5. What measures are in place to support patients with mental health conditions following COVID-19 treatment? OQ56141

8. What action is the Welsh Government taking to support the mental health and well-being of families affected by coronavirus? OQ56149

Thanks, David, and I understand that there's been permission given to group this with question 8. Is that right? Great.

The Welsh Government published a national rehabilitation framework underpinning population-specific guidance in May 2020 to help services to consider increasing the demand for rehabilitation, reablement and recovery throughout health and social care services. Mental health and well-being needs are embedded across the populations identified in that framework.  

Thank you, Minister. Can I urge that the mental health ministerial delivery oversight board that you have established looks at this? You also reflect on the recent report of the Senedd's Health, Social Care and Sport Committee, which looked at the pandemic and its implications. We will have people with long COVID, we've become increasingly aware of post syndromes—post polio, for instance, those who had polio in the last great epidemic in the 1950s presenting with problems and mental health is often one of them directly associated. And also, there will be people who would've been quite traumatized by their treatment, just because of the invasive nature of it. They are going to present with some very real mental health concerns that will require quite a specific response that relates to the context of those mental health difficulties being created.

Thanks very much, David. We absolutely recognise not just that long COVID is something that people are going to have to live with, and as you've seen, we've developed an app to try and help recovery for people, which we've launched this week. But also, we've got to focus, I think, on particular groups. Some of those are people who've had a prolonged time in hospital and critical care, so that's one group of people we've got to understand. People who, perhaps, are not being directly impacted by COVID, but have been indirectly in the sense that they were waiting for a different kind of operation, and that can lead to mental health issues. There are people, of course, who've avoided accessing services because they were concerned that they may catch COVID, or whatever, while they're in there. And also, there are socially isolated groups where lockdown has really increased the pressure that they have felt, and that lack of social connectivity. So, there is a lot, I think, that we need to recognise, and slightly different aspects. 

It's clear that every person who lives with a mental health issue has to be dealt with as an individual, and that it is a uniquely individual issue that needs to be understood. But I do think that we, as a community now, need to understand that we have gone through trauma, as a society, and that trauma-informed approach needs to inform our response to the pandemic. Certainly, the oversight board will have COVID as something that we keep an eye on and that we need to remain flexible with. 

The other issue that I think is probably worth noting is that there will be a particular issue, I think, with people on the front line. And it was interesting to speak to the Royal College of Physicians last week about what they see as being an issue in terms of the longer term, that, actually, people on the front line have not got time to think at the moment, but when this is over, the kind of post-traumatic stress could really kick in and they're suggesting that that could take about three or four years to actually hit. So, we've got to put all of that provision in place to prepare for what could be quite a significant impact on the people who are on the front line.

Minister, the amount of questions you've received today from Members regarding the impact of COVID on mental well-being, I think, highlights the challenges that are ahead of us in addressing some of those issues. And it's not often that we talk about the individuals in relation to this, but of course, the individuals are part of a family unit, very often, and families are also affected by their trauma—and I think the word you used in answer to David Melding, 'trauma', was correct, and we need to address this.

Mike Hedges highlighted the bereavement issue and there'll be challenges there with people who feel guilty because they weren't at the end of life for the individual because they weren't allowed to be. So, it's a large trauma upon our families, and my colleague in my neighbouring constituency of Neath, Jeremy Miles, has initiated a trauma awareness programme that he runs with Neath Port Talbot Mind. What discussions is the Welsh Government having with the third sector organisations and mental health charities to discuss how they're going to address the trauma awareness agenda, which is definitely going to be coming down the line to families as well as individuals?

Thanks very much, David. I meet very regularly with the third sector and it was there where there were people who emphasised the importance of understanding trauma. They're the people who have really made sure that I've understood that that is fundamental to the way we move forward as a society—that we have been through a traumatic experience as a society. But of course, you're quite right, there are individuals who are affected, but the individuals within the families may then have a ripple effect on other members in the family, and those are things that we need to keep an eye on as well. 

There are different projects that we're funding. Certainly, we've given about £750,000 to Action for Children and Mind Active Monitoring. So, we're recognising that there's a family issue here that needs to be addressed. Also, we have given an additional £900,000 to our hospices and bereavement people to make sure that there is that support there to help those families through what is a very, very difficult time in their lives.

Minister, those fortunate enough to leave hospital following admission for COVID-19 not only face many months of physical recuperation, they also have to come to terms with the mental trauma they have suffered. New research shows that one in five survivors will develop mental illness and many survivors struggle with post-traumatic stress disorder for months after leaving hospital. It has also been discovered that survivors are at a greater risk of developing dementia. Minister, how will the Welsh Government ensure all survivors are closely monitored and receive the necessary support early enough to stave off the most severe complications? Diolch. 

Thanks very much, and you're absolutely right, Caroline, that we must recognise that when people have a physical problem in these very difficult circumstances, there is a real possibility that there will be a spillover into a mental health problem. In particular, those who've had, frankly, a confrontation with death—there are a lot of people who've come very, very close, and that in itself is a traumatic experience. That's why we recognise that PTSD is likely to become something that we need to pay more attention to in future. Also, we need to monitor people who have left hospital. Obviously, at the moment, people are very focused on just getting people well, but there has been follow-up in local authorities just to make sure that people are on the right track.

Dementia is another point that you mentioned. I think one of the things that is clear to me is that a lot of people who are, perhaps, beginning to have an issue with dementia—we've seen that the isolation that many have felt has actually increased the speed at which that dementia has taken hold. So, that is, again, something that we need to keep an eye on, and you'll be aware that we've got a £10 million programme addressing the issue of dementia in Wales.