The following amendment has been selected: amendment 1 in the name of Rhun ap Iorwerth.

We now move on to item 7, which is the Welsh Conservative debate on mental health, and I call on Angela Burns to move the motion.

Motion NDM6658 Paul Davies

To propose that the National Assembly for Wales:

1. Recognises the importance of good mental health.

2. Regrets that some people with mental health conditions face injustices and challenges when accessing services.

3. Calls on the Welsh Government to ensure that Wales’s health and social care sectors are able to deliver effective, preventative mental health services.

Motion moved.

Thank you very much, Deputy Presiding Officer. I'm delighted to move the motion tabled today by the Welsh Conservatives on the subject of mental health. This issue is one that will affect many of us during our lifetime, either directly or through close family and friends, and I'd like to start my contribution by saying thank you to those Members who have raised their personal experiences surrounding mental health in this Chamber on previous occasions. It's been open and courageous of you. By sharing those experiences, I believe it has helped others to understand that there is no shame in being unwell.

We have tabled this debate today because we want to draw attention to mental health. We want to draw attention to the fact that, if run in a more proactive and holistic manner, mental health services in Wales could be world leading. We want to send out the message to all those people currently living with mental health issues that there is a light at the end of the tunnel, and that people do understand.

Mental health is very much a catch-all term for a range of conditions. People suffering from mental health problems can have conditions ranging from mild anxiety, depression, eating disorders, through to bipolar disorder or schizophrenia. Whilst healthcare professionals are much more aware and adept at treating the more common mental health conditions, it is far harder to access or speak to experts quickly who deal with the more severe and complex conditions. This lack of adequate support for the more complex conditions can have dire consequences on a patient's health and may lead them to seeking other forms of support, by turning to drugs or alcohol.

Good mental health can have a positive impact, not only on the individual, but also on the whole community. It allows us to be more resilient and cope with what life has to throw at us. It is estimated that one in four of us—that's 25 per cent; that's a quarter of everybody in this Chamber—will suffer from a common mental disorder at some point in our lifetime. This is a concerning statistic, made all the more difficult by the fact that an unfounded stigma still surrounds mental illness, stopping many people, especially men, from facing their feelings or seeking advice because they can no longer cope.

According to Samaritans Wales, somewhere between 300 and 350 people die by suicide each year—almost one per day; 30 a month. About three quarters of these are men. A further 150,000 people have suicidal thoughts, according to the 2017 Welsh confederation report into mental health. This is around 5 per cent of the whole population, which is a truly sobering statistic. And it's not just the male/female split that's become apparent in recent years. Samaritans Wales also reports a growing difference between those living in poverty and those from more affluent areas. The charity's research found that, as deprivation increases, so does suicidal behaviour. Hospital admissions from self-harm are twice as high in deprived areas compared with the most affluent, while suicide risk increased with unemployment. Other research has estimated that the cost of poor mental health in the workplace amounts to £12 billion a year, nearly £860 for every employee in Wales. Cabinet Secretary, this begs the question as to what can be done to educate all of us on how we can spot the signs of poor mental health much earlier.

There are many reasons for mental health conditions becoming evident. In some cases, adverse childhood experiences, known as ACEs, can lead to mental health problems later in life, and there are explicit links to drug dependency and thus early death. A single instance of an adverse childhood experience can be traumatic, but often we see adults who have had to deal with multiple cases in their formative years. What happens to us as we grow up matters, and it's not just the more traditional horrors that some children face. Today's kids have so many pressures on them in this modern world.

Speaking as a mother of two young girls, I can tell you we have constant battles about body image, the content of social media, what the print media says. The pressure on children, and especially girls, to conform to a certain look or style has only been made worse in recent years, and we all know how cruel children can be to one another. Childline reported that in 2015-16 they received over 1,500 contacts from girls, the youngest being eight, worried about their body image—at eight, really? Cabinet Secretary, this is something the Government must find a way of addressing as quickly as possible, because today's raunchy, celebrity-focused world damages those yet to develop the thick skin and emotional resilience to shrug the nonsense off. The result? Anxiety, depression, eating disorders—all patterns that can have a negative influence on a person's life going forward.

This leads me to the second point of our debate, where I would like to focus on aspects of mental health treatment that we believe are not working well. The first, you will not be surprised to hear, concerns the lack of consistency across Wales in providing good-quality child and adolescent mental health services. Despite their fragile and often far more vulnerable nature, a small percentage of clients who fall under the CAMHS umbrella are seen within the recommended four-week waiting time. Worryingly, only three out of seven Welsh health boards provide a 12-hours CAMHS crisis team, working 12 hours a day, seven days a week. The one in Powys only operates until 5 p.m. Monday to Friday, and not at all weekends. What does that say about where our importance is on mental health?

I, and I know many other Assembly Members—and I'd like to single out Lynne Neagle on this—remain concerned that the CAMHS services do not work effectively. Lynne has been an enormous champion on this area. The criteria that they follow are often too narrow. Clients are treated according to their mental health condition as opposed to being treated as an individual. Children threatening suicide are not provided with help because they haven't been diagnosed with a medicalised problem. Children suffering from the effects of abuse or neglect or with attachment issues are refused access, as a children and young people committee report into post-adoption support highlighted very, very clearly. So where do they go? I fear they go nowhere.

