5. Statement by the Minister for Mental Health and Early Years: Improving mental health in Wales

– in the Senedd at 4:41 pm on 14 May 2024.

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Photo of Elin Jones Elin Jones Plaid Cymru 4:41, 14 May 2024

(Translated)

Item 5 is next, the statement by the Minister for Mental Health and Early Years on improving mental health in Wales. The Minister, Jayne Bryant.

Photo of Jayne Bryant Jayne Bryant Labour 4:42, 14 May 2024

Diolch, Llywydd. I’m really pleased that my first ministerial statement is about improving mental health in Wales as we mark Mental Health Awareness Week. The theme for this year’s event is ‘Movement: moving more for our mental health’. This week highlights the connection between the positive benefits physical activity can have on our mental health. Too often, we only talk about the impact it can have on our physical health, but we know that being active, moving, in whatever way we're able to, is really important to support our mental health and well-being.

When we talk about physical activity, many of us will conjure up images of lifting weights in gyms, running marathons or organised team sports. But while it can be all of those things, physical activity is also about working with your own body to incorporate movement into our daily routines. The Chief Medical Officer for Wales recommends that working-age adults do around 150 minutes of moderate, or 75 minutes of vigorous, exercise a week. There are different recommendations for other age groups and for disabled people. But the message is clear: whatever you are able to do, benefits are achieved at levels below or above those guidelines. Doing something every day has a positive impact on our physical and mental health. It could be about taking the stairs instead of the lift, doing the parkrun, going for a walk in your local community or doing some yoga. 

Our 'Healthy Weight: Healthy Wales' strategy acknowledges this link between physical movement and mental well-being and supports it through a range of interventions. Our 60-plus active leisure scheme, supported by £500,000 of Welsh Government funding, helps to increase physical activity levels, confidence, strength and balance, as well as providing opportunities to increase interactions and reduce social isolation, which we know is a risk factor for poorer mental health and well-being.

We have also invested in supporting the Football Association of Wales and the English Football League Trust in rolling out the Fit Fans programme to football clubs across Wales. With programmes up and running in Cardiff, Swansea, Newport and Wrexham, and projects in Aberystwyth and Newtown in the pipeline, early assessments show positive results. The schemes are not just supporting increased physical activity and weight loss, but also improvements in mental well-being. I look forward to receiving the fuller evaluation in due course.

(Translated)

The Deputy Presiding Officer took the Chair.

Photo of Jayne Bryant Jayne Bryant Labour 4:45, 14 May 2024

We're currently consulting on our new mental health and well-being strategy, which sets out our vision for the next 10 years. Now, I want to pay tribute to the huge amount of work my predecessor, Lynne Neagle, has done in this portfolio, particularly in developing the new mental health and suicide prevention strategies and rolling out the '111 press 2' service. The new mental health strategy has a real focus on prevention, to protect and improve our mental health and well-being. This includes by being more physically active. It also highlights the interconnection between the range of things that we can do to protect our mental health. For instance, joining a local walking group to be more active also helps us feel part of a community, to connect with people and engage with nature. Such interconnectedness demonstrates that improving mental health must be a cross-Government approach to ensure that people have the knowledge, understanding and opportunity to empower them to take action. I am committed to continuing to drive this approach across Welsh Government

Another priority for me is to change how we talk about and understand our mental health. Mental health has become a term that is used to describe a wide range of issues and circumstances and is often linked to NHS services, but many people don’t need specialist mental health support, and there is a range of easy-to-access services where you can get additional support, without the need for a referral from a healthcare professional. Every health board website has links to resources that can provide help and support. 

Mental Health Awareness Week is a good opportunity for us to reflect on what we can do change the narrative around mental health. I am, of course, committed to ensuring that mental health services are accessible to all those who need this support and to reducing waiting times. I think it’s vital that we take a preventative approach and we work across services to support the wide range of issues that can impact our mental health and well-being. We all have a role to play in improving mental health and well-being. Moving more this Mental Health Awareness Week and encouraging others to do the same is a good place to start. Diolch.

