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Wales Mental Health in Primary Care

Wales Mental Health in Primary Care. 2011 Survey. Objectives. To review changes from 2009 survey To seek opinion on certain topics To provide evidence to shape actions. Methodology. Initial meeting in July to discuss survey Survey Monkey used to design and administer survey

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Wales Mental Health in Primary Care

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  1. Wales Mental Health in Primary Care 2011 Survey

  2. Objectives • To review changes from 2009 survey • To seek opinion on certain topics • To provide evidence to shape actions

  3. Methodology • Initial meeting in July to discuss survey • Survey Monkey used to design and administer survey • Pilot group of GPs used to test flow and length of survey • Primary Care letters sent to practices with link to survey • Results collated and survey closed October 11

  4. Terms used • HCPs – Health Care Professionals • MH – Mental Health • HBs – Welsh Health Boards • PC – Primary Care • SC – Secondary Care

  5. Summary • In total the survey attracted 202 respondents compared to 172 in 2009 Mental Health in Wales • Improvements are needed with the interface between primary and secondary care, in terms of referrals and pathways • From the patient’s side, HCPs feel social issues including the support of family and availability of employment, affect the ability to manage mental health. • On the medical practice side, HCPs consider that funding constraints and infrastructure affect the management of mental health • Nearly two thirds of the HCPs feel able to deal with mental health and consult with their primary care colleagues when appropriate. • More support is needed across the mental health pathway. • The two improvement areas considered to be of high importance are outreach and community services and the referral/interface system to secondary care.

  6. Summary Wales Mental Health in Primary Care (WaMHinPC) • More people have heard of WaMHinPC compared with 2009 • Information sheets appear to be received but few HCPs are reading or using them in practice • Dementia and CAMHS standard are the areas that HCPs think should be priority areas to focus on Mental Health (Wales) Measure 2010 • Just over a third of HCPs have heard of the Measure, with a range of awareness across the Health Boards • The low awareness and knowledge of the measure indicates that education is required. • Those that knew about Part 1 hoped to see more mental health trained workers from primary or secondary care working within practices

  7. Summary Dementia • Less than 20% of HCPs are aware of the National Dementia Vision for Wales • They feel extra support with behavioural disturbance in patients is the main improvement needed for managing dementia Patients • Most of the HCPs with Welsh speaking patients feel their needs are being met as either patients switch to speaking English or the GP speaks Welsh • The majority of HCPs with BME patients consider their cultural background, however there aren’t many examples of specific services offered. • On average HCPs treat 1-3 patients with an eating disorder.

  8. Summary Respondents • More females completed the survey and there was an increase in respondents aged 40 and under • Compared with the 2009 survey the split between GPs and nurses is near enough identical • The mix of respondents across Health Boards has changed versus the 2009 survey. • Against the 2009 survey there has been a slight increase in the HCPs with a specific qualification in mental health but not an increase in those interested in mental health.

  9. Mental Health

  10. Q1. In your opinion how difficult is the area of mental health to manage at Primary Care level? Nearly 80% of HCPs feel that mental health within PC is difficult to very difficult

  11. Q2 Setting aside issues of funding, resources or service quality, what factors contribute to making the management of mental health more challenging in primary care? Social issues are considered to be the most important factor for HCPs, 65% ranked this 1st, 2nd or 3rd. Only 15% of HCPs ranked ageing population highly. NB: In 2009 there were 7 options, in 2011 there were 9.

  12. Q2 Which other factors contribute to making mental health more challenging in primary care? • The most common other factor mentioned by respondents is issues surrounding CMHT and secondary care. • Examples included patients being ‘bounced’ between CMHTs and primary care. Also those patients that need an urgent referral are not always able to be seen promptly

  13. Q3. Which of the following do you feel affects the successful delivery of improvements to PC MH services in Wales? As with 2009, lack of infrastructure was chosen by most HCPs. Not as many respondents chose funding constraints compared with 2009. Professional knowledge and training is seen as more important than 2009.