I would like to draw attention to the Mind Cymru study that surveyed 400 people in February 2016 who had either requested or accessed psychological therapies in the previous three years. This found that 57 per cent of people faced a wait of more than three months just to get an assessment with the service, and 21 per cent faced a wait of more than a year to be assessed. We've just had a debate on loneliness and isolation, and that's a depressive thing. I cannot imagine; there you are, you're in that awful state, you desperately need help, your mind is struggling, all sorts of thoughts are in your head, but you've got to wait 12 months to be seen. The 'Together for Mental Health' draft delivery plan for 2016-19 requires health boards to report on the 26-week referral-to-treatment target in specialist secondary mental health services for all patients, including those in inpatient services.

Now, in the Welsh Conservative 2017 manifesto, we said that people should have parity of access, regardless of whether they are in primary or secondary care—a policy that's backed by Mind Cymru—and I call on the Welsh Government to introduce a target for all people to be able to access psychological therapies within 28 days. Cabinet Secretary, I ask if you would just look to see if you can make this possible. And in doing so, will you also review the way that training on mental health issues is structured, Cabinet Secretary? For example, GPs currently only undertake one training module, out of 21, dedicated to mental health. Numbers of trainee GPs undertaking a rotation in psychiatry is steadily falling and many GPs only see the most severe cases of mental health illness in primary care facilities during their training and therefore are less familiar and therefore find it harder to identify more moderate cases of anxiety or depression that may benefit from early intervention when those people cross the door into their surgeries.

Another issue that I've raised again and again is the way in which the ring fence on mental health spending has been applied by health boards. Despite being protected by a ring fence since 2008, mental health is an area of our health service that has been chronically underfunded. In 2015-16, just 5.1 per cent of NHS expenditure was spent on adult mental health, and just 0.7 per cent spent on children and adolescent mental health services. Although the ring fence highlights how important it is to protect spending on mental health, we know that it is not a true reflection of where mental health funding needs to be, because almost all of the health boards say they spend far more than that on mental health. But, we also know that the mental health ring fence or the use of the ring fence is open to interpretation with many of the health boards playing the system and stating that the ring fence can be used to incorporate all costs in relation to a patient. We heard evidence in the health and social care committee recently that, and I'm going to quote,

'For example, if a patient with a mental health primary diagnosis presents with a fractured hip the costs of treating the hip will be captured within the mental health ring-fence.'

Cabinet Secretary, would you pledge to review this ring fence on spending to ensure that the funding is being used to bring about much-needed developments in this service? Because if it's used on things like hips when you've identified it for mental health, then how can we transform how we deliver mental health?

As I bring my remarks to a close, I would like to highlight a couple of examples where innovative projects are changing lives. In my own patch, Hywel Dda, in conjunction with Dyfed-Powys Police, are setting up three crisis cafes across the region with the intention of allowing people to drop in and chat to relevant support bodies over a coffee. This is a vast change to the current use of police as first responders to so many people exhibiting signs of poor mental health. It simply adds to the fear and that stigma and ultimately criminalises those with mental health issues—and I make it clear I do not hold the police forces to account for this; they are often the only ones available.

Another example of best practice comes from England where six NHS trusts have trained teams in an open dialogue approach. This approach means that people are seen within 24 hours of becoming unwell. Meetings with psychiatric teams are held at home or wherever the patients feel comfortable, and it also ensures that the 'nothing about you without you' mantra is adopted and allows the patient to have full access to their notes. It's an innovative idea well worth the Welsh NHS looking at. There are clear calls now in Wales, not just from the National Assembly but also from those working across our public services and the third sector and individuals, to radically reform the way mental health services are delivered. We need to fully recognise the individual social and economic benefits of preventing mental health from deteriorating. We need to give mental health the same parity of service provision as physical health, and we need to ensure that our secondary and crisis services are able to support people safely and effectively when they are needed. Ultimately, it's about people. We are flesh and blood, but we are also mind and soul. We can only be well when all of us is treated as one.

Thank you. I have selected the amendment to the motion, and I call on Rhun ap Iorwerth to move amendment 1, tabled in his name.

Amendment 1. Rhun ap Iorwerth

Add as new point at end of motion:

Ensures that children who require treatment for mental health receive it promptly before their condition gets worse and that the Welsh Government publishes statistics on performance against this objective.

Amendment 1 moved.

Thank you very much, Deputy Presiding Officer. I move the amendment tabled in my name, which endeavours to add to and strengthen the original motion. We can’t overemphasise the need to have effective mental health provision for young people, and we can’t overemphasise the need to deal with the health problems of young people at an early stage, because we do know that, in the most extreme cases, failure to deal with problems can be disastrous, and suicide is the second most common cause of death among people in their teenage years. The suicide rates here in Wales are higher than in England and in Scotland, and the recent figures demonstrate that many of the young people who have committed suicide were unknown to CAMHS, or only had a very brief interaction with those services, which suggests that the current provision is a long way short of what we need to meet demand.