Photo of Gareth Davies Gareth Davies Conservative 4:47, 14 May 2024

Thank you very much for your statement this afternoon, Minister. I welcome you to your new role. I hope that you're getting to grips with the portfolio, because, certainly from the shadow side of things, it's been quite a challenge taking on some new responsibilities. I'd just like to thank my predecessor as well, James Evans, for the commitment and passion that he shared on this subject and I hope I can do it some justice from my end of the bargain as well. But thanks again for your statement this afternoon.

We're speaking on this issue during Mental Health Awareness Week, so it's important that, whilst addressing the challenges in mental health treatment in Wales, we also recognise our responsibility to raise awareness, remove the social stigma regarding poor mental health and recognise that it touches everyone's life, in one way or another, with one in four of us experiencing a mental health problem every year.

There are logistical challenges that I would like to address, but also areas that mental health strategies can better address. On the logistical challenges, waiting times for children's mental health support are disgraceful. A freedom of information request that we submitted revealed that children in Wales are waiting almost two years for mental health treatment; a wait of this time means that the problems that these children are presenting with will significantly become more complex and difficult to address if not dealt with in a timely fashion. In the Cardiff and Vale University Health Board, someone waited a year and two months to be seen for the first time and, in Swansea Bay University Health Board, someone waited 59 weeks for their first appointment. We shouldn't be shy about the fact that this can sometimes be the difference between life and death, and some of these young people are very vulnerable. Mind Cymru have also described these figures as very concerning. Although, overall, those on a patient pathway waiting longer than four weeks for their first child and adolescent mental health services appointment has been reducing, which is welcome news, the shocking outlier cases are a concern. And not just the outliers, but follow-up appointments are a critical issue to be addressed.

There also should be some recognition of certain groups in society that are more prone to mental health challenges than others, such as those from ethnic minority communities, the elderly, the young, LGBTQ+, neurodivergent and those living in poverty. Men are also disproportionately affected by suicide, with three quarters, or 75 per cent, of all suicides being men.

The unique mental health difficulties that many farmers and members of rural communities have been raised in the Senedd before by my colleague James Evans and other Members also. So, there is no one-size-fits-all strategy. Care must sometimes be tailored to the needs of certain demographics, and this is something that the mental health strategy currently fails to do.

Child mental health services need the most attention, not just with the disgraceful waiting times that I have laid out, but also the Welsh Government's strategy. There has been a failure to address the so-called missing middle, with a huge gulf of children in this category who do not meet the threshold for medical diagnosis or a CAMHS referral, but for whom social prescribing or community therapy is a more appropriate remedy. Many mental health experts have also highlighted that, when the appropriate treatment for children in the missing middle is provided, it will often prevent these children from developing from more complex issues and becoming a CAMHS case. Also, many experts draw attention to how children's mental health treatment will be cut off at the age of 18, with resources suddenly withdrawn without consideration of the fact that they are still a vulnerable young person with a developing brain, and in need of continued support.

There are also gross failings in the Swansea Bay University Health Board, which apologised after a patient absconded from a secure unit and went on to fatally attack their father in the family home—negligence with devastating consequences. Healthcare Inspectorate Wales has consistently found and said that care and treatment plans, or CTPs, are of poor quality, are not being co-produced, and are not being completed in accordance with primary legislation.

The proposed new mental health strategy does not do enough to identify or detail what actions need to be taken, and we need to see some new ideas from the Welsh Government. We hear today what they are going to do to improve waiting times for children's mental health treatment, but we need to hear how the Welsh Government plans to address the missing middle—a large number of children who have, sadly, slipped through the net.

We would like to see an independent review into all the tragic deaths of mental health patients, and to see the Minister address the recommendations of the Healthcare Inspectorate Wales report. In light of the current challenges that the Welsh Government is facing with all of these issues, I think that it would be appropriate to hear some contrition for the 8.8 per cent cut to the Welsh Government's mental health budget, which was a terrible decision at the worst possible time. I look forward to hearing your response. Thank you very much.

