The mental health (wales) measure 2010 is a new law passed by the national assembly for wales and, as such, has the same legal status in wales as other mental health acts.Cognitive behavioral learning theory however, whilst the 1983 and 2007 mental health acts are largely about compulsory powers, and admission to or discharge from hospital, the 2010 measure is all about the support that should be available for people with mental health problems in wales wherever they may be living.Cognitive behavioral learning theory

The measure became law in december 2010 but significant preparation was needed before it could be implemented. So the main provisions only began to take effect between april and october 2012 and it will be some time yet before the full impact will be felt.Cognitive behavioral learning theory it is important, however, that people with mental health problems and their families understand the main points of the measure and know about the support they are now legally entitled to.Cognitive behavioral learning theory

The measure is intended to ensure that where mental health services are delivered, they focus more appropriately on people’s individual needs.Cognitive behavioral learning theory it has four main parts (parts 5 and 6 are essentially about administrative issues), and each places new legal duties on local health boards and local authorities to improve service delivery.Cognitive behavioral learning theory the four parts are as follows.

Below we will look at each of the four parts of the measure in more detail. Parts 2 and 3 will have the greatest impact for those with serious mental illnesses and who are receiving secondary care services but, as we explain, all have some relevance.Cognitive behavioral learning theory however, before moving on to parts 1 to 4, we must begin by explaining some guiding principles. THE GUIDING PRINCIPLES

• clear communication in terms of language and culture is essential to ensure patients and their carers are truly involved, and receive the best possible care and treatment – so that there is always an understanding that poor communication too often leads to inappropriate care and treatment, and that good communication is likely to lead to better outcomes.Cognitive behavioral learning theory this principle also states that all possible steps should be taken to ensure that bilingual (welsh and english) services are available.

• care and treatment should be integrated and coordinated – so that when offering care and treatment, professionals recognise the range of services that may benefit a person, whether in the statutory or voluntary sectors, or whether specialist mental health services or more general services, and actively work together with other services to coordinate service delivery.Cognitive behavioral learning theory

There is no one document that summarises for the wider public the proposed improvements to primary mental health services, but they are set out in detail for service providers in the welsh government document “national service model for local primary mental health support services” (2011).Cognitive behavioral learning theory what follows is a summary of some of the key elements of that document.

• primary mental health assessment – A person will be offered this assessment if their GP or other worker believes they would benefit from a more detailed mental health assessment, with the aim of identifying whether local primary mental health treatment or any other local service might improve, or prevent a deterioration in, that person’s mental health.Cognitive behavioral learning theory the aim is for a person to wait no more than 28 days for an assessment.

• short-term treatment or support – following assessment, a person should be offered short-term help where this is appropriate.Cognitive behavioral learning theory examples of this help could be counselling, psychological interventions including cognitive behavioural therapy, solution-focussed therapy, family work, online support, stress management, bibliotherapy or education, and it could be offered individually or through group work.Cognitive behavioral learning theory

• information and advice to individuals and their carers – A further key role of primary mental health services will be to develop a good understanding of the range of services in their local area, including both general services and more specialist services.Cognitive behavioral learning theory this will enable them to offer appropriate information and advice as to what options for additional support may be available, and it is particularly hoped there will be “signposting” to support provided by voluntary sector organisations.Cognitive behavioral learning theory A clear aim is also to provide this information, not only to service users but also their families and carers.

• whilst lhbs and las will remain ultimately responsible for ensuring that services are being delivered properly, services may not always be provided by them.Cognitive behavioral learning theory rather it is suggested that lhbs and las should actively recruit other local partners to help deliver the service, and particularly should “recognise and draw upon the contribution and expertise of specialist third sector organisations”.Cognitive behavioral learning theory

• an important requirement is that service users know where they are in relation to the service and what they can expect. For example it should always be clear to them as to whether they are receiving a local primary mental health support service or being referred on to a secondary care service so they are not running the risk of “being lost between services”.Cognitive behavioral learning theory they should also be clear about their “pathway of care” with “defined entry and exit points”.

This is a very brief part of the measure, in fact the shortest part with just 5 key paragraphs.Cognitive behavioral learning theory however, those few paragraphs include duties and rights that hafal has campaigned hard for over many years, and which we hope will significantly improve the experience of secondary mental health services for people in wales.Cognitive behavioral learning theory essentially part 2 places duties on service providers (health boards and local authorities) to act in a coordinated manner to improve the effectiveness of the mental health services they provide, and it gives people who receive secondary mental health services two essential new rights:

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Whilst part 2 of the measure is relatively short, it is backed up by a comprehensive new code of practice which runs to some 60 pages. This is a statutory code of practice, prepared under section 44 of the measure.Cognitive behavioral learning theory like the welsh code of practice for the mental health act, it is not law which must be automatically followed, but it is an important document as it offers “statutory guidance”, and professionals who do not follow this guidance can be challenged in court.Cognitive behavioral learning theory