We’ve recently heard a great deal of talk, and questions asked of the Government in this Chamber, about mental health care for young people. Waiting lists and waiting times are one important measure of the performance. To remind you, between 2013 and 2015 there was a huge increase in waiting times, particularly for those waiting over 16 weeks or four months. We were in a situation where almost half of those people waiting had to wait longer than four months. There was some improvement then, but by February 2017, the last month of data that we have available for comparison, the waiting times still hadn’t returned to the level of the summer of 2013, so the decline is very clear.

But the Government’s response time and time again, unfortunately, was to deny there was a problem. On many occasions, the First Minister claimed that the real problem was that there were too many people on the waiting list that didn’t need to be there. And in March of last year, what we saw was the statistics changing overnight. The number of people on the list recorded as being waiting for a CAMHS appointment went down 74 per cent, as non-CAMHS routes were withdrawn—that was over 1,700 children and young people. Our amendment today reflects the fact that we don’t know what happened to those children; the CAMHS data is the only performance data available.

Inevitably, a change in the way that waiting times were measured led the Government to tell us that the waiting times were improved because the data did demonstrate a great improvement: 86.7 per cent of cases were being seen within four weeks. A huge increase on the 35.2 per cent in the previous month. But, of course, what’s happened here is a change in the way things are recorded, and we can’t make real comparisons, and we don’t know what happened to that other 74 per cent of children that we used to record.

The First Minister wrote to Leanne Wood when we raised this issue in November, confirming that our figures were accurate: 74 per cent of the other cases were either children who would now be seen by specialist services for children with neurodevelopmental problems, which were developed in 2016-2017, or lesser cases that had been dealt with by primary care mental health services at a local level, which had been wrongly included in the previous CAMHS figures. But, of course, we don’t have data for the children who need those services.

We do accept that some children and young people had needed treatment for neurodevelopmental issues, rather than CAMHS. We also know that the threshold for CAMHS has been far too high. That was noted by the Children, Young People and Education Committee inquiry in 2014. The Wales Audit Office also noted that there was a problem of treatment for young people being stopped if an appointment was missed, and that was an issue that had an impact on the figures.

But I am a long way from being convinced that the only problem with CAMHS was there were too many children and young people there who didn’t need to be there. We know that it’s a capacity issue, an issue of a shortage of specialist services, and a failure to take the issue seriously enough. A lack of data is a problem that means that we can’t measure and assess and put pressure on the Government to take the steps that our young people need. We can’t accept the status quo of not knowing how the NHS is performing when it comes to looking after some of our most vulnerable people.

I am pleased to have the opportunity to take part in this afternoon's debate.

Yesterday, I had the privilege of holding a joint briefing session on mental health services in rural areas with Simon Thomas. This event highlighted some of the serious issues regarding mental health provision in our rural communities. As Angela Burns said, one in four people suffer from mental health issues at some point in their lives, and the agricultural industry has one of the highest rates of suicide. The farming industry can be a very arduous one to work in, and several factors that cause stress are out of farmers' hands, such as fluctuating prices in the market or the emotional effect of bovine TB. Many farmers work in isolated conditions and spend long hours on their own with very little contact with others. The nature of the work demands long hours of difficult physical labour.

Indeed, according to a report on supporting farmers' well-being by the Nuffield Farming Scholarships Trust, approximately 50 farmers in the UK die by suicide every year. In the United States, farmers, foresters and fishermen have the highest rates of suicide of any profession in the country. Despite these facts, mental health is not often discussed in the farming industry, and even though efforts are being made to address this issue, it is clear that more could be done. 

However, awareness of mental health in rural areas is increasing and good work is being done across Wales. In my constituency, Emma Picton-Jones established the DPJ Foundation in July 2016 following the death of her husband Daniel, and we heard an excellent presentation from Emma in yesterday's briefing session. The foundation's aim is to support men in rural communities who face mental health issues by using Daniel's story to help challenge the stigma associated with mental health. Very recently, it launched Share the Load, an outreach counselling service that offers talking therapies and outreach advice services to those who need the support. The foundation's work is currently focused on Pembrokeshire, but there are examples of these kinds of activities in other parts of Wales, and it's vital that the Welsh Government promotes more locally based mental health support networks that are suited to the requirements of a particular locality. Perhaps in responding to this debate, the Cabinet Secretary might tell us how the Welsh Government is working with smaller community networks, especially in rural Wales, to get to grips with mental health issues in those communities.

Of course, raising awareness is one thing, but it is also important that services are available to people who face mental health issues, and there are concerns that there is no access to services in rural areas. The remote nature of many farming communities means that they are often geographically removed from core health services. For example, Hywel Dda local health board held a consultation on its plans to change the way it provides mental health services across west Wales by establishing a central specialist assessment unit at Glangwili hospital, with a central treatment unit located at Prince Philip Hospital in Llanelli. For rural communities located in Pembrokeshire, this once again means that patients will have to travel further afield for specialist treatment. Unfortunately, the health board's proposals will naturally add to journey times, and there is no doubt that people who depend on public transport will face additional difficulties because transport infrastructure in Pembrokeshire is restricted. So, it is, therefore, vital that the Welsh Government acknowledges that there is no one-size-fits-all solution and that health boards must understand this when they plan their services.