Photo of Jayne Bryant Jayne Bryant Labour 4:53, 14 May 2024

Diolch yn fawr, Gareth. Thank you very much for your kind words at the start, and I welcome you to your post as well. So, we've both come to this portfolio, and I'm sure that we'll work together on lots of issues that I am sure that we can get behind. I'm really looking forward to working with you on that, so welcome to this. I understand that you've got a lot to get to grips with, just like me, on this, so thank you for your kind words. I, too, would like to pay tribute to your predecessor as well, James Evans, who I know campaigns strongly on this issue and worked really hard on that portfolio as well, and I'm sure that you'll do that justice as well. So, thank you for mentioning James, as it gives me an opportunity to say that.

You've given me lots of points to answer on that first question, and I'm sure that we'll come on to those. The first point that you made was around young people. I think that it's really important that we—. And I, again, mention Lynne Neagle and all the work that she's done in this area in the past and I know she'll continue to do in her role as Cabinet Secretary. But I just want to reiterate that protecting young people's mental health is an absolute priority for us as a Government. We must not lose sight of that.

You certainly mentioned a few points on mental health waiting times. Most young people referred to mental health services will be seen within four weeks, and all health boards have plans in place to reduce waiting times. We continue to invest in a range of support to reduce the need for more specialist services, like online access to mental health and support in schools. There's a lot to do, and I can assure you that I'll be keeping my eye on that as well, and I look forward to working with you on that, as with others. 

You also mentioned some points around the draft strategy. It gives me an opportunity to mention the draft strategy that's out for consultation at the moment. The consultation closes on 11 June. I hope that you can encourage as many people as possible to contribute to that strategy, because it's important that we do everything we can to move forward in that space. So, again, a reminder that it's 11 June that that consultation closes, and it's our draft mental health and well-being strategy. There's also a new draft suicide and self-harm prevention strategy, which is also out for consultation at the same time. Our policy aim of early intervention and prevention is really to help upstream, to prevent those with a mental health related need requiring specialist case, whilst, at the same time, improving access to specialist care when that is clinically needed. We've included a focus on the particular needs of those with a severe and enduring mental health illness within the draft mental health and well-being strategy as well. But this is a really important area that we need to get right.

You also mentioned particular groups, and I just wanted to say a bit about farming, which you touched on. We've just heard from the Cabinet Secretary as well. One of the events that I was fortunate to go to myself a few weeks ago was an event hosted here in the Senedd, and there a really interesting presentation by a group in Powys, Mamwlad, and it was really good to hear about the work they've been doing, trying to work with farmers and the farming community in that area. It's a project in collaboration between Care and Repair in Powys and Age Cymru Powys, and I'd really encourage you to take a look at that as well. I think it's really important to pick out those areas where there's some really good work, and I'm sure I'll learn more about those positive benefits. I've also spoken to farmers in my own community, in my personal capacity as a Senedd Member, in an area where you don't—it's an urban area—often think of many farmers in particular, and some of the isolation that they might feel. So, it is really important that we remember those groups, and it's important that we do all we can to raise awareness within the farming industry of the importance of looking after mental and physical health.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:57, 14 May 2024

(Translated)

Thank you to the Minister for her statement this afternoon. I'd like to start by congratulating her on her appointment to this role, and I look forward to working with her on an issue of such great importance.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:58, 14 May 2024

Before going after specific policy areas or issues, it's worth highlighting one issue that should underpin all others when dealing with broader mental health issues: all new strategies and policy initiatives need to be underpinned by a robust mental health data set. Mind Cymru has recommended developing an effective and transparent set of national indicators, both output and outcome, on mental health, to guide investment and prioritisation. This is also the case for ensuring greater transparency around how the investment made by the Welsh Government, or health boards and other public sector organisations, is making the biggest possible impact. So, can the Minister explain what actions she will be taking to ensure improved data sets and data gathering?

