Work of the Mental Health Improvement Board

20.10.06

2 Deputy K.G. Pamplin of St. Saviour of the Minister for Health and Social Services regarding the work of the Mental Health Improvement Board (OQ.261/2020)

Will the Minister provide the Assembly with an update on the progress of the Mental Health Improvement Board, with particular reference to any proposed mental health service improvements that are currently outstanding in terms of delivery?

Deputy R.J. Renouf of St. Ouen (The Minister for Health and Social Services):

I will ask my Assistant Minister , Senator Pallett, to also answer this question.

Senator S.W. Pallett (Assistant Minister, Health and Social Services - rapporteur):

I thank the Deputy for his question. Certainly as we head towards World Mental Health Day this coming Saturday, although the question does not specifically mention the mental health improvement plan, which was developed to guide the work of the board, I will briefly update Members on both the board and the plan. The Mental Health Improvement Board has continued to meet throughout the pandemic and has supported mental health service providers to respond to the effects of COVID-19. To ensure its ongoing effectiveness the board is currently reviewing its scope, terms of reference and membership. This review is at an early stage and once complete evidence- based changes will be discussed more widely with a wide range of partners and stakeholders, including with our Scrutiny Panel. Moving on to mental health improvement plan, this was always intended to be a live document. It is rag-rated and updated to show progress on each workstream. The Deputy will no doubt be aware of recent successes that include delivery of the Listening Lounge, the review of Jersey Talking Therapies, that has already seen waiting lists removed for low intensity step 2 support, and completed upgrades at Orchard House and La Chasse. With the mental health care group in place our strong leadership team are working towards closer integration of social care and mental health functions to improve patient care. COVID-19 has had an effect on service delivery delaying the development of the crisis prevention service. As a response to the pandemic, we established our home treatment team in a street triage service, and these are being progressed further, but is now the priority to set up a 24-hour crisis line for Islanders in immediate need. We must continue to improve our collaboration with external partners but also need to build even better relationships with our government colleagues who have important roles to play in supporting the mental health of Islanders. Just to finish, I want to assure the Deputy that many of the recommendations within the Scrutiny Panel report of 2018 have been implemented and I am more than happy to take the Deputy and his Scrutiny Panel through the mental health improvement plan in more detail, as it is impossible to do it justice in an oral question.

1. Deputy K.G. Pamplin:

I thank the Senator for his answer and equally for working together on Tuesday on the States Assembly Facebook page to talk about mental health services. He is indeed correct, it is World Mental Health Day on Saturday. Mental health is one of the most neglected areas of public health, the World Health Organization ...

The Bailiff :

Is there a question please, Deputy ?

Deputy K.G. Pamplin:

Yes, just getting to it as quickly as I can. Is driving this year their theme of investment into the service. Will he champion the continued and improved funding required for the mental health service lacking on this Island?

Senator S.W. Pallett:

As the Deputy knows, the answer to that is absolutely yes. We have within the Government Plan committed a great deal of funding towards supporting mental health services within the Island. I think, as importantly, making sure that the physical infrastructure is modern and fit for purpose. Recently we have updated Orchard House, as he knows, and we have got La Chasse opening very soon, are key parts of the service. So the investment will be there and he is right, we do have to commit to investing in mental health not just now but in the future.

2. Deputy L.M.C. Doublet of St. Saviour :

Could the Assistant Minister please give some detail of what is within this mental health plan in terms of improvements to perinatal mental health services please?

Senator S.W. Pallett:

In terms of the specifics around perinatal, I am sorry but I am going to have to get back to the Deputy on that. It is a very long and detailed plan. I do have it in front of me but I am going to take time going through it to find it, but I am happy to get back to the Deputy on that particular issue.

3. Deputy L.M.C. Doublet :

I thank the Minister for that and I hope he will get back to me. Does he agree with me that perinatal mental health is an extremely important area, given that it affects children's mental health and we have committed to putting children first?

Senator S.W. Pallett:

Absolutely. I think in supporting children from the earliest possible age is absolutely vital. I also include families and parents within that as well. It is absolutely key that we provide the support for new parents and, in fact, parents when they have second and third children, making sure that they get the support that they need at a very difficult time. I can assure the Deputy that we will be putting the investment and the effort into making sure parents and young children get that support.

4. Deputy R.J. Ward of St. Helier :

Will the Minister commit to a full range of mental health support beyond initial programmes, such as Talking Therapies and the Listening Lounge, i.e. when referrals are needed beyond those services?