We could also learn lessons from across the globe with regard to how other nations tackle mental health in rural communities. The Nuffield Farming Scholarships Trust report makes it clear that Australia and New Zealand are leading the way in their response to mental health issues among farmers, and perhaps we could benefit from some of their ideas. For example, New Zealand has a system of health pit stops where farmers have an opportunity to have a general physical and mental health check. These pit stops are held at major industry events, such as agricultural fairs. This trailer has also developed institutions such as the Centre for Rural and Remote Mental Health and the National Centre for Farmer Health, which focus on developing intervention strategies for mental health and well-being in rural communities. So, there is scope for Wales to look at these initiatives to see how we can learn from some of the successes, and I hope that the Welsh Government will ensure that our health boards learn from successful schemes worldwide.

In closing, Deputy Presiding Officer, may I once again reiterate the importance of investing in mental health support networks for rural communities? Farmers are some of the most important workers in Wales, but they are also sometimes some of our most vulnerable citizens. And so, as part of any strategy or policy that the Government develops on mental health, I would like to see a deeper understanding of and greater attention paid to our rural communities and those who work in them. I therefore urge Members to support this motion. Thank you very much.

I'm speaking this afternoon in my capacity as Chair of the Assembly's Children, Young People and Education Committee. We've recently undertaken a comprehensive inquiry into the emotional and mental health of children and young people in Wales. Tomorrow, we will hold our final oral evidence session, hearing from the Cabinet Secretary for Health and Social Services and the Cabinet Secretary for Education. We are aiming to report before Easter this year, so I will avoid pre-empting our conclusions and recommendations in my contribution today.

However, I wanted to draw Members' attention to the valuable evidence we have taken on this subject in recent months, and the particular emphasis that has been placed on the importance of effective preventative work by expert stakeholders, front-line staff and children and young people themselves. We began our inquiry last summer.

The first thing we did was to visit settings that are providing support to children and young people at opposite ends of the spectrum of need. While some of us visited Wales's two in-patient units, which provide support for those suffering the most acute mental ill health and requiring the most specialist of support, others visited Ysgol Pen y Bryn in Colwyn Bay, a primary school that has embedded mindfulness across its primary and junior school teaching. While visiting Ysgol Pen y Bryn, Members saw first-hand what can be achieved in terms of children's resilience if a whole-school approach is adopted that promotes well-being and good mental health for all pupils from an early age. Children as young as six told us that mindfulness helped them when they were worried, nervous or anxious. In contrast, the young people with whom we spoke in Tŷ Llidiard, the unit for children and young people in south Wales who require in-patient care, told us that more needed to be done to raise awareness about mental health and to empower young people to talk about their concerns. They told us that they'd been suffering with mental health problems for a long time before they had access to any form of support, specialist or otherwise.

During the course of our evidence gathering, it has become clear that school settings are key to promoting emotional well-being and good mental health. There is a strong consensus that by addressing issues as early as possible, before matters become serious enough to merit specialist intervention, significant deterioration in mental well-being can be avoided. We heard that if support is to be truly preventative in nature, we need to make sure that children and young people can speak openly about their emotional well-being and know where to turn if they have concerns about themselves or others. The opportunities afforded by the reform of the curriculum in Wales have been raised by almost every witness.

Nevertheless, it is also clear that a step change is needed to realise this ambition. The evidence we've heard demonstrates that, despite an overarching desire to see education, health and social care working more closely to align their support, in practice, this has yet to be implemented to the degree necessary. Despite the efforts of organisations such as the Samaritans to roll out support such as the DEAL project—Developing Emotional Awareness and Listening—too many children find themselves without the tools they need to enable them to respond with resilience to the pressures that life throws at them from an increasingly early age. As Dr Liz Gregory, a consultant clinical psychologist, told us, too often when we have concerns about the mental health of our children, we turn to an adult model of care. This fails to recognise the inherent vulnerability and lack of control children have over their own lives at such a relatively early stage in their life journey.

In closing, I want to note that, as a committee, we have shone a light on this topic over the last six months, with the aim of reforming a system that has, for too long, relied on children and young people reaching a point where treatment and medical intervention is needed before support is provided. When we report later this term, we will focus on the steps we need to take to reverse this, to encourage good mental health and well-being so that our children and young people are enabled to discuss their emotions without fear of stigma and to ensure they have the tools they need to face pressures and challenges with resilience and confidence. Thank you.

I'm very pleased to take part in this debate and I welcome the contribution that's just been made about the work of the CYPE committee. 