Every time we've had a statement or a debate in this Siambr on mental health, I've made a point of urging the Government to concentrate on perinatal mental health. I therefore welcome the fact that the Minister is Minister for Mental Health and Early Years, and how the First Minister put great emphasis on the importance of the first 1,000 days of a child's life during his leadership campaign. But this is where that rhetoric is now tested. That first 1,000 days of a baby's life starts with having a healthy mother and, sadly, far too often, new mothers are left to look after themselves and suffer in silence. New and expectant parents are disproportionately at risk of experiencing poor mental health, with up to one in five mums affected in the UK, and one in 10 dads also experience mental health problems during the perinatal period. If left untreated, perinatal mental health problems can have a devastating impact on the mental and physical health of mums, partners and babies. While there has been positive progress in establishing specialist perinatal mental health services in Wales, worrying gaps remain, and none of the seven perinatal mental health services in Wales currently meet the 100 per cent of type 1 national College Centre for Quality Improvement standards. The latest MBRRACE-UK report on the confidential inquiry into maternal deaths in the UK and Ireland has shown that 40 per cent of maternal deaths in the first postnatal year are due to mental ill health, and that suicide remains the leading cause of direct maternal death in the first postnatal year. So, how will a new mental health strategy for Wales deal in particular with the issue of perinatal mental health?

Looking next at rural communities, which you touched on earlier, I might also suggest the need for a particular and tailored approach to tackling poor mental health in our rural communities. A 2023 survey by the Farm Safety Foundation found that 94 per cent of farmers under 40 believe that serious mental health problems are the main challenges facing the sector. According to the Farmers Union of Wales, paperwork and animal health were key causes of stress for farmers. So, will a new mental health strategy seek to deal with the causes and consequences of poor mental health in rural areas, and how will the Minister work with the Cabinet Secretary for Climate Change and Rural Affairs, and indeed other members of the Cabinet, to deliver this?

The Minister referred to the 60-plus active leisure scheme, and how proud the Government is of the scheme. Can she confirm that the budget for this scheme hasn’t changed over the last year, and that that budget will be maintained moving forward?

Finally, to touch on the majority of the statement made today, I note that the statement puts great responsibility on individuals to look after their health by taking physical exercise. This follows the Cabinet Secretary’s regular statements calling on people to take personal responsibility. However, we know that people’s mental health is linked to their childhood experiences and their economic circumstances, such as poverty and deprivation, so does the Minister not agree that this Government should do more to tackle poverty, domestic violence and other key factors that would help in our ambition to improve people’s mental health, instead of putting blame on individuals? Thank you.

Photo of Jayne Bryant Jayne Bryant Labour 5:02, 14 May 2024

Diolch, Mabon, and thank you very much as well. I’m really looking forward to working with you in this brief, so thank you for your welcome as well. Diolch yn fawr.

On your points around data and the mental health programme, we have provided £2.2 million to establish a strategic mental health programme within the NHS Wales Executive, which will drive improvements in the quality, safety and performance of services, and reduce variation in services. Within the strategy, we’re clear that to deliver both effective and person-centred services, we need to drive improvements within our care and treatment planning, and this will be a key focus of the strategic programme for mental health.

You mentioned the first 1,000 days and the importance of that, and thank you for raising that and also the important issue around perinatal mental health. I know that you have a keen interest in that, and I appreciate you acknowledging the work that’s gone ahead on specialist perinatal mental health and the progress that’s been made on that. We remain committed to improving perinatal mental health services. This is a priority area for action within the refreshed 'Together for Mental Health' delivery plan. Since 2015, we’ve invested in specialist perinatal mental health. There are now services in every health board area and over £3 million of mental health service improvement funding is supporting these services annually. Health boards are also working towards meeting the relevant Royal College of Psychiatrists' quality standards, and we have made service improvement funding available in order to support that. The national clinical lead for perinatal mental health is leading the national network’s work programme. This includes the development of a fully integrated care pathway and supporting health boards to work towards meeting the Royal College of Psychiatrists' quality standards. So, there is work going on in that area and we will continue to do that.

On the point you made around the 60-plus active leisure scheme, promoting physical activity amongst older people is facilitated through that scheme. Our 'Healthy Weight: Healthy Wales' delivery plan commits to the scheme via an investment of £500,000 per annum, and we also provide that transformation programme funding of over £500,000 across 2022-23, 2023-24 to the Football Association of Wales for the Fit Fans programme, which I have already mentioned. So, there is a lot of work going on in this area, but we will continue to progress that.

