In March 2022, we published a report following our National Review of Mental Health Crisis Prevention in the Community.
The review identified several significant issues within the mental health support system, particularly the service gap for individuals requiring more than the standard General Practitioner (GP) support but not meeting the criteria for specialised services. GPs often lacked awareness of alternative support services, and the cumbersome referral processes result in delays, jeopardising timely support and potentially exacerbating individuals' mental health conditions.
The Key themes highlighted from our work include:
- Enhanced engagement and communication: There was a necessity for improved coordination and communication between different services to clearly define urgent referrals and avoid unnecessary delays
- Post-crisis support: While the initial response to crises is generally adequate, ongoing support following the crisis intervention is often delayed, leading to repeated referral cycles
- Referral process inefficiencies: Inefficiencies in direct referral processes place additional strain on emergency departments, delaying critical mental health support
- Emergency services management: Positive examples were found within emergency services where mental health professionals manage calls, enabling timely support through telephone advice and appropriate signposting, but this was inconsistent across Wales
- Third sector organisations: These organisations provide valuable support but face inefficiencies due to their inability to refer directly to specialist services
- Physical health monitoring: There was a lack of clarity on the responsibility for physical health monitoring among mental health patients, impacting overall health management
- Positive initiatives: Positive steps include single points of access for specialist mental health professionals, local Mental Health Practitioner roles, and ‘safe places’ for short-term crisis support. However, these initiatives were not uniformly implemented across all regions.
Overall, whilst there was dedication among staff to deliver effective and timely care, service design and efficiency required improvement to better support individuals and prevent mental health crises.
The report highlighted 19 recommendations for improvement, and organisations were required to submit an improvement plan to HIW in response to these. This was to ensure that the matters raised by our review were being addressed.
Over the past two years following publication of the report, we have monitored health boards’ progress with each improvement plan. We conducted a two-stage follow up of progress on each health board’s improvement plan, with analysis of progress for the later stage in comparison to stage one, which was completed late summer 2024.
It is encouraging to note that overall, progress on completing actions across all health boards was broadly positive. The key areas where actions for improvement had been fully implemented in a timely manner across all health boards, includes the following:
Health boards have begun to improve arrangements to allow primary care professionals to access timely specialist advice on mental health conditions, treatments, and medications, therefore gradually making primary care more effective in managing mental health cases.
Plans are being embedded to improve engagement with, and involvement of the third sector, to generate a broader range of support for individuals needing mental health and well-being services and emphasises the availability of other support networks for patients.
Health boards are streamlining referral processes for all services and are establishing a single point of access to various mental health services. This will help simplify the referral process and provided better options for patients and for referrers.
Benchmarking mental health services across Wales is improving, to highlight good practices and positive initiatives, which will allow for the sharing of valuable insights and learning across regions.
There is a renewed focus on access to mental health crisis teams for emergency services which will help support these teams to offer timely advice and support to individuals with urgent mental health needs. Fully embedding this is vital for emergency situations. Mental health staff are being integrated into emergency call handling teams across Wales, aiding early advice and support for individuals needing urgent mental health care. This includes the NHS 111 press 2 service to improve the response to mental health emergencies.
Health boards have begun improving their efforts to provide timelier and clearer advice and information to individuals with mental health needs. This will help increase people's awareness of additional support services available to them within the community, including those offered by the third sector.
Whilst several health boards had completed almost all their actions, some actions remained outstanding for most health boards, therefore, additional efforts are needed to address these and ensure the sustainability of the actions.
Health boards must establish clear processes to ensure that physical health assessments and monitoring are conducted for relevant patients under the Mental Health (Wales) Measure 2010. Enhancing communication between health boards and GP services is essential and must be sustained, to support and improve timely mental health advice and referral processes.
Work remains needed to strengthen linkages between all services to improve access and provision for individuals requiring mental health support. Robust follow-up processes must also be established to ensure timely and appropriate care for individuals who receive crisis intervention but are not subsequently admitted to the hospital. Health boards should also review and tailor community mental health services to focus on individual needs, aiming to prevent deterioration in mental health and provide timely support throughout all community services.
Whilst strengthening collaboration with third sector organisations is improving, a renewed focus is necessary to facilitate direct referrals into NHS mental health services when required. The implementation of single points of access to mental health services is improving across Wales but must be sustained to ensure equitable prompt support and care is available to individuals with mental health needs. Furthermore, health boards must maintain a continued focus to integrate mental health practitioner roles within a seamless mental health pathway.
Finally, there is also a need for equitable and easily accessible safe spaces in the community for adults with urgent mental health needs, providing a calm alternative to hospital admission or emergency services. Health boards should also explore additional measures to raise awareness of mental health support for men where suicide ideation is the highest, thereby promoting their well-being and directing them to appropriate services.
We will undertake further follow up in due course with the outlying health board where multiple recommendations were incomplete, or actions were ongoing.
Overall, the original review highlighted the critical gaps and areas needing improvement within mental health services in Wales. The ongoing monitoring and follow-up of actions demonstrate a strong commitment to addressing the identified issues and to enhancing the quality of mental health care. Whilst there has been commendable progress across most health boards, continued effort and focus on the incomplete recommendations are essential for achieving comprehensive and effective mental health support.