I want to focus, if I may, my comments on the plight of veterans' mental health services. It's an issue that is frequently raised in the cross-party group on the armed forces and cadets, and it's something that we actually visited earlier this week as well in our cross-party group meeting, at which Angela Burns was present. We all know that veterans don't just face stresses on their mental health from actually being in conflict and war zones, but they can actually face pressures during the transition back into civilian life post their service. So, it's really very essential that we have a health and social care system that meets their particular needs, because of course we know that if we don't meet their needs, then there could be a cycle of decline, which is significant and which actually costs the taxpayer much more money to resolve than had these issues been nipped in the bud in the first place: family breakdown, criminal justice system episodes, and—unfortunately, as is the case with the farming community, as we've also heard—people deciding to end their own lives.

Now, the Welsh Government, I have to say, has to be commended for the establishment of Veterans' NHS Wales. It's something that we on these benches have continuously supported and championed over the years. We know that almost 3,000 veterans have used the service since it was established in 2010, and that the numbers of individuals accessing the service have increased year on year since it was started. Just last week, I visited the Cardiff and Vale hub of the service to meet with Dr Neil Kitchener, who of course supervises the service across Wales, and I saw, there, the tremendous work that's been going on with their 3MDR research, which is an immersive technology that gets veterans to confront the trauma that they have experienced in the past, in the hope that it will help to resolve that trauma and get them through it, and I know that the Cabinet Secretary has also been to visit—tremendous research, cutting-edge research, which is taking place here in Wales, and I want to trumpet that fact, because it's something we can all be very proud of. 

However, there are pressures within the Veterans' NHS Wales service that need to be addressed. One of the big problems that they've had in recent years is capacity, and the Cabinet Secretary is aware that there are variable waiting times across Wales for access to the service. In some places, the wait can be as short as eight weeks, which is obviously very, very good. In other places, it can be as long as 38 weeks, which is clearly unacceptable, at the moment. And, of course, those pressures have been relieved, to a certain extent, with an additional investment of £100,000, which recently came through from the Welsh Government, but I'm afraid it's insufficient still to meet the scale of the demand that's out there. So, the service itself reckons that it needs an additional £250,000 to provide peer mentoring support, which can be embedded as part of the service, which was traditionally there as a result of the Change Step service, which was a Wales-wide service, which was being run by CAIS, which is a charity that operates from my own constituency. And the peer mentoring support services at the moment are actually funded partly by Help for Heroes and partly, to their credit, by the Betsi Cadwaladr University Local Health Board, which complements the Veterans' NHS Wales therapist service, which is available.

So, for just £0.25 million per year, which is small beer in terms of the overall Wales-wide NHS budget, we can make a real difference to these veterans, and I do believe, Cabinet Secretary, that it's your will that we have the best service that we can possibly have for those veterans here in Wales, so I would sincerely ask that you review the funding arrangements for Veterans' NHS Wales to see whether you might be able to consider this £250,000, in addition to the resources that you've already pledged, so that that service can be a gold-standard service in a way that no other part of the UK actually has.

I just want to close with a plug for Veterans Shed services as well. The very first veterans' shed—. People will be familiar with Men's Sheds services, but the very first veterans' shed was actually established in my own constituency in Llanddulas, and I'm very proud of that fact. They also are doing, at a very much lower level, but they're building resilience in the veteran community when they are facing challenges after returning to civilian life. So, I want to plug them and Martin Margerison, the gentleman who started that in my own constituency. I feel that we need more of those veterans' sheds across Wales, and I want to commend the Government for the work it's doing on NHS veterans, but I do think that we need to more.

I would like to thank the Welsh Conservatives for tabling this debate today and Angela for opening the debate and for her eloquent contribution. 

Unfortunately, mental health still does not get the attention it deserves within our NHS. I welcome the additional £20 million for the mental health ring-fenced budget, which raises the total to £649 million. However, this is still simply not enough.

Having worked with people who have varying degrees of mental health issues, it is harrowing to say the least, and meeting their families—it was very disturbing. Having also worked closely with the Samaritans, I feel humbled by the work they do and the around-the-clock service they provide and also the lives that they save. I accept that the ring-fenced budget is the minimum spend and that the actual spend can be much higher than that, but it’s usually not much higher. The actual spend for the last year for which we have figures, 2015-16: Wales spent £683 million. When you consider that the health budget stands at around £7.5 billion and that mental health issues affect more than a quarter of our population, why are we spending around 10 or 11 per cent on mental health services?

PricewaterhouseCoopers, in their review of the financial ring-fencing arrangements for mental health services in Wales, state that the ring fence allocation is not based on a robust assessment of healthcare needs. The Welsh Government needs to change the ring-fencing arrangements as a matter of urgency.

I won't repeat the veterans' cause because Darren has already said it, but my sentiment is there also.

Waiting times for mental health services are still far too long, particularly for child and adolescent mental health services. Despite a 28-day target, more than half the children referred to CAMHS wait more than four weeks, and some children and young people are waiting more than half a year. One constituent of mine called me as she'd been waiting seven months for an assessment, and upon speaking to a member of the CAMHS team, I was told that the backlog—this was six months ago—was vast and that some people had been waiting almost a year. So, the picture for adult mental health services isn’t much better. Twelve and a half per cent of patients wait up to 56 days and more than 9 per cent of patients wait much longer than that.

