Mental health

Our mental health affects how we think, feel and act. A healthy outlook can reduce both the intensity and duration of illnesses, whereas poor mental health can have the opposite effect. It has been shown that depression and its symptoms are major risk factors in the development of coronary heart disease and death after myocardial infarction. Stigma surrounding mental illness is common and can play a role in people potentially hiding issues surrounding their mental health rather than seeking help, which can be mitigated through increasing the information, education and public awareness.

According to the Welsh Government’s Together for Mental Health Strategy:

• 1 in 4 adults experience mental health problems or illness at some point in their lifetime

• 1 in 6 adults are experiencing symptoms at any one time

• 1 in 10 children between the ages of 5 and 16 has a mental health problem, and many more have behavioural issues

• Approximately 50% of people who go on to have serious mental health problems will have symptoms by the time they are 14 and many at a much younger age

The Hywel Dda Mental Health Quality and Outcomes Framework (QOF) register records approximately 4,100 patients in 2019.

• Current data shows that in Ceredigion there are currently 6,192 women, and 3,616 men, with common mental disorders. By 2043, projections show that there will be a small decrease, with 5,868 women, and 3,243 men, living with common mental disorders. In Pembrokeshire, data shows that there are 10,425 women, and 6,276 men with common mental disorders. Current 2043 projections show a slight increase, with 10,492 women, and 6,384 men with common mental disorders. In Carmarthenshire, there are currently 15,845 women, and 9,498 men, with common mental disorders. Current projections show a slight increase by 2043, with an expected 16,378 women, and 9,544 men with common mental disorders.

• Data shows that there are 375 women and 1,058 men with an antisocial personality disorder in Ceredigion. Projections show a reduction in these numbers by 2043, with 342 women and 933 men with an antisocial personality disorder. In Pembrokeshire, data shows that 571 women and 1,676 men, with an antisocial personality disorder, with projections showing that by 2043, that this will decrease to 533 women and 1,606 men. In Carmarthenshire, there are 907 women and 2,551 men with an antisocial personality disorder, projections show that in 2043 this will decrease to 887 women and 2,487 men.

• Data shows that there are 496 women and 558 men 16 and over with bipolar disorder in Ceredigion. By 2043 this will decrease to 451 women, and 490 men. In Pembrokeshire, there are 779 women, and 898 men with bipolar disorder. By 2043, data shows that these numbers could fall slightly, to 731 women, and 871 men. In Carmarthenshire, there are 1,224 women, and 1,372 men with by bipolar disorder. Projections show similar numbers by 2043, with 1,202 women, and 1,347 men with bipolar disorder. Across the West Wales region, men are generally more affected by bipolar disorder than women, except in the 16-24 and 65-74 age categories.

• Data shows that in Ceredigion, there are currently 643 women, and 448 men, with borderline personality disorder. Projections to 2043 show that a slight reduction is expected, to 602 women, and 414 men. In Pembrokeshire, data shows that there are currently 898 women, and 602 men with borderline personality disorder. 2043 projections show a slight decrease in these figures, to 839 women, and 600 men. In Carmarthenshire, there are currently 1,422 women, and 963 men, with borderline personality disorder. Current projections show a small change, to 1,402 women, and 944 men by 2043. Across the West Wales region, the data shows that the condition is most common in people aged 16-34.

• Data shows that in Ceredigion, there are currently 169 women, and 113 men with psychotic disorders. By 2043, current projections show a small decrease in these numbers, to154 women, and 94 men. In Pembrokeshire, there are 297 women, and 205 men, with psychotic disorders. Projections show very little change by 2043, with 291 women, and 200 men, with psychotic disorders. In Carmarthenshire, there are currently 458 women, and 304 men, with psychotic disorders. Projections show very little change, with an expected 461 women, and 306 men, with psychotic disorders in 2043.

• There are 3,785 people on the mental health Quality and Outcomes Framework (QOF) register in the West Wales region.

To provide an assessment of the level and range of current mental health services, determine the adequacy of these services, and identify future care and support needs and areas for improvement, virtual engagement sessions were carried out with both service providers and service users from West Wales Action for Mental Health (WWAMH) and Mind.

Care and support provision

Since 2010 and the introduction of the Mental Health (Wales) Measure, the majority of mental health cases are treated at the primary care level. This is to promote early intervention, to reduce the likelihood of their condition deteriorating and needing further secondary mental health services.

Current support services

Current support services Care, services and support needs for people with mental health issues in West Wales are coordinated by Local Primary Mental Health Support Services (LPMHSS) and Community Mental Health Teams (CMHTs).

