1. What is the Welsh Government doing to improve access to emergency mental health care? OQ56338

Llywydd, on 21 December, the Minister for mental health, Eluned Morgan, published 'Beyond the Call', the Welsh Government review of urgent access to mental health services. Cabinet agreement has since been secured to implementation of the report’s recommendations across the range of ministerial responsibilities.

Thank you, First Minister, for that answer. I'm particularly concerned about our children and young people accessing the appropriate care in terms of the pressures placed on them during the pandemic. So, it's welcome that the Welsh Government has prioritised them with the recent £9.4 million for the schools in-reach pilot and children and mental health adolescent services. However, the pandemic has also highlighted the all too real health inequalities faced by far too many communities across Wales, including in my own constituency of Cynon Valley. How is the Welsh Government tackling this in service provision?

Llywydd, I thank Vikki Howells for that supplementary question. It gives me an opportunity, hearing her mention health inequalities, to remind colleagues here that this week is the fiftieth anniversary of Dr Julian Tudor Hart's paper in The Lancet on the inverse care law, a paper that has had a genuinely global impact far beyond Wales. It was sent to me, Llywydd, again this week by our former colleague Dr Brian Gibbons, reminding me of the continued relevance of that 50-year-old seminal piece of work. And, of course, Vikki Howells is right, as was Dr Gibbons, that the pandemic has exposed those fault lines in our society all over again. And in emergency mental health services, Llywydd, we know that those people who have the least access to mainstream services often have to gain and obtain health services through emergency routes. It's why the 'Beyond the Call' review was so important, to make sure that those routes are as clear and as easy as possible for people to read. 

Members who've had a chance to have a look at it will know that it tracks the 950 calls every day that come into emergency and out-of-normal-hours services across Wales from people with a mental health need of one sort or another. It looks to see what happens to those people, and only three out of 10 of them, Llywydd, turn out to need simply an NHS response; there are other aspects of their lives that need attention as well. So, the report's focus is on collaboration, on timeliness, on crisis planning for people who are known to have a pre-existing condition, on a missing person protocol, particularly important for young people, as Vikki Howells focused on in her supplementary question, and a single point of entry to help those who need help to get it in a crisis. And I'm very pleased to say that we've now got pilots, 111 pilots, in Swansea Bay, Hywel Dda and Aneurin Bevan health boards, all designed to put that aspect of the report into practice, so that we can do better in the way that Vikki Howells asked in her original question, to make sure that emergency mental health care is available to people at that point of need. 

First Minister, do you agree with me that priority needs to be given to capital investment in modern acute facilities? It's still the case that some are old fashioned, inappropriate, too large, with adolescents, for instance, in adult facilities, and anyone suffering acute mental distress and/or psychosis can find their trauma is increased by grossly inappropriate facilities sometimes, including being held in prison cells whilst placements are sought. This is unacceptable in the modern age.

Llywydd, I do absolutely agree with David Melding that people should get the help they need in the right setting. It's completely unacceptable that someone who has primarily a mental health need or condition should end up in a criminal justice context. I know that David Melding will be pleased that one of the 'Beyond the Call' recommendations that has been implemented is that we should have conveyance pilots—that people who are in acute mental distress should not be taken to where they can get help in the back of a police car. And we have three of those pilots going on at the moment with St John Ambulance Cymru—in Swansea Bay, Cwm Taf Morgannwg, and here in Cardiff and the Vale. And it's precisely in order to address the sorts of circumstances that David Melding has referenced—that those people should get the help they need in a way that is sensitive to the distress that they are experiencing, and not in places or by means that add to that distress. And that will need further investment. I'm very pleased to say that we still hope that the Tonna in-patient perinatal mental health service will open to patients in April of this year, and that will be in physical conditions that meet the standards of the twenty-first century.

First Minister, I've raised this matter of the mental health effects of the lockdown policy since it was evident that the three weeks to flatten the curve was nothing of the sort. We won't know the full effects of lockdown policy in terms of suicide, mental health crises, cancers and waiting times for a long time yet. That said, your Government seems to be investing heavily in mental health services, with £10 million additional funding to deal with the effects of lockdown. Can you tell the Chamber how this sum was calculated, please, and how, specifically, it will benefit those unfortunate enough to need access to emergency mental health services? Thank you.

I thank the Member for her question. Of course, we have recognised throughout that there is more than one sort of harm that comes from coronavirus, and the impact on people's mental health and well-being is certainly one of the things to which we have always attempted to pay close attention. I know the Member will be pleased that the British Medical Journal recently reported on evidence that there has not been a rise in suicide rates in the early part of the pandemic. But I agree with what Mandy Jones said that these are early days, and that the impact of the pandemic will go on for many months, and longer than that, to come. But it was at least encouraging that the worst feared impacts in those early days did not appear to have materialised.

The additional investment in mental health is actually £43 million in the draft budget. That comes on top of the fact that mental health is the single largest budget line within the health service here in Wales. That £43 million has to do an awful lot, Llywydd, of course: it has to strengthen services in the community; it has to make sure that young people do not, as David Melding alluded, end up in age-inappropriate settings if they need in-patient treatment; it has to make sure that we go on improving services for people with dementia and the need for mental health services later on in life. But it will have been calculated in the normal ways, in partnership with the health service, the third sector and those who do so much to help provide services for people in Wales with a mental health condition.