The next item is the statement by the Deputy Minister for Mental Health and Well-being: 'Together for Mental Health' strategy and next steps. I call on the Deputy Minister to make the statement. Lynne Neagle.

Thank you, Deputy Llywydd. Yesterday we marked World Mental Health Day, and this Government is steadfast in its commitment to improve the protection of and support for mental health and well-being. This is demonstrated through my appointment as dedicated Deputy Minister for Mental Health and Well-being and the positioning of mental health as a priority in our programme for government.

As we emerge from the pandemic, the mental health impact of coronavirus is becoming even clearer. Services are reporting an increased number of referrals with more complexity. Each month, although our local primary mental health services teams receive more than 5,000 referrals, more than 17,000 people are receiving care and treatment from specialist mental health services. There is increasing demand for people needing psychological therapies and crisis support, with more than 1,200 referrals to crisis resolution and home treatment teams each month. Against this backdrop, I am acutely aware that the current cost-of-living crisis is likely to add to the challenge.

We are reaching the end of our 10-year 'Together for Mental Health' and 'Talk to me 2' strategies, and I want to take this opportunity to update Members on progress, the independent evaluation of these strategies and our next steps. We have come a long way since the publication of both strategies, and the services, support and investment that we have today demonstrates a significant step change compared with what was in place in 2012. In that time, our annual ring-fenced investment to the NHS for mental health has risen from £577 million to £760 million. We've also committed a further £50 million in 2022-23, rising to £90 million in 2024-25 to support mental health and well-being.

With this investment, we have transformed services implemented at the start of the strategy. This includes the creation of local primary mental health teams across Wales, crisis resolution and home treatment teams, psychiatric liaison services and community perinatal teams. We've also established single points of contact for child and adolescent mental health services to improve accessibility, and we have embedded the Mental Health (Wales) Measure 2010, a unique piece of legislation that provides the framework to improve mental health services in Wales. We have also established a mother and baby unit in south Wales and are progressing our commitment to improve access to these services in north Wales.

We have significantly expanded support at tier 0/1 levels to provide easy access to a range of support and to avoid escalation to specialist support where appropriate. This includes through our 24/7 CALL helpline and online cognitive behavioural therapy. These services alone have received around 97,000 contacts since September 2020. We've also commenced the phased roll-out of urgent mental health advice through 111, which will provide immediate access to advice from a mental health professional. I expect all health boards to have commenced a phased roll-out towards 24/7 cover by Christmas.

However, we recognise the importance of early intervention and taking a whole-system approach to improving mental health and well-being. We have created a joint health and education programme and a joint ministerial approach, built around schools, to deliver a whole system approach to emotional mental health and well-being. Delivering on our programme for government commitment, we are also rolling out schools CAMHS in-reach support across Wales to ensure issues are identified and support provided earlier.

Good progress has now been made with key legislation underpinning our agenda, and we have now consulted on the draft regulations for Wales to support the implementation of the Mental Capacity (Amendment) Act 2019 and the liberty protection safeguards. 

Preventing suicide remains one of our top priorities. We have targeted an additional £1 million in 2022-23 to support this work. In April 2022, Welsh Government, in partnership with the police, NHS and Public Health Wales, implemented the real-time suicide surveillance system. This system will provide crucial information to strengthen preventative work, ensure rapid support and to identify trends or clusters.

I can announce today that later this month we will launch a consultation on new guidance to support people bereaved by, exposed to or affected by suicide. The guidance has been informed by insight from people affected by suicide and aims to ensure a more compassionate response, offering both practical and emotional support, at the different steps on that journey. The implementation of this guidance will be a key focus following the consultation.

Our current 10-year 'Together for Mental Health' and 'Talk to me 2' strategies are based on the principle of partnership working across Government, public and third sectors to improve mental health in Wales. We committed to an independent evaluation of the strategies to assess their impact and inform our next steps. This evaluation was commissioned in September 2021, and the evaluation team has engaged widely with service users, providers and key stakeholders. The team has conducted in-depth interviews and workshop events with stakeholders across Wales and with service users, carers and front-line practitioners. I will issue a written statement shortly, when the findings of the evaluation are ready to be published.

I am today announcing that, following this comprehensive engagement and evaluation, work is now under way to develop the future strategies. It is essential that we now learn from the evaluation findings, build upon our progress, make the best use of our resources and develop first-class mental health services that meet future needs and demand. The main findings from the evaluation will help guide and inform our focus and priorities in developing the next strategies and my officials will now engage further to expand upon this research and evidence. I am committed to a fully inclusive approach and to ensuring that citizen voice and the lived experience of those who use our mental health services are reflected in the design of our future services. 

