an enormous change within a year but
it is pleasing to see an increase in the proportion of people accessing support within
four weeks and an increase in the proportion of people being offered advice and
alternative forms of support. However, there must be a continued focus on improving the
understanding and empathy of primary care staff; increasing the range of support options
offered to patients; further reducing waiting times; and ultimately improving patient’s
mental health and wellbeing. While it is useful to collect process data such as waiting
times, there needs to be a mechanism to determine whether these services are improving
outcomes.
Many of these recommendations are similar to those published in last year’s report but we
believe that they remain relevant to service improvement. The term ‘local mental health
partners’ refers to the local health board and local authority for a particular area, in line
with the Part One of the Mental Health (Wales) Measure.
Recommendations
1. Local mental health partners should ensure that primary mental health workers and
all relevant staff participate in the Part One training curriculum that was developed by
NLIAH to support the implementation of the Measure.
2. Local mental health partners should ensure that GPs and other primary care staff
attend training to increase their awareness and understanding of mental health
problems.
3. Local mental health partners should (continue to) promote Time to Change Wales
across their services and encourage GP practices and LPMHSS to engage with the
campaign to tackle stigma and discriminations.
4. Welsh Government should require local mental health partners to routinely measure
and report on patient experiences of the empathy, understanding, values and
attitudes demonstrated by GPs and other primary care staff towards people with
mental health problems.
5. In line with the Measure, local mental health partners should ensure that appropriate
information and support is provided to GPs and other primary care staff, so that they
are better informed and more confident about offering a range of advice, treatment
and support options.
6. Local mental health partners should work to increase primary care practitioners’
awareness of alternative support services in the community and encourage general
practices to positively engage with third sector organisations and other providers of
these services.
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7. Local mental health partners should continue to explore opportunities and take
action to reduce waiting times for assessments and support services such as talking
therapies.
8. Local mental health partners should encourage the promotion of schemes such as
Books Prescription Wales and exercise referral, which patients can utilise while they
are waiting for other services such as talking therapies.
9. The social model and a holistic, whole person approach to mental health and
wellbeing should be taught within the training that GPs receive pre-qualification.
10. Local mental health partners should ask patients who were referred to LPMHSS
whether they were able to access the advice, information and support they required,
and if not, what else could the service have done to meet their needs.
11. Local mental health partners should assess whether they have enough out of hours
provision to meet the needs of people who work full time.
12. Local mental health partners should assess whether they have enough services
available through the Welsh language to meet the needs of local people, paying
particular attention to the provision of talking therapies.
13. Welsh Government should ensure that national schemes such as the Books on
Prescription Scheme are accessible to disabled people throughout Wales, including
those with sight or hearing loss problems.
14. The Welsh Government should establish a mechanism to understand whether
primary mental health support services are having a positive impact on people’s
mental health and wellbeing.
15. Where appropriate GPs should book a follow up appointment with the patient to
ensure that they see the same doctor and do not have to repeat their history or
experiences.
16. Local mental health partners should identify inconsistencies in application of primary
mental health support services and whether these are delivering different outcomes
for patients or are justified as a way of meeting local needs.
17. The Welsh Government, health boards and local authorities should work to improve
integration and communication between health and social care.
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Website: www.gofal.org.uk
Twitter: @Gofal_
Facebook: GofalCymru
Email: [email protected]
Telephone: 01656 647722
Head office: Derwen House, 2 Court Road, Bridgend CF31 1BN