Photo of Vikki Howells Vikki Howells Labour 5:05, 14 May 2024

Thank you, Minister, for your statement and I'm delighted to welcome you to your role. I'd like to begin with social prescribing, which I feel has a really important role to play in improving mental health, and one that especially fits with this year's theme of movement in mind. I've seen the benefits of this time and again through the excellent work of Cynon Valley Organic Adventures in Abercynon, and I know that Jan and her team would be delighted to welcome you, Minister, if you ever wanted to visit. So, for my first question I'd like to ask: in the context of the national framework for social prescribing, how is Welsh Government working not only to increase opportunities for social prescribing, but also awareness of the benefits of social prescribing too? 

Secondly, I was privileged to join New Horizons Mental Health in Aberdare this morning for their event to mark Mental Health Awareness Week. It was a celebration of the importance of positive mental health, but also a recognition of the important role that charities and other grass-roots organisations play in supporting people in the community. So, how can Welsh Government best support and engage with local groups such as those, so that they can help the people living around them in turn? Thank you.

Photo of Jayne Bryant Jayne Bryant Labour 5:06, 14 May 2024

Thank you for that question, Vikki, and I appreciate your kind comments at the start. Diolch yn fawr. You're absolutely right: social prescribing is really important. It's woven into the fabric of what Welsh Government does in terms of empowering people and communities. It really is key. I'm very happy to visit any place that you think would be really helpful for me to learn from and to see, so I look forward to doing that with you.

We're clear within this strategy on the absolutely vital role that the third sector will play in its implementation. We've developed the strategy with the understanding that there will be a need to be aware of setting priorities, ensuring the best use of existing resources and an opportunity to be clear about what we can realistically deliver. And we can only do that by working together, and working together with the third sector. So, they're an important partner and I hope that you will encourage them to take part in the consultation that is out, which closes on 11 June, because it is really important that we get as many voices through that consultation as possible. Diolch yn fawr. 

Photo of James Evans James Evans Conservative 5:08, 14 May 2024

Minister, I'd also like to welcome you to your place and out of all the ministerial appointments, this was the one that I was actually quite looking forward to with all the work that you and I did together on the Children, Young People and Education Committee. I know of your commitment to improving the mental health of young people across Wales. I also look forward to working with you on the development of my mental health standards of care (Wales) Bill, which I'm looking forward to having positive, proactive engagement with the Welsh Government on, and I look forward to following that work with you. 

My question, Minister, is around waiting lists. We are seeing the amount of people waiting for a first appointment for the child and adolescent mental health service going up—I think Cwm Taf Morgannwg is the worst health board across Wales—but it does beg the question: how long are young people in Wales waiting for their follow-up appointment? And I think that's something that the Welsh Government currently doesn't hold in data terms, and I think that's something that the Welsh Government should look at, because, yes, we can get them their first appointment, but if they don't get the follow-up appointment they're actually still going to be in the situation that they come into the system in. So, I'd be interested in hearing your thoughts on that and whether that's something that you'd be keen to look at the new Minister for mental health.   

Photo of Jayne Bryant Jayne Bryant Labour 5:09, 14 May 2024

Diolch yn fawr, James, and thank you very much, and I know this is an area, as I said, that you're very interested in and you've worked on over the last few years, in particular. I look forward to working with you on the work that you're doing on the Bill. We look forward to seeing some more detail around the proposals, and I know that you have invited me to a round-table. So, I look forward to attending that round-table in due course.

Absolutely, I've heard your comments previously on CAMHS and your concerns around that second appointment, the follow-up appointment. We're providing £13.6 million this year to support schools to implement the whole-school approach to mental health and well-being. This will enable schools to expand and improve school counselling, deliver universal and targeted well-being interventions, and train school staff on well-being. It also will enable continued support to health boards, to provide CAMHS school in-reach across Wales, with dedicated mental health practitioners available in schools, providing consultation, liaison, advice and training. So, you know, there are things that we're looking at, and I look forward to continuing to work with you on this.

Photo of Heledd Fychan Heledd Fychan Plaid Cymru 5:10, 14 May 2024

(Translated)

May I ask, Minister, what impact do you believe the cuts have had on what you can provide? You mention the importance of the third sector, but the third sector is on its knees and many of these services can't be sustained, despite playing a crucial role in improving mental health. Also, we've been briefed by ColegauCymru and Sport Wales about the crucial funding that it receives, but as you know, the increase in the number of young people that need support has been huge, and there is uncertainty in terms of the continuation of that funding. [Translation should read: 'I've been briefed by CollegesWales Sport about the crucial funding that the sector receives currently, but as you know, the increase in the number of young people that need support has been huge, and there is uncertainty in terms of the continuation of that funding.']