A key priority will be developing a sustainable and diverse mental health workforce though the implementation of the Health Education and Improvement Wales and Social Care Wales strategic mental health workforce plan. I want to see better integration of mental health services, building on the work we've done to embed mental health in the strategic programme for primary care and the urgent and emergency care programme, and, of course, a focus on inequalities and access to mental health support.

Whilst we must maintain our focus on cross-Government working, prevention and early intervention, we also need to set out a clear vision for specialist mental health services to ensure this level of support is accessible closer to home. In all this work, I expect to build upon the service user engagement arrangements that are now firmly established, including our national service user and carer forum.

These are just a few areas of focus, but we expect to see significant engagement with partners in the statutory and third sectors, as well as service users themselves, as we develop the successor strategies. It will be important to do this in a meaningful way, and I expect this work to be undertaken during 2023, with a view to the publication of a draft strategy for consultation towards the end of 2023. I look forward to updating Members on progress with this important work.  

Thank you very much for your statement this afternoon, Deputy Minister. However, it is disappointing that this is not an annual report. While the willingness and enthusiasm is there from the Deputy Minister to improve mental health services, the Senedd needs to be able to analyse progress through clear reporting, rather than just a statement.

'Together for Mental Health' in its decade tenure has only provided one annual report in 2013 and one progress report back in 2018. Given the significance and focus of Welsh Government on mental health, it's imperative that it is able to demonstrate clearly to the Senedd where it has achieved its aims and where more work needs to be carried out. While we realise that COVID-19 has had an impact on mental health services, this is an opportunity to deliver key improvements to the Welsh mental health system. And there are a number of improvements and milestones met. However, the Welsh Government seem to seek to plug the gaps in community mental health services and crisis care with a reliance on third sector organisations to deliver sanctuary. Although I agree that there is a place for the knowledge and experience of the third sector, the Welsh Government should also fully implement its own agenda through the NHS and improvement of services within its own systems. And while the ardour and zeal and warm words are present in the statement this afternoon, Deputy Minister, I believe that an annual report should be published so that the Senedd has the opportunity to scrutinise this in a full, proper and democratic way that will encompass the needs of people the length and breadth of Wales, as I'm sure you can understand, Deputy Minister, that the needs of people in Cardiff will be very different to those in Denbighshire and my constituency, for example. 

I welcome the mother and baby unit in south Wales, but could I please ask this afternoon as well why this wasn't extended to north Wales, and whether you could provide any more information on whether that could be a possibility for north Wales in the future? I note that some high-level outcomes of the 2012 strategy, including improving the mental health and well-being of the entire population and reducing the stigma of mental ill health, have been turned on their head as a direct result of the pandemic, as you alluded to. It is concerning that, despite 'Together for Mental Health' aims to reduce stigma, Time to Change Wales found that just 5 per cent of adults have more understanding and tolerance of mental health issues, and that help-seeking behaviour has declined, with large drops in the number of people in Wales willing to talk about a mental health problem with family, friends or employers. So, how will your new strategy address the mental health fallout from the pandemic?

We're also fully aware that certain local health boards are still failing in their duty of care towards mental health in-patients, despite the significant funds your Government has ring fenced for mental health, Deputy Minister. In Betsi Cadwaladr, for example, under targeted intervention, and previously under special measures for mental health, we're seeing repeated mistakes, including two deaths in two years, and vulnerable and high-risk patients not being protected from avoidable harm in Ysbyty Glan Clwyd's emergency department. So, how will your new strategy ensure that these mistakes aren't made again so that assurances can be provided to people in Denbighshire and north Wales?

Deputy Minister, prior to the pandemic, Mind Cymru outlined that thousands of people were waiting longer than ever to receive psychological therapy. Although adult waiting times have improved since the pandemic, it should still be of grave concern that just one in two patients in CAMHS received a local primary mental health support service assessment within 28 days, with just one in five children and young people in Swansea bay receiving their assessment within this time.

We also see from the latest figures that therapeutic interventions for children and young people are worse, with just 40 per cent starting their therapy within 28 days. So, Deputy Minister, is this a sign that your current mental health strategy has failed children and young people? What urgent action are you taking to reverse this situation? And are you now going to undertake a full review of mental health services? Thank you.