• assessment – the measure itself does not make specific reference to assessment in secondary care, but the code of practice fully recognises that effective care planning must be preceded by comprehensive assessment, stating “the aim is for the assessment process to establish information from which care and treatment planning, and future work, can take place” (2.11).Cognitive behavioral learning theory assessment should consider both need and risk. In relation to needs, it should be “holistic” and consider all the eight areas of a person’s life also included in a care and treatment plan (see below) (2.14).Cognitive behavioral learning theory in relation to risk, it should “seek to identify any risks the relevant patient may be exposed to and any risks they may present to themselves or others” (2.18).Cognitive behavioral learning theory

• role of care coordinators – A person’s care coordinator will be a key, if not the key, professional working with them in secondary mental health services.Cognitive behavioral learning theory their care coordinator will be their “principle source of information” and will be “responsible for seeking their active involvement and engagement with the care planning process” (3.5).Cognitive behavioral learning theory the care coordinator will also be ultimately responsible for ensuring the person has a written care and treatment plan and that it is reviewed and updated (3.4).Cognitive behavioral learning theory the duties and functions of care coordinators are set out in detail in the code of practice (3.32 to 3.36) and amount to ensuring they are actively working with, and coordinating the care and treatment of, the people they are responsible for.Cognitive behavioral learning theory

• allocation of care coordinators – it is the duty of statutory service providers, normally a local health board or local authority, to appoint a care coordinator, and the code of practice sets out in detail where this duty lies (3.06 to 3.12).Cognitive behavioral learning theory it also stresses the importance of ensuring that a person knows consistently who their care coordinator is and lays out in detail what should happen if there has to be a change in a person’s care coordinator (3.13 to 3.23).Cognitive behavioral learning theory

• who can be care coordinators – the code of practice is specific as to which professionals can act as care coordinators, and the list has similarities with the one for approved mental health professionals (amhps) under the mental health act.Cognitive behavioral learning theory they must be mental health professionals with appropriate skills and qualifications including (3.26):

• care and treatment planning – chapter 4, the longest chapter of the code of practice, deals with care and treatment planning.Cognitive behavioral learning theory it sets out in great detail not only what a care and treatment plan should look like, but also how it should be discussed, negotiated, distributed, and revised.Cognitive behavioral learning theory in summary the care coordinator must work hard to involve the person, and/or their representative or advocate, and appropriate family members and carers, and to consult widely with appropriate team members, professionals and services (4.3 to 4.32).Cognitive behavioral learning theory the care coordinator should aim to complete the care and treatment plan within 6 weeks (4.87) and copy it to everyone with a direct interest (4.91).Cognitive behavioral learning theory

• coordinating service provision – care coordinators have a responsibility for monitoring the implementation of care and treatment plans, but they do not have the responsibility for ensuring that specified services are delivered.Cognitive behavioral learning theory this wider responsibility lies with the service provider and the code of practice acknowledges there are likely to be instances of unmet need (5.8).Cognitive behavioral learning theory when services are not provided, the care coordinator should review and revise the care and treatment plan with the service user.

A person’s care and treatment plan must then be reviewed at least yearly, but the code of practice goes on to say that “reviews should be needs-led” (6,11) and can be triggered by the person, carer or service provider as well as by the care coordinator.Cognitive behavioral learning theory reviews should be carefully prepared and organised (6.18) and properly recorded (6.16).

• ending of secondary mental health services – the code of practice for part 2 of the measure finally looks a person’s discharge from secondary mental health services.Cognitive behavioral learning theory this will hopefully be a positive event marking an important stage in a person’s recovery but, even when it is, it needs to be recognised that it may be a difficult time for the person involved.Cognitive behavioral learning theory the code of practice, therefore, requires the relevant authority, whether local health board or local authority, to provide the person with clear information about why the secondary care service is ending and where future support may be accessed.Cognitive behavioral learning theory importantly the person must also be informed of their right to a further assessment under part 3 of the measure which we will go on to now.

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The aim of part 3 of the measure is to make it easier for people who are not currently receiving secondary mental health services, but who have been done so in the previous three years, to access those services again.Cognitive behavioral learning theory it gives them the right, if they believe their mental health is deteriorating to the point where they need specialist care and treatment again, to refer themselves directly back to secondary services, without first having to see a GP or go elsewhere for a referral.Cognitive behavioral learning theory

• a person over 18 who has been known to secondary mental health services within the previous three years and still lives in the local area is entitled to “seek a further assessment of their mental health, with a view to determining whether secondary mental health services (or other services) may be required to improve or prevent a deterioration of their mental health” (8.18)

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The mental health act 2007, which amended the mental health act 1983, gave people detained under the act an important new right to receive help and support from an independent mental health advocate (or IMHA).Cognitive behavioral learning theory however, this right was only available to people under longer-term sections (sections 2 and 3) and to people living in the community subject to guardianship or supervised community treatment.Cognitive behavioral learning theory

• rights and duties of imhas – imhas have a duty to respond to any reasonable request to visit and interview a patient they are helping, and they have the right to visit and interview that person in private.Cognitive behavioral learning theory they also have the right to visit and interview any person who is professionally concerned with a patient’s medical treatment (58 to 68).