  14. Q3 What other factors do you feel affect the successful delivery of improvements to MH in PC? • The most common factor stated by respondents is the lack of support from secondary care. • Examples included unable to contact services out of hours and communication pathways being poor • HCPs also mentioned that there are long waiting lists in PC for counselling and the need for staff to be trained on mental health

  15. Q4. Do you feel there should be a greater or lesser level of investment in time and resources in mental healthcare in Wales, relative to other primary healthcare priorities in general? There is no changed compared with 2009. Nearly 90% of HCPs think there should be more investment in mental health compared to other primary health priorities.

  16. Q4. Do you feel there should be a greater or lesser level of investment in time and resources in mental healthcare in Wales, relative to other primary healthcare priorities in general? Most HBs follow the national trend indicating there is little variance between the organisations. ABM appears to be the HB that moves away from the national picture, with a spread of opinion.

  17. Q5 How would you describe your own skill level to mental health treatment for people of all ages? The majority of HCPs (60%) are happy to deal with most mental health problems and 50% will consult with a primary care colleague. However this means that 40% of HCPs aren’t comfortable dealing with mental health

  18. Q6: what proportion of your practice time is spent on mental health related work? There has been an increase in HCPs spending less time on mental health and an increase in those spending more time compared to 2009. In 2009 90% of doctors spent 5 to 50% of their time on MH now it is 77%, indicating some HCPs might be taking the lead and taking workload off colleagues

  19. Q6: what proportion of your practice time is spent on mental health related work? Split by HB There is a wide range of mental health workload across the LHBs and within in the LHBs. For example in Cardiff nearly 35% of HCPs spend less than 5% on MH and 45% spend over 50%. Cwm Taf and Aneurin Bevan have a higher workload than the national average

  20. Q9 How confident is your practice overall in dealing with each of the following steps in the patient’s pathway? A greater proportion of HCPs feel more confident with the early and proactive detection of signs of MH issues compared to 2009. Promotion of MH and wellbeing is the pathway step that they feel the least confident in

  21. Q9 & 10 How competent/confident is your practice overall in dealing with each of the following steps in the patient’s pathway? Confidence and competence levels are similar.

  22. Q11 How much support do you feel your practice has overall in dealing with each of the following? HCPs consider themselves confident and competent in MH areas but feel there is not a high level of support. Also the respondents to the 2011 survey consider there is less support compared with 2009 NB: Respondents who answer 4 or 5

  23. Q12 If you were responsible for improving the overall mental health provision in your area, which aspects of care would you addresses as a priority? Nearly 80% of respondents felt outreach and community MH services would be the area to focus on, closely followed by referral system. This is supported by verbatim in Q3 where respondents felt lack of support from secondary care affected MH in primary care NB: Respondents could choose up to 5

  24. Q12 Which other areas would you address as a priority? • There were 13 additional suggestions for priority areas. • The top two were access to counselling and increased levels of staff in Primary Care • Access to and availability of counselling has been mentioned in other questions, in that there are long waiting times for the service. • The small percentage of respondents who suggested additional areas indicates that the majority were content with the list suggested

  25. Q13 Please rank the over importance of these factors in determining mental well-being for the population in general The top 2 factors that HCPs feel are important are support of close family and friends and availability of employment. However only the first factor is consistently ranked 1st or 2nd. The factors listed could be considered ones that HCPs feel they have little, if any, influence over. NB: Respondents could choose up to 5

  26. Q13 Which other factors determine mental well being? • There were only 5 respondents to this part of the question which generated 3 groups of factors. • Again, as with previous questions this indicates respondents were able to choose the factors they felt determine mental well being from the given list

  27. Wales Mental Health in Primary Care WaMHinPC

  28. Q14 Have you heard of WaMHinPC before this survey? There has been a 23% increase in the proportion of people who had heard of WaMHinPC before the survey

  29. Q14 Have you heard of WaMHinPC before this survey? Split by HB Doctors in ABM, Aneurin Bevan, Cardiff, Cwm Taf and Hywel Dda are more likely to have heard of WaMH in PC.

  30. Q15 If you have heard of WaMHinPC before, how? Over half of the HCPs who have heard of WaMHinPC have done so via email

  31. Q15 How else have you heard about WaMHinPC? • In addition to the options given respondents have heard about WaMHinPC via conferences

  32. Q16 Did you complete the WaMH in PC survey in 2009? For the 2011 survey it can be considered that there is a new group of HCPS who have completed it.