Can I thank the Member for those comments? Obviously, there were a lot of issues there to respond to. If I can pick up, first of all, on your comments about the reporting on the 'Together for Mental Health' strategy, there are regular reports made to the national mental health partnership forum, as well as other bodies. Also, I have established—well, my predecessor established—an NHS ministerial oversight board to monitor progress against all the streams of the 'Together for Mental Health' programme. But certainly, as part of our consideration of how we are going to develop the new strategy, I’m very happy to look at reporting and how we can make that more transparent, in addition to the regular statements and scrutiny that I undergo in the Senedd. Just to add as well: we are planning to publish a closure report after we have completed the current strategy, so you will be able to see exactly where we are with all of those things.

I don’t really concur with what you have said about the balance of support with the third sector. The third sector provides, in my experience, enormously important and much valued support to communities and, in many ways, is best placed really to break down those barriers, especially in communities that we sometimes describe—although I don’t like the term—as hard to reach. They are very well placed to do that. We have massively increased funding for mental health services, including for the third sector, but that is not to the exclusion of NHS services. Just this year alone, we are spending an additional £23 million on priority areas in the 'Together for Mental Health' plan and addressing waiting times pressures. So, it is certainly not a question of investing in the third sector to the exclusion of statutory services.

Thank you for your welcome for the MBU in south Wales, which I was delighted to visit a few months ago. I am acutely aware of the need for there to be provision in north Wales. Modelling has been undertaken to identify the possible need for an MBU in north Wales, and it has been identified that, currently, around two beds—possibly three—will be needed. So, on that basis, it’s very difficult to establish a stand-alone mother and baby unit in north Wales. But, what we are doing now is working with the NHS in north-west England to establish a unit that women in north Wales can have access to. I am very committed to making sure that we deliver that mother and baby unit provision in north Wales.

The Member made some points about stigma, and referred to Time to Change Wales. Of course, unlike England, we have continued to fund Time to Change in Welsh Government. We announced £1.4 million a little while ago to continue the programme, jointly with the economy Minister, because that’s the approach that we take to mental health in Wales. It’s a cross-Government approach. But there is always more that we can do in terms of tackling stigma, and that will be a key feature of the work that we are doing around the new strategy.

In relation to the points that you have made around Betsi Cadwaladr, as you are well aware, Betsi Cadwaladr is in targeted intervention for mental health. That has been supported by £12 million in recurrent funding to improve services. And in addition to the many meetings that take place to drive performance in the NHS, in Betsi there are also targeted intervention meetings; I meet them quarterly to go through the targeted intervention matrix. You'll be aware that we announced a while ago that there will now be an independent review of the various reviews that have been undertaken of the incidents that you've referred to, to really look at to what extent those recommendations have been fully embedded in Betsi Cadwaladr.

You made a number of points around waiting times. We have got a delivery unit review of psychological therapies at the moment, which is looking at that. But in general terms, services are achieving around 70 per cent against the 80 per cent target for access to adult psychological therapies, although we recognise there's more we can do. That data isn't currently published at the moment, but we are working towards that, and the delivery unit review will help us with that.

In relation to your points about CAMHS, there's nothing that is more important to me than delivering on services for our children and young people, and you've repeated your call again for a review of services, even though I was very clear in the debate we had about this that we have got a review that is nearly finished. It is the delivery unit review of CAMHS that will be reporting this month, and that will enable us to look at the data, check that we're counting the same things in different health boards, and, vitally, will make some recommendations about how we improve those services. That will be an absolute priority for me.

But I have to say to the Member that it is not just about specialist services. Lots of the children and young people who are waiting for specialist services will be referred back out again because they don't meet that threshold. What we are doing in Government is a whole-system approach to supporting children and young people where they live their lives, so starting in schools with our whole-school approach, then through our NEST framework providing early help and enhanced support with the community, and then moving on to more specialist services, and of course crisis support is a key part of that as well. So, there is nothing that is a higher priority for me. We are making good progress and we'll want to look through the next strategy about how we can consolidate that.

I thank the Deputy Minister for her statement this afternoon. I don't think we can over-emphasise the significance of this point in time in terms of the attention we give to mental health. It has been positive to have the 'Together for Mental Health' strategy to give us a focus on the work that needs to be done, to understand the problems that we face in terms of mental health and well-being in Wales, and now, as we're at that point where that strategy is being reborn, we must get it right.