We don’t leave injured patients in pain, so why do we tolerate leaving those suffering from mental ill health in mental anguish for months on end? Not only do we have insufficient funding for mental health services, we also have a huge shortage of clinical staff. We have just six consultant psychiatrists per 100,000 patients. There are 10 per 100,000 in Scotland and eight in England. We have huge shortages in general psychiatry, geriatric psychiatry and clinical psychology. No wonder waiting times are so high.

For cognitive behavioural therapy and other talking therapies most patients wait between three to four months to a year, and 15 per cent of patients wait much longer than a year. As a result, there has been an overreliance on prescription medication. According to the latest Gofal snapshot, 80 per cent of patients are offered psychiatric medication, up from around 60 per cent in 2012. Psychiatric medication, while beneficial to many, should not be seen as a cure-all. There can be horrendous side effects from antidepressants and antipsychotics, ranging from decreased alertness to suicidal feelings.

Unfortunately, a combination of overworked GPs and long waiting lists for psychological therapies is leaving people with no alternative but to take drugs that could leave them feeling much worse. This is not what was envisaged by the Mental Health (Wales) Measure 2010 and is possibly contributing to our suicide rates, which result in three times as many deaths as road traffic accidents. We are letting down our constituents, of whom one in four suffer from mental health issues.

I urge all Members to support the motion, together with the Plaid Cymru amendment, and urge the Welsh Government to take urgent action to improve mental health provision for all in Wales. 

It's a pleasure to take part in this debate. It's one of a series we've had this afternoon when there is cross-party support for better services in a particular area.

Last week, I sponsored for the Time to Change Wales campaign an event here in the Senedd. As you will know, the goal of that campaign is to end mental health stigma and discrimination in Wales. Only a week before—I'm sure many other colleagues did the same as I did—I took part in the Time to Talk Day, a day that promotes the message that any day, any minute, any time is a good time to talk about mental health. I actually tweeted, with the aid, I must say, of my very able researcher, but anyway, I won't—[Laughter.] You know, you can't transform someone completely, can you? Not over night, anyway. But anyway, half way down Lloyd George Avenue, by the public art there of two faces talking, or kissing maybe—I don't know; it depends on your interpretation—I stood in front, and I talked about my own experiences and how important it is just to speak about mental health and well-being and recovery.

I do think that we could have even more world-class mental health services than we have at the moment, and we do have some. Let's acknowledge that. There is some great best practice in Wales. But I think, with a suite of really far-seeing legislation, such as the Well-being of Future Generations (Wales) Act 2015, the Social Services and Well-being (Wales) Act 2014, the Public Health (Wales) Act 2017 and, most recently, the parliamentary review, all highlighting a level of consensus across the Assembly, that we need more anticipation, more person-centred approaches, more inter-generational planning for what we should be delivering, and really ending barriers between physical and mental health in terms of what we're trying to achieve.

So, we need to build, I think, on the better practice when it emerges. I learned recently of Mind Cymru and their work with GPs and local health boards to roll out early prevention services. Now, this does seem to me to be key, and they have active monitoring. I'm glad to see that the scheme of active monitoring has been supported by Welsh Government funding. So far, active monitoring has exceeded all initial expectations, with 38 GP surgeries across Wales offering patients services under active monitoring, and some 433 patients at the moment having help. Of those patients, 71 of people experiencing clinical levels of anxiety and panic attacks fully recovered, with 54 per cent of people experiencing clinical levels of depression fully recovering.

Can I say, I suspect I'm not the only Assembly Member, but I'm certainly one, who has had a number of episodes of panic attack? It is horribly debilitating. It has a huge effect on your confidence and what you think you're going to be able to do. When you get through that, and when you've had the treatment, the support, whatever it is, the fulfilment you feel, the well-being you feel, and the stability you feel is something beyond measure. I think any services that get people to that better condition are to be hugely valued. They're not often very intensive. We're not talking about people in serious illness. Let's remember that. Anxiety and depression and panic attacks: they may accompany more serious illness, but people who are not seriously ill in terms of their mental health can still be prone to these things. So, mild to moderate ill health can be very, very debilitating, and has huge effects on the economy as well, and family life and all sorts of things.

David, will you take an intervention on that point?

Yes.

I think it's only fair to commend, at this stage, your erstwhile colleague Jonathan Morgan, when he was Assembly Member here, who pushed through the Mental Health (Wales) Measure in 2010, which is all about prevention being better than cure, early treatment, early talking therapies, and we still await the full fulfilment of that mental health Measure.

Thank you for that. I'm delighted to refer to my friend and colleague Jonathan Morgan, who I greatly miss here, if I might be indulgent. But I think, absolutely, and that was a shift in our practice and aspirations in Wales. Can I just finally, in conclusion, say that I do welcome the Plaid Cymru amendment? I think it does add to the motion, and just to say, in terms of some recent meta-analysis of school-based programmes for mental health and well-being, the efficacy is shown to be quite remarkable. And this meta-analysis found that there was a significant increase in educational performance, with 11 per cent improvement in academic achievement. Now, that's what happens when you support people when they need support and prevent things from getting worse. I could say a lot more, but I fear I'm out of time. Thank you, Deputy Presiding Officer. 