  33. Q17 Which of the following WaMH in PC information sheets have you received, read and used? There is a pattern with the information sheet that can be seen. The HCPs remember receiving the sheets, fewer read them and even fewer find them useful. Only information sheets 2 & 6 appear to have been used in clinical practice. Further research maybe required to discover how they can be made more relevant n=39

  34. Q18 Of the standards that WaMHinPC are developing which are the priority areas? HCPs feel that dementia care and CAMHS are priority areas.

  35. Q19 Which other areas would you focus on (for quality standards)? • There were 11 suggestions for additional areas to focus on from 12 respondents (see below) • From the small number of respondents to this question it can be suggested that either HCPs consider the WaMHinPC list to be adequate or can not think of any other areas

  36. Q20 Are you aware that Part 1 of the Mental Health (Wales) Measure 2010 requires local primary mental health support service to be established and these services are expected to be introduced in October 2012? Just over a third of HCPs are aware of the detail of the Mental Health Measure

  37. Q20 Are you aware that Part 1 of the Mental Health (Wales) Measure 2010 requires local primary mental health support service to be established and these services are expected to be introduced in October 2012? Split by LHB Doctors in ABM are the most likely to have awareness of the detail of the Mental Health Measure

  38. Q21 What is your level of understanding about Part 1 of the Mental Health (Wales) Measure? Nearly 70% of HCPs have no understanding of the Mental Health Measure. Also only 40% of HCPs feel it should be a priority area for WaMHinPC to focus on. Those that had received the information sheet (n=13) on the MH Measure had a slightly better understanding, 54% answer some or good.

  39. Q21 What is your level of understanding about Part 1 of the Mental Health (Wales) Measure? Split by HB HCPs in Powys, Cardiff and Aneurin Bevan have less of an understanding of the Measure compared to the national average. Perhaps further education is required across Wales.

  40. Q22 What improvements to primary care practice would you wish to see as a result of the implementation of Part 1 of the Measure? • There were 49 respondents to the question, 41 of which detailed improvements. Of these 49, 43% stated they had no knowledge of the Mental Health Measure. • The area with the most suggestions was a hope that more mental health trained workers would be in primary care. These could either come from existing primary care staff, secondary care workers moving into PC (temporarily or permanently) or from other sectors. • The second most mentioned improvement was better access to MH services and support. This links with Q12 where HCPs feel that the interface with secondary care is a priority area for improvement

  41. Q23 Are you aware of the National Dementia Vision for Wales? Less than 20% of HCPs are aware of the National Dementia Vision for Wales. As with the Mental Health Measure, education maybe required.

  42. Q24 What key improvements would help you manage patients with dementia? Over 80% of HCPs would like to see an improvement in support with managing the behavioural disturbances in patients with dementia

  43. Q24 What other improvements would help you manage patients with dementia? • Carer support and respite is consider an improvement that is required. • Four respondents, from 3 health boards, also felt that the current service works well.

  44. Patients

  45. Q7 Do you have any Welsh speaking patients? 70% of HCPs have Welsh speaking patients. Across HBs this ranges from 38% in Aneurin Bevan and 100% in Hywel Dda.

  46. Q8: If yes, do you think that the language needs of your Welsh speaking patients are being met? Two thirds of HCPs consider their Welsh speaking patients needs are being met. This is achieved through Welsh speaking HCPs or the patient speaks English. HCPs feel the needs are not being met when a doctor or nurse does not speak Welsh.

  47. Q8 How are Welsh speaking patient’s needs being met/not being met? • Welsh speaking patients are not having their needs met as GPs do not speak Welsh or there is little literature in Welsh • Welsh speaking patients are having their needs met as they are able to speak English or the primary care staff are able to speak Welsh

  48. Q25 Do you considered the cultural background of BME patients? Over 80% of HCPs say they consider the cultural background of their BME patients. An additional 26 HCPs state they have no BME patients

  49. Q25 What culturally sensitive services do you offer? • The most common type of service offered was translation and/or interpretation • Some HCPs had awareness of the culture and customs of their patients • However 13 HCPs stated they offered no services

  50. Q26 How many patients do you personally treat who have been diagnosed with an eating disorder? Nearly a quarter of HCPs have no patients with a diagnosed eating disorder. The majority of HCPs have 1 to 3 patients

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