Yes, steps have been taken over recent years. Yes, there has been an increase in investment in mental health, but the fact that we continue to face such intense problems in this area tells us that something is still wrong. Just as we talk of the need to invest in the preventative in the context of the NHS in general, I'd like to hear from the Minister what intention she has to ensure that even more of a percentage of the budget is invested in tackling problems at an early stage, before they develop into problems that are a greater burden for the individual, but are also a greater burden on the acute services, which are so expensive to provide, and create more heartache for the people who need those services.

I would like to know what work the Minister is intending to do at this point to ensure that, in future years, we won't continue to face problems in the provision of acute mental health services of the kinds that we've seen in north Wales in recent years—the ongoing problems at the Hergest unit in Ysbyty Gwynedd, where staff are still turning to us as local representatives and describing problems of low morale and concerns about patient safety. That isn't acceptable, so I would like to hear more about the kinds of ideas that the Deputy Minister is developing in this area.

And finally, I need an assurance here that more will be done to prioritise children and young people. We know that, despite the increase in expenditure and despite the additional focus on mental health—and we welcome that—we are still failing to move children and young people into mental health and well-being services at an early enough stage, and that means that the problems that could be resolved do become more difficult to resolve. I know of people who have given up entirely on NHS services and have decided that there is no option for them but to go private, and that’s in all sorts of areas, including eating disorders.

I need an assurance from the Deputy Minister that there will be a renewed focus on this and a rebalancing of priorities for young people, but also for that transition period between young people's services and adult services. I would be grateful for some comments on that too. We know that Mind Cymru and their plan, Sort the Switch, deals with this area specifically. So, once again, this is a key point. I will support the Government in making the right decisions now, but I do look forward to seeing that strategy being more robust than it has been in the past when it’s before us very soon.

Can I thank Rhun ap Iorwerth for his comments, and particularly the recognition of the positive work that's been undertaken through the strategy? I absolutely agree that we must get this right, and, as you've acknowledged, we have hugely increased investment. You alluded to the continuing issues with children and young people's mental health, but I think that we have to acknowledge that the COVID pandemic has had a huge impact on everybody's mental health, and particularly children and young people.

You talked about the need to prioritise children and young people's mental health. That's why I've come into this job, Rhun; I've come into this job because I care so passionately about that, having led the work in the committee, and my dedication is to delivering on that agenda. And we are making progress. You referred to prevention. We are spending money on prevention through what is a cross-Government strategy that deals with housing, employment, debt advice, money advice—all those issues. So, we absolutely recognise the importance of prevention, and that is supported by the funding that we are investing in those programmes. 

We are seeing reforms of children and young people's mental health services. I referred in the statement to the single points of access. They have made a difference, because that means that children aren't batted about the system, back and forth then. They can be put in touch with the right people; it's our 'no wrong door' approach in action. And as I said to the previous Member, lots of these young people won't need specialist CAMHS. They're not mentally ill; they are experiencing distress because of what's been going on in their lives, and there is more appropriate help available to them. What we have to do is make sure that they can get that help, and we are investing I think it's £12 million extra this year in the whole-school approach for mental health. Our NEST framework is underpinned by additional funding, and we have, as you know, the co-operation agreement with Plaid Cymru to pilot the sanctuary provision for young people, although we very much hope that young people won't need to be in crisis; we want to stop that escalation earlier on.

Thank you for your comments regarding Betsi Cadwaladr. I've outlined already the steps that are being taken in Government. As I say, I meet with Betsi quarterly to go through the targeted intervention framework in detail. That's in addition to all the other meetings that are held to monitor quality and performance in Betsi, and the targeted intervention meetings. We have got this review now that is going to look across the range of recommendations that have been made in relation to Betsi in recent years. I'm sure you'll be pleased to know that the health Minister approved the outline business case for the new mental health provision at Ysbyty Glan Clwyd, which is really important. Having the right capital really matters, and that's a message that has been given to me many, many times when I've talked to the staff in Betsi. So, that will, I think, make a really big difference.

I'm very happy, Rhun, to give you the assurance around eating disorder services. I've been very clear that those services are a priority for me. I've been going around visiting the different eating disorder teams, and had a very positive visit to the one in Betsi, where they're doing really brilliant work preventing problems escalating for service users. We've underpinned our commitment to eating disorder services with an additional £2.5 million every year from this year, and I've been really clear with all health boards that they're expected to meet the National Institute for Health and Care Excellence guidance on eating disorders, including the four-week waiting time. But we're also focusing on early intervention as well, because that's absolutely key, and our work in schools. So, I'm very happy to give you that assurance, and I will be going to see the other eating disorder teams. I've got to say that, actually, the experience of visiting them has been incredibly positive. They're incredibly committed people who are doing really wonderful work. I think we need to do more to talk up the really good work that goes on in our mental health services in the NHS. 