No, thank you. I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething. 

Thank you, Deputy Presiding Officer. I'm happy to start this debate by confirming that the Government will support the motion. And I also want to set out that I won't be able to respond to all of the detailed points that Members have made in the debate, but I have taken the time to listen to each of the contributions and the points that have been made. Of course, I will have the opportunity, as the Chair of the Children, Young People and Education Committee has set out, to answer some detailed questions at the end of the evidence for the inquiry that is taking place. I suspect that, given that there are only two hours to speak to myself and the Cabinet Secretary for Education, there may yet be some questions for us to answer in correspondence afterwards, and I'm recognising one of my faults as a person in doing so. 

I want to reaffirm this Government's recognition of the impact of mental health issues on a wide variety of areas and on our ability to function as people, as individuals and with others, but also to restate our commitment to, and investment in, improving mental health across Wales. And, of course, the Government restated our commitment and recognition of the key importance of mental health by positioning it as one of the five priority areas in our national strategy 'Prosperity for All'. And, importantly, this isn't just a health challenge. All of the Welsh Government and our partners outside Government need to consider the impact of mental health across all that we do, because this is a complex issue and one that cannot be tackled by the NHS alone. So, this isn't just a public service issue. It's an issue that cuts across the public and the private sector, voluntary and statutory, an issue for each and every community in Wales. For instance, parenting, education, employment and housing are all protective factors for mental health, and if any one of those fails, it often has a consequence in mental health outcomes. People had more to say about adverse childhood experiences, and I was pleased to hear Angela Burns mention that in her opening remarks. 

The Government's cross-cutting approach is underpinned by a range of policies, programmes and legislation that we have introduced to improve mental health and well-being in Wales. The Mental Health (Wales) Measure 2010 is a unique piece of cross-party legislation, designed to improve access to, and delivery of, services. And the Measure has helped to drive improvement in mental health service delivery since its implementation in 2012. That Measure is at the heart of our 10-year mental health strategy, 'Together for Mental Health', which we published in 2012. It takes a population approach to improve the mental well-being of people in Wales, and to support people with a mental illness. It sets out clearly our actions and those of partner organisations to make the strategy a reality, and this approach is supported by significant investment.

We continue to spend more on mental health services than any other part of NHS Wales. And, as was acknowledged, there is a ring-fence around mental health spending, and I'll take on board some of the comments made by Angela Burns on that. We've increased funding, not just previously, as we're going to be seeing an increase in funding in the mental health ring-fence by a further £20 million to nearly £650 million in the next financial year. And on top of those general increases, £22 million of funding has been targeted to improve access to a number of specific service improvement areas for people of all ages in the previous two years. In this, I really do think that the Government in Wales has a good record of not just talking about mental health, because when we say that increases are going to be found for mental health services, they are spent in those areas.

I would say that when we look at the picture across the border in England, I think it's been a really positive thing to have the last two Prime Ministers talk so openly about mental health. The challenge there is is that lots of the money that has been outlined for mental health has actually gone into the bottom line for services. So, actually, in England, they have a challenge about catching up with some of the progress we have made in this area. We have the alternative challenge of continuing to improve in this area to make sure that the money that we spend delivers real value in each and every one of our communities. But, the value and the commitment to mental health that I believe we have consistently demonstrated through the Measure, 'Together for Mental Health' and our targeted investment provides a strong foundation for us to engage with the transformational vision demanded of us in the parliamentary review.

In terms of access to mental health services—people rightly regularly discuss and talk about it in correspondence, in person, in corridors, in the Chamber, and of course in committees too—our aim still remains, and it must be, to ensure that everyone in Wales has access to the right care when they need it, irrespective of other factors such as race, sexuality or language. This is about genuinely providing the right service. So, we're working with both the NHS and with third sector partners to try and deliver equal access for all. For example, this morning, I published our new dementia plan and all of the actions in that dementia plan are underpinned by the principle of equitable access. 

But, we do recognise, as Angela Burns mentioned, the very real challenge of stigma around mental health. It's one of the most significant issues that prevents people from talking about their problems and seeking help at as early an opportunity as possible. The challenge there is, again, how people are prepared to listen, to demonstrate more kindness to the people around them, and at the same time to encourage people to get over that stigma and actually say, 'I need help', and to understand where to find it.

Will you take an intervention? Thank you, Cabinet Secretary, for taking an intervention. I absolutely recognise the approach you're taking in responding to this, but I would like to ask you for your view on the provision of crisis care centres, because people are not nine-to-five robots and people do have mental health issues out of hours and at weekends. You've just talked about access to services and you've just talked about equality and equity for all, yet we know in some health boards there simply isn't that support for people when they need it.

Actually, as I'll be setting out tomorrow, we're reviewing some of the challenges in mental health service provision, whether it's through CAMHS or local primary mental health services. I'd expect that review to take on board the issues that you've mentioned.

But, of course, the challenge about stigma is why we continue to support the Time to Change Wales campaign. I'm delighted David Melding mentioned it, and again I recognise his own bravery for sharing his own experience, both of going through mental health challenges and being able to come out the other side and say, 'I recognise I'm in a better place now as a result.' There's something there about encouraging more people to do the same, to open up about their own challenges, to change the nature of both public debate but also the private debate that we have as ordinary citizens too.