Local Primary Mental Health Support Services and Community Mental Health Teams

The introduction of Local Primary Mental Health Support Services (LPMHSS) aimed to increase the availability and uptake of mental health services at the primary care level, as well as improving integration of services, and working with GPs and practice staff to provide support and training. Community Mental Health Teams (CMHTs) in West Wales are a partnership between Hywel Dda University Health Board and Social Services and provide the point of referral for those requiring access to secondary mental health services. CMHTs have a duty to assess anyone experiencing mental health issues which are affecting their ability to lead their life.

Third Sector

The health board and local authorities continue to commission a range of third sector organisations to support people with mental health issues such as advocacy services, information and advice, activities, healthy lifestyles and a range of supported accommodation and tenancy related support services.

Mind is a mental health charity that operates throughout West Wales. They provide advice and support to empower anyone experiencing a mental health problem. They also campaign to improve services, raise awareness and promote understanding. Mind services operating in West Wales are Pembrokeshire Mind, Carmarthenshire Mind and Mind Aberystwyth.

Other third sector organisations operating in West Wales include Hafal, which works with individuals recovering from mental health problems, with a special emphasis on those with serious mental illness, and FRAME, which provides around 80 people a week the opportunity practice work and train new skills. 134 West Wales Action for Mental Health (WWAMH) is a mental health development organisation in West Wales. It provides a range of services to voluntary groups, carers and individuals who require support around mental health in the West Wales region and seeks to improve the services and opportunities available to people with mental health problems, their families and carers.

Twilight Sanctuaries

Twilight sanctuaries are part of the service provided by Mind. They are designed to offer support to people at risk of deteriorating mental health outside of normal office hours. Currently in West Wales, there are twilight sanctuary services in Llanelli and Haverfordwest, with plans for 3rd Twilight sanctuary to be implemented in Ceredigion soon. This will mean a twilight sanctuary in each of the three local authority areas by December.

The following are some of the key issues identified during engagements:

• Follow up services need to be improved to educate and support people with lifelong conditions after they have been released from a service; this could help people to self-manage their condition better and avoid them returning in the future

• There needs to be a greater recognition and awareness of dual diagnosis and neurodiversity, with increasing numbers of people diagnosed on the autism spectrum

• Although progress has been made since 2017 in providing a 24/7 service, further work is still needed to achieve this. A twilight sanctuary has been set up in each of the three counties to provide support for people out of hours, but these do not offer around the clock support and are not always accessible for people in rural areas

• These services need to be reviewed to ensure that a 24-hour service is delivering support in response to need, in the most appropriate, smart and cost-effective way. For example, prioritising the service as a safe haven out of hours, with therapeutic support available there during the day

• Overnight accommodation associated with the sanctuaries is currently underutilised, which could suggest the threshold for admission is set too high

• Although some improvements have been made with regards to crisis management and intervention, there needs to be further consideration of effective alternatives to hospital attendance in response to crisis, to avoid A & E being the default option for situations where people are considered “too difficult to deal with”

• Access and referrals to Community Mental Health Teams (CMHTs) need to be improved 

• Assessment processes need to be improved to avoid people being released prematurely without the appropriate post-discharge support, only to be re-admitted.

The pandemic has led to increased isolation and a disruption of normal life and had a dramatic impact on people’s access to services. With access to primary care services severely curtailed or becoming virtual, many people have been unable or too worried to access the support they would expect. People that were doing well before COVID often have been unable to access support needed because of it. Whilst some of the impact may be short-term and resolved by increasing the visibility and accessibility of services, it is not clear what the long-term impact might be on mental health and wellbeing.

In the period immediately before the pandemic, it was reported that 11.7% of Welsh people suffered from severe mental health issues. This reportedly climbed to 28.1% in April 2020. This deterioration in mental health was equivalent to someone who is employed becoming unemployed. Young people reportedly experienced the largest deterioration because of COVID-19, with the average GHQ score among those aged 16-24 rising by 3 points, or 24% relative to pre-pandemic period. Women also experience worse levels of mental health than men after the onset of the pandemic, with the gap in mental health between men and women reportedly increasing from 9.9% to 14.1%. It is reported to have had a worse effect on those from black, Asian and minority ethnic (BAME) backgrounds – in June 2020 BAME individuals in Wales reported on average 4.1 problems associated with mental distress, whereas for white British individuals this was 2.7 (a 55% difference in relative terms). Mental health between the lowest and highest income has also widened significantly during the pandemic. Average GHQ-12 score in November 2020 for the lowest income quintile increased by 39% compared to the pre-COVID level. The top quintile of earners, however, only experience an increase of 6.5% over the same period. A common response from the engagement events suggests “COVID has highlighted cracks that were already there and made them worse”.