We are the Health and Social Security Scrutiny Panel. Our remit is to look at the draft policies or matters of public importance relating to the work of the Minister for Health and Social Services and the Minister for Social Security.
THE ISSUE
The Panel was tasked with a follow-up review of Mental Health Services in Jersey; this followed the Panel's 2018 Assessment of Mental Health Services.
THE REVIEW
The Health and Social Security Scrutiny Panel launched a review ‘Assessment of Mental Health Services’ on 31st July 2018 and its report, (S.R.4/2019) was published on 6th March 2019. The Panel has maintained an interest in the provision of Mental Health Services through this term of office and felt that it would be appropriate to revisit the review and formally report on the progress and change since S.R.4/2019 was published. The Panel launched its follow-up review on 1st February 2019.
Unlike the Panel's last review, we have not undertaken a large data gathering exercise, or survey to poll service users on their experiences of Mental Health Services. This Report is intended to be a short and targeted review which will provide the public with information about Jersey's Mental Health Services and summarise what we have established are the plans for the future direction for the service.
The Panel held a public hearing with the Minister for Health and Social Services and the Minister and Assistant Minister for Children and Education and undertook site visits to Rosewood House, Clinique Pinel, Orchard House and La Chasse in February 2022. In addition, we were welcomed to the CAMHS office in St Helier and also visited H.M. Prison La Moye.
The Panel has also received submissions from the Minister for Home Affairs in respect of the States of Jersey Police, States of Jersey Prison Service an the States of Jersey Ambulance Service and the Minister for Infrastructure in relation to the status of building work on the mental health estate.
Finally, the Panel sent targeted letters to 25 relevant organisations to ask questions about the perception of Mental Health Services and the impact of COVID-19. We received 8 pieces of written evidence that the contributors were happy for us to share publicly.
IMPACT OF THE COVID-19 PANDEMIC ON MENTAL HEALTH SERVICES
The Panel has considered the impact of the COVID-19 pandemic on mental health services. We learned that, whilst the pandemic has helped raise awareness for mental health and wellbeing, there are serious concerns and there has not been enough recent focus on people who suffer with serious mental illness. The Panel has suggested that the services should be reviewed as part of the next Government Plan, particularly outlining the support offered to people with severe mental illness.
The pandemic accelerated the establishment of some services, such as the Community Triage Team and the Home Treatment Team, however, the Panel was advised that there is further work required to embed these within a coherent community model of care, which is expected to be agreed by the end of April 2022. The Panel has recommended that the Minister publish further details about the community model of care and provide further details on the implementation and change process.
The Panel has also been made aware that the pandemic has impacted waiting times for the face-to-face community provision from AMHS. A backlog saw patients waiting longer for appointments, particularly for Jersey Talking Therapies and the Memory Assessment Service. This was due to the initial closure of some services at the start of the pandemic and, also, the subsequent redeployment and / or sickness of staff.
The Panel heard about the impact of the pandemic on carers when support services were changed and has recommended that the Minister engage with Carers Jersey to develop draft legislation for carers.
The pandemic has also been given as the reason for the delay of the replacement Mental Health Strategy and limited progress made with the Mental Health Improvement Plan, however, the Panel was advised that there are plans for a new strategy to be drafted during the course of 2022.
Independent Review of Adult Mental Health Services in Jersey
The Independent Review was published in November 2021 and the Panel explores the impact of this on AMHS.
The Panel noted that a number of the findings from the Independent Report echoed those of S.R.4/2019. Furthermore, changes had been made to the management and leadership of AMHS, including the creation of a new role - the Director of Adult Mental Health and Social Care. This appointment had invigorated the process of reviewing strategy and future direction for mental health services, including a staff engagement programme which is intended to receive their feedback on the requirements for key areas of change.
The Panel learned that AMHS has taken on large numbers of actions and that process of prioritising these, with consideration of the resources available to fulfil them is underway. The Panel recommended that this process is transparent, and details should be made available as to what is (and is not) taken forward.
The Panel learned that, as a result of the Independent Report, Adult Mental Health and Adult Social Care ceased the process of integration. At the date of the Panel’s review the two care groups were operating separately, and a decision would be taken during summer 2022 regarding their integration. The Panel requests that an update is provided by September 2022, together with clarity about where the decision has been made.
ADDITIONAL FUNDING OF £500,000 FOR MENTAL HEALTH SERVICES
The Panel reviewed the intentions for the £500,000 of additional funding from the COVID-19 reserve that was assigned to AMHS following the amendment to the Government Plan for 2022-2025 (P.90/2021).
The Panel was not provided with a clear breakdown of how the funding would be spent but has recommended that it should be reported to the incoming Health and Social Security Scrutiny Panel by the end of September 2022, with specific details about how the funding will benefit frontline services and service users.
The Panel has identified each of the 21 recommendations made in S.R.4/2019 and look at these individually in order to assess progress.
In overall summary, whilst an initial address to S.R.4/2019 was made with the Mental Health Improvement Plan, progress in developing faltered due to the pandemic priorities. The Panel is also concerned about the delays to some projects, such as Clinique Pinel, and the emergence of themes such as the lack of a coherent and coordinated approach – both with AMHS and between other government departments to tackle some of the bigger issues such as cost of living.
The Panel acknowledges that Health and Community Services (HCS) and Adult Mental Health Services (AMHS) have faced significant challenges during the COVID-19 pandemic. It is recognised that it has been a particularly difficult time for staff in this sector, as they have had to incorporate new ways of working and managing heightened infection control measures, in addition to the business-as-usual frontline requirements of AMHS.
The Panel has found that there has been some limited progress against the recommendations of S.R.4/2019 and had concerns that a more recent Independent Review, published in November 2021 also highlighted a number of severe concerns about the AMHS.
The Panel has also recognised that there are a number of factors within our findings that are beyond the remit of AMHS alone. For example the issues for recruitment that are impacted by Jersey’s cost of living. However, the idea of joined-up systems for mental health services and networks of communication between government departments, services, as well as the private and charitable sectors have become apparent themes of this review.
The Panel has made a number of recommendations to reflect the importance of getting the governance for AMHS structures right. Transparency and clear lines of accountability will help to make the coherent networks more accessible for all parties and accountable for the patients who need them.