Senator S.W. Pallett:

Absolutely. The Deputy is absolutely right. It is not just about the initial early intervention work, it is very much making sure that those that need more acute support have got that to be able to access. We are currently recruiting people into position to make sure that our trauma pathways are correct and make sure that people do get the support that they need. It has been a difficult time for the mental health team, especially through the COVID period, but we are now getting back to business as usual, our psychology teams are back to full strength. I think the move back to La Chasse, which is really our adult mental health front door and where most of our contacts take place, getting that back in service is going to be really important to providing the care that people need.

5. Deputy R.J. Ward :

What would the Minister consider to be an acceptable waiting time for this further help that may be needed?

Senator S.W. Pallett:

To be blunt, I think anybody that needs to wait ... there is no acceptable wait. I would like to see people treated as early as possible but I think under the current restraints we have got in terms of staffing it is difficult to see people sometimes when they are most at risk but we are making all efforts now to try to bring waiting times down in step 3 and step 4 within mental health. Jersey Talking Therapies is back up and running and we are looking at our waiting list for step 3, for example, that currently stands at 167. For me that is too many and people are waiting too long. But we are getting that service back to where it needs to be and we will carry on investing in that service until we have ... I do not want to see any waiting lists for people with mental health issues because for me that is only going to mean they get worse, their condition gets worse and that is clearly not acceptable.

6. Deputy G.P. Southern of St. Helier :

To what extent are mental health improvements dependent on progress on the Jersey Care Model in 2021 and, in particular, what measures have been prioritised on progress towards, for example, greater G.P. (general practitioner) involvement in mental health issues?

Senator S.W. Pallett:

I pick up on the last point because I think the Jersey Care Model to some degree is based on preventative care, and I think G.P.s have a huge role to play within that service. For many, going to the G.P. will be their first point of contact. We do say to people that are struggling with mental health issues that G.P.s quite often are the right route into the service. So we are working more closely with G.P.s in terms of making sure that they fully understand the issues involved around mental health and know the key pathways to making sure people get the right help that they need. Sometimes it is not always medical help. Quite often it can be other issues and social prescribing where we can provide other sources of help and support for people, quite often can be an answer to those that are in mental health stress. It will be linked closely to the Jersey Care Model. Mental health and physical health do need to be treated as one. I mentioned parity of esteem in the past and it is true. We do need to ensure that mental health is treated in the same way that physical health is treated. It needs to be equal treatment.

7. Deputy G.P. Southern :

In particular, how involved have G.P.s been in making primary care in the community, which is the aim of the J.C.M. (Jersey Care Model), making that affordable? To what extent is that happening?

Senator S.W. Pallett:

In terms of affordability, I think it goes into a wider issue that I know the Deputy has close concerns around. Again, I support him. I think there has to be care, it does not matter whether it is physical care or mental health care.

[10:00]

It needs to be affordable and it needs to be accessible to people in the community. I think with the G.P. service we do. There are some decisions we are going to have to make about how we deal with that affordability, as the Deputy is aware. But people need to be able to access it quickly. There are various pathways into our mental health services, some of them are already free, others we may

have to consider how we deal with the affordability and accessibility. But I support the Deputy . They do need to be affordable. That is a decision the Assembly are going to have to make in the next few weeks.

8. Deputy K.G. Pamplin:

I thank Members for joining in. Can the Senator update us on the impact of the outstanding strategies, I talk about the carer strategy, dementia strategies, and how they are so important to the ongoing support of mental health services.

Senator S.W. Pallett:

I suppose one of the disappointments I have around the dementia strategy is we have not really progressed in a way we need to. We know that we are going to be dealing with a lot more elderly people - although it does not just affect elderly people - with dementia in coming years. So we do need to have a strategy that deals with that. That is something we do need to put some effort and concentrate on before the end of this political term. As I think the Deputy knows, suicide framework is being moved forward - another key area - in ensuring that we are supporting Islanders through difficult times and they do not end up doing something that is avoidable with the right support. But all areas of mental health need to be dealt with equally but I think some of the strategies that are involved are cross-cutting through Government, and it is important that I think we assess and we take time to reflect before too long on some of the strategies that have not had enough effort put into to date, and dementia strategy is one of those. I have spoken to the dementia charity and they are clear that they want to see some more progress made on this, and I understand where they are coming from.