We do recognise the importance of prevention. That's why it's a key theme, together with early intervention, in 'Together for Mental Health', and that includes a focus on non-clinical support. So, we're keen to maximise opportunities to support people with a wider range of non-clinical community services that offer real health and well-being benefits. Plans for our well-being bond, which will include a focus on mental health, are being finalised and I'll look forward to being able to provide more information to Members on this shortly. We're also committed to a mental health social prescribing pilot and we're on track to have that pilot in place from April this year.

As was recognised earlier by a range of people, including Angela Burns, the roots of health and well-being lie in our childhood. The experiences that we have whilst growing up, the support, the connections, the resources available to us or not, are instrumental in determining our life outcomes and our resilience in dealing with the challenges that life will present us. That's why the Government, together with Public Health Wales, has funded the ACE support hub—adverse childhood experiences. That centre of expertise is to increase understanding of ACEs, to increase resilience, to support and inspire individuals, communities and organisations to learn about ACEs, and to become more aware and to change thinking and behaviour.

We continue to invest in our ambitious programme to improve access to specialist CAMHS services in response to significant increases in recent years. Members will know we've invested significantly in this. Members will also know we've set a new waiting time standard and the challenge now is that I expect to see a further and sustained improvement in performance from March onwards. We'll continue to publish a range of performance data in relation to that access, available by month and individual health board. I look forward to working with people within and outside this Assembly Chamber to continue to improve mental health in every community across Wales.

Thank you. I call on Nick Ramsay to reply to the debate.

Diolch, Dirprwy Lywydd. Can I thank everyone who's contributed to today's thought-provoking debate? You were all great. You all raised many issues of importance. Can I also say, first, in response to the Cabinet Secretary's comments, that I'm pleased that you are going to be supporting today's motion? It has been tabled in a constructive way and one in which we really hope to move the debate on. I hope, in looking at how you can address some of these issues, you look at some global examples as well, because I think there's a lot of good practice out there.

I can't mention everyone's comments today, but I will touch on a few of the speakers. First of all, in opening, Angela Burns spoke of the importance of removing the stigma surrounding mental health. That's such an important point, and you were right to say that AMs here who have spoken about their experience have been key to getting rid of that stigma and moving this debate on in the past, and that deserves to be commended. You also spoke about the suicide statistics, which I think I will take away from this debate as being shocking. That is something that, when this system fails, when things go wrong, that is what you're looking at at the end of this—you're looking at the loss of life and that needs to be dealt with in the way that you spoke of.

That's where Paul Davies came in, because I attended the DPJ Foundation event that Paul hosted yesterday, I think it was—time flies by. It was fascinating listening to the experiences that people have gone through—they themselves have gone through the issues and their families have gone through the issues of dealing with suicide. You did a great job yesterday, Paul. Keep up the good work, and DPJ Foundation need to keep up the good work as well, because it's really important.

Lynne Neagle, you identified the need for a step change in addressing these issues and you spoke about curriculum change bringing health and social services together. In fact, you made a point that was later made by the Cabinet Secretary that this is a cross-cutting issue; it touches on all aspects of life and all aspects that Government deals with. So, it's not a question of putting this in one silo and dealing with it there, we do need a truly joined-up approach. Darren Millar spoke of the need to support veterans who are suffering from mental health issues.

David Melding, you mentioned Jonathan Morgan, as did Dai Lloyd, and yes, he did a lot to move this issue on. Thinking back, I think he was the first person to bring a Measure—the mental health Measure—to this Chamber, which was later adopted by the Welsh Government. He's not in the Chamber today—well, not in body, anyway—but in spirit, he has been invoked, so I hope he's watching this debate and will appreciate that we appreciate what he did. 

Can I say in closing, Dirprwy Lywydd, that I'd like to reiterate Angela's key call, actually, in her contribution, when she said that we call on the Welsh Government to introduce a target for all people to be able to access psychological therapies within 28 days? That's a really important call. Hopefully, if we can't achieve other things, we can achieve that, Cabinet Secretary, and we can ensure that those therapies, that treatment is there when people need it.

Very finally, the Time to Change Wales campaign has been mentioned by a number of Assembly Members. Bev Jones who helps run that campaign and set it up lives near me, in my village, so I know Bev very well, and I know just how dedicated she is to the cause of mental health and how pleased she is that we're having this debate today. 

The statistics say it all. Most of us, all of us, will either have a mental health issue during our lives or we will be affected by it in some way through our friends and families. So, I'm glad you're supporting this debate. I urge everyone to vote for this motion today, and let's get on with the job of changing Wales, because that time has come.

Thank you. The proposal is to agree the motion, does any Member object? No? Therefore, the motion—[Interruption.] Just in time. You have got to be quicker than that. I would've expected you to have been on the ball, as a rugby player, but there we go. All right. We move to voting time, unless three Members wish for the bell to be rung. Does anybody want the bell to be rung? No.