Involving service users in mental health services in Wales

Users of mental health services have needs that transcend the boundaries of services. Here we explain the importance of involving people who use mental health services and their carers in the planning of mental health services within Bridgend.

User involvement in planning and developing services is becoming a reality in Wales for mental health service users, writes Christopher Moss and colleagues

The National Institute for Health and Clinical Excellence advocates that agencies that have responsibility for planning and providing services should work with service users in order to address issues of development and delivery.(1) The Welsh assembly is a keen proponent of this.

Within the context of mental health, the Welsh assembly has published several documents that provide the strategic direction, namely the Adult Mental Health Services for Wales Strategy(2), the accompanying national service framework,(3) the user involvement document Stronger in Partnership,(4) and a report on the review of user and carer participation.(5)

The direction of these documents is explicit, with local mental health partnerships being required to encourage the full participation of service users and their carers in all aspects of mental health services, including planning and commissioning. Specifically they stipulate that:

● People who use mental health services and their carers should have timely access to comprehensive, clear, and helpful information.
● The NHS and local authorities should ensure that people who use mental health services and their carers are meaningfully involved in the planning, design, delivery, monitoring and evaluation of mental health services.

So what does meaningful involvement actually mean? The Welsh assembly says that people with mental health needs and their carers should be equal partners at every stage of the planning and commissioning process – that is from inception, through planning, implementation, monitoring and evaluation of services.

Mechanisms and support are needed to achieve this level of participation. This might include a designated development officer, access to information, or assistance to prepare for meetings. Meetings should be held at times and in places convenient to people with mental health needs and their carers and not just to suit the schedules of health and social care professionals.

There are several barriers that can hinder meaningful involvement, namely:

● Potential conflict between the needs of carers and those of service users.
● Staff in health and social services not being skilled or trained to facilitate the involvement of people with mental health needs and carers.
● The financial cost of participation – expenses paid will encourage involvement.
● Service users’ perception that their input is tokenistic.
● Service users’ lack of confidence, which leads to them not making an impact in meetings.
● Too much jargon and use of acronyms.
● The inability of any single individual to adequately represent service user and carer interests.
● An assumption that a seat at the table is the only valid means of participation.

Mechanisms can be put in place to overcome these barriers, including a strategy for engagement and continuing support for people with mental health needs and their carers adopted by all partner agencies, the establishment of patient councils and other user and carer groups, and the appointment of a user development officer.

The Welsh assembly has recommended that local health boards, NHS trusts, councils and the voluntary sector work together in a framework with clearly defined goals, encourage participation, fund and support user organisations, and adopt a multi-agency approach with funding targeted at empowerment and developing local arrangements for effective participation.

It says partner agencies should provide funding for staff training, user and carer training and remuneration, advocacy, and patient participation posts. It also advocates providing briefings and papers in accessible formats. Agencies should recruit and train staff with the right attitude and skills and monitor performance, as well as provide an adequate number of patient participation officers to meet need.

It also suggests providing training for users on consultation and ensuring that staff have sufficient time to spend with users and carers.

Taken together and carried out with enthusiasm, these measures can transform services into modern, personalised care and empower mental health service users and their carers to become full, active members of society.

Participation in Bridgend

The Bridgend Joint Mental Health Strategy Planning Team, established in 1999, plans mental health services for the area.

The team consists of the Bridgend Association of Voluntary Organisations, Bridgend Council, Bridgend local health board, Bro Morgannwg NHS Trust, and most importantly users and their carers.

To ensure the latter are meaningfully involved, the multi-agency team has:

● Set up a patients’ council.
● Run training programmes to focus staff on the recovery model approach to the delivery of care.
● Developed a values statement to help ensure that people with mental health needs are treated with respect and provided with opportunities so they can reach their full potential while enjoying health and well-being.

A directory of mental health services has been produced as part of an information pack for users and their carers. Local partners are also in the process of recruiting a dedicated service user and carer participation officer.

The team has also supported initiatives to further involve people with mental health services and their carers, including:

● Appointing a mental health development officer located in the voluntary sector to support the team to effectively involve users and carers.
● Creating a fund to remunerate people with mental health needs and carers for expenses incurred in their participation.
● Establishing interview panels for mental health posts comprising people with mental health needs and their carers.
● Arranging for health and social care professionals to receive training delivered by people with mental health needs and their carers.
● The establishment of forums for people with mental health needs and carers that report to the team.

The team is looking at rescheduling planning meetings to times and venues more convenient to people with mental health needs. It will also pay them for their participation, and develop ways of engaging them more effectively.

Christopher Moss is an adult services planning manager, Bridgend Local Health Board. 
Andy Fraser is a mental health development officer, Bridgend Association of Voluntary Organisations.
Vernon King is a principal officer, social services, Bridgend Council.
Peter Wakeford is a community advocacy service manager, Mental Health Matters, Bridgend Council.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

References
(1) S Markwell, J Watson, V Speller, S Platt, & T Younger, The Working Partnership, Health Development Agency, 2003
(2) National Assembly for Wales, Adult Mental Health Services for Wales: Equity, Empowerment, Effectiveness, Efficiency, 2001
(3) Welsh Assembly Government, Adult Mental Health Services Raising the Standard: The Revised Adult Mental Health National Service Framework and Action Plan for Wales, 2005
(4) Welsh Assembly Government, Stronger in Partnership: Involving Users in the Design, Planning, Delivery and Evaluation of Mental Health Services in Wales, 2004
(5) National Assembly for Wales, Review of the National Service Framework for Mental Health Standard 2: User and Carer Participation, 2005

This article appeared in the 8 March issue of the magazine under the headline “Come in and help”