Also in terms of the 60-plus programme, I think you said in your response to Mabon ap Gwynfor that it was £0.5 million that's available—a cut to the £1 million that was previously available. I know, in my own region, that some of those activities have had to cease. So, what I'd like to know is—. Now, in terms of some of the things that you've named, I know that some of these have already been cut, so how can we sustain the level of support and increase it?

And specifically, Dirprwy Lywydd, if I may just ask: when will the Welsh Government respond to the Youth Parliament and what they put forward in 'Young Minds Matter'? It's two years later and there's been no formal response; it's crucial that that is provided. When will they get that formal response?

Photo of Jayne Bryant Jayne Bryant Labour 5:11, 14 May 2024

Diolch yn fawr, Heledd, and thank you very much for your questions. Obviously, we're in very difficult financial times, and the severe budgetary constraints that the Welsh Government is facing are very real, and I know that that pressure then is put on other organisations, and you mentioned the importance of the third sector, as I have mentioned. You know, we've seen the stress on that particular sector. We are aware of that and I realise that is a very real issue.

Due to the budgetary pressures, we've reduced centrally held funds by around £6 million, alongside not retaining the planned £15 million due to be included in centrally held funds for mental health, to ensure that most funding reaches those front-line services. Whilst the financial position remains challenging, we do remain committed to supporting the most vulnerable. We have invested significantly in open-access support at a national level. This provides easy access to mental health support for all, without the need for a referral from a health professional. The aim is to reduce the pressure on more specialist mental health services.

And your point around Sport Wales funding and the issue around that, I will be working with other Cabinet colleagues around these sorts of issues, because it is important it's across Government as well. So, I can assure you that I'll work with Cabinet colleagues on some of those points that you've raised.

The point around the Welsh Youth Parliament, in my previous role, I attended both of those sessions here in the Siambr, with the Youth Parliament, and I heard the voices very loudly, and they've been consistent over a number of years on the issues that they've raised. I'm new into this post in terms of where we are with that, so I will look into that and respond as well.

Photo of David Rees David Rees Labour 5:14, 14 May 2024

(Translated)

Finally, Laura Anne Jones.

Photo of Laura Anne Jones Laura Anne Jones Conservative

Thank you. Minister, I too want to welcome you to your portfolio, and I'll watch with interest what you do with it, considering the knowledge that you have. As a fantastic former chairman of the children and young people's committee, you'll know that we've been told that there is money, apparently, to tackle mental health in schools, but schools I've visited across Wales haven't seen this money. Not only that, there has been no national approach to helping our children and young people, whilst there's been a massive rise in health problems. No national strategy, no guidance, every school has a different approach—some good, some concerningly poor. One school in my own region, in the city that we both represent, have enlisted the help of a third-party organisation, Mind Cymru, originally to be there for one day a week. But due to the high demand in that school—and many schools would chomp at the bit for this—they've increased that provision to five days a week.

Minister, when are we going to see some help, some guidance and a consistent approach across Wales to tackling mental health challenges in our schools, and what are your thoughts on using third-party organisations? Will you take firm action to share the best practice that is happening across Wales, and how will you work with the Cabinet Secretary for Education to achieve this? Diolch.

Photo of Jayne Bryant Jayne Bryant Labour 5:15, 14 May 2024

Thank you very much, Laura. I really appreciate your warm words of welcome, and I look forward to working with you in an area that I know you feel very passionately about. As I said, protecting young people's mental health is a priority for us, it continues to be a priority for us. We are providing £13.6 million this year to support schools to implement that whole-school approach. This will enable schools to expand and improve those services such as school counselling, to deliver universal and targeted well-being interventions, and to train staff. So, there is work going on. You said that there are some really good examples as well, and I look forward to learning about and seeing some of those examples in practice. I'll also be working very closely with the Cabinet Secretary for Education. I know that you're aware of her commitment in this area as well. So, I can assure you that already we have looked at how we can work closely together, and we will continue to do that.