The Llywydd took the Chair.

Good afternoon, Deputy Minister. I do welcome the statement, and also the work that I know you have done and the commitment you have to this particular area of work.

Just two things from me, if I may. Firstly, the situation with CAMHS was bad before COVID, significantly bad. It was worsened, yes, but now we still have 60 per cent of young people having their first appointment within four weeks. That still isn't good enough, and I just hope that there will still be a light shone on this particular area of work, because I know we all know the devastation that mental health issues in young people will bring. I'm not sure I totally agree with your analysis that they don't need the mental health support, that they need other support; I'd like to see the data and the information on that.

The second point, if I may make it, is that we believe in parity: mental health and physical health. I'm delighted to see the tier 1 services, 97,000 people included in that, but there is an issue still about crisis care, and we would like to see a 24/7 crisis care service in mental health. I wondered if you would meet with me just to talk that through, because it's not just simply about health services; it's about a range of services. Thank you very much. Diolch yn fawr iawn.

Thank you very much, Jane, and thank you for the kind words as well, which are much appreciated. I just want to be clear that I didn't say that all young people don't need specialist mental health support. What we know, though, is that some of those young people who are referred into specialist CAMHS won't meet the threshold for specialist CAMHS because they're not mentally ill; they're experiencing acute distress because of what's going on in their lives. It's the sort of missing-middle children and young people that we picked up in 'Mind over matter'. What matters is that wherever young people need that support, they're able to get it at whatever point they need it. That's what our 'no wrong door' approach is all about. 

I do have to take issue with some of the things you've said about waiting times, because if we look at the most recent figures for your own constituency in Powys, they're well above the 80 per cent target: 97.4 per cent of children are seen within the four weeks, and are actually receiving an intervention within 97.1 per cent for primary mental health services. For specialist CAMHS it's 91.3 per cent, although I acknowledge that other areas are not in such a good position. And, just to give you the assurance, the delivery unit review that I've referred to is coming to completion now. They've been working with all health boards to develop trajectories so that health boards can all recover their performance to meet the targets that we've set out. 

I'm very happy to meet you, Jane, to talk about crisis services. Just to say as well, as I said in the statement, we are making good progress with our 111 'press 2 for mental health'. I met with all the vice chairs last week to have a full update on where they're at, and entirely recognise that this won't be just about mental health services. That's why the health boards have to get the right pathways in place, because lots of the people, we know from the data, who come forward for crisis support will, unfortunately, be people who are struggling with things like the cost-of-living crisis, debt and things like that as well. So, we've got to have that range of pathways in place so that we can connect people with the right services. But I'm very happy to have that discussion with you.

Minister, I wanted to ask about the mental health impact of miscarriages. There's still this strange societal expectation that we don't talk about miscarriages, and people grieve for the little lives that were part of their world for a short time. They mourn the moments they never had together. And their grief is something that those parents are expected to process privately and then get on with things. There's not always an expectation that employers will give compassionate leave and mental health support after miscarriages—maternity rights only kick in if you lose your baby after 24 weeks. So, Minister, will the Government work with charities and families to ensure that workplaces across Wales adopt policies that get rid of this taboo around miscarriages and offer compassionate leave and mental health support? Because little steps like this can help ensure that women affected and families affected are bathed in a wave of light, and help ensure that their babies are not forgotten.

Thank you, Delyth, for making those points. I entirely recognise what is, in some ways, a unique form of grief with a miscarriage, because, often, people don't recognise it as the devastating loss that it is, and that compounds the grief that people feel when they lose a baby. We've got a bereavement steering group in Wales and we've published a national bereavement framework for Wales that is trying to make sure people have support when they need it. As part of that then we're also developing specific pathways for particular types of bereavement. We launched the first one in the summer, which was for sudden and traumatic death of a young person. But the next work stream is on baby loss, and we are working with those organisations that work in this area to try and make sure that we get that pathway right. Obviously, employment matters are not devolved to the Senedd, but I'm very happy to pick up with officials how we can make sure, as part of that pathway, that we raise awareness of the needs of people who are bereaved through miscarriage or baby loss.

I thank the Deputy Minister. 

The next items are items 7 and 8. In accordance with Standing Order 12.24, unless a Member objects now, the two motions under items 7 and 8 will be grouped for debate, but with separate votes. Unless there are any objections, we will move on. There are no objections.