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Morgan: Improving care for mental health patients in Wales

Speech to the National Assembly for Wales.

"I ask for the Assembly's approval to bring forward a proposed Legislative Competence Order to devolve aspects of mental health legislation from the United Kingdom Parliament to the National Assembly for Wales. I have chosen this area of policy because, along with many others in this Chamber, I am very concerned about the state of mental health services in Wales today.

I am particularly concerned about the way that we treat people with mental illness and the lack of rights accorded to patients who need our help. This is the significant area of Welsh health policy governed by UK legislation. However, it is an area that could be developed here according to Welsh needs, and an area where a couple of very straightforward changes could radically reshape the services that we provide.

I know that many Assembly Members are committed to seeing changes to the provision of services for people who suffer from a mental illness. The statistics are quite shocking when you consider that one in four, perhaps one in three, of the Welsh population will suffer from some form of mental illness at some point.

In fact, one in 40 of the population will suffer, and do suffer, from a severe mental illness. Indeed, the warning signs already exist with regard to young people: there has been a substantial increase in the number of problems in the past five to 10 years. The rights of patients are few and far between and the services available in many cases are sub-standard, even Victorian.

It is important that we put this in context. Imagine a patient waiting many weeks, or perhaps months, for a diagnosis, then not receiving the necessary assessment and treatment. Imagine that patient being unable to access independent help and advice and being unable to convince the medic of the help that they need.

Imagine that patient being forced to accept that their individual preferences be ignored, because the NHS simply did not intervene early enough. Now imagine that patient is suffering from cancer. It all looks very different when we think of services for those with a physical condition. If one in four of the population with a physical condition received care that was regarded by the Assembly as being poor or sub-standard, there would be an outcry.

However, because we are dealing with people whose condition is psychological, the lack of services becomes almost easy to ignore. For these reasons, I want the Assembly to have more authority to determine the rights of patients and the services that they receive.

The basis of my proposal is to enshrine in law specific patient rights. We should legislate to provide a right to assessment and a right to treatment in a therapeutic setting before compulsion becomes the only safe option. For many people, their mental health deteriorates to such an extent that detention is the only safe option for them as a patient and for the wider public. However, for many patients, this situation can be tackled if earlier intervention and a right to treatment become the standard practice.

We have received a great deal of evidence. Hafal pointed out to us in its submission that around half of the people who end up being treated against their will have asked for help at some point before compulsion had become necessary.

We should provide a right to independent advocacy. The Mental Health Act 2007 provides advocacy for those people who have already been detained, but there is no right to independent advocacy before the point of compulsion. This is a substantial gap in the legislation, which we should tackle.

There is a right to independent advocacy for those who wish to complain about the services that they receive, and, as I said, there is also a right for those who have already been detained, but the right does not exist before the state makes it compulsory for you to be detained and for treatment to be provided. This could easily be resolved by the Assembly.

This request for new Welsh laws does not intend to criticise the work done by Parliament on the Mental Health Act 2007, neither is it an attempt to cross over into the criminal justice field. It is a precise request to allow the Assembly to add something to the current legislative framework.

While my proposed new law would allow the Assembly to legislate to achieve these new rights—and I am confident that we can design the legislative competence Order in such a precise way that it does this—we need to think beyond legislation, because any new rights would set new standards, beyond which the Assembly Government would have to ensure that resources were available to provide better services for those with a mental illness.

We need more training for clinicians, more investment in cognitive behavioural therapy for those with lower levels of mental illness—as is now being pursued in England; it is something that the Minister should examine in Wales—we need to see earlier intervention, more consistent planning, and the co-ordination of services. All of that needs to be done, and I hope that the proposed legislative competence Order, the proposed new law, would set the standard in helping to achieve that.

Before outlining how I want to deal with this proposal, I thank the Minister and welcome her commitment and that of my colleagues in both Plaid Cymru and the Liberal Democrats. I firmly believe that all-party support would powerfully demonstrate to the United Kingdom Parliament the seriousness with which we view the plight of those who are mentally ill and whose rights and liberties are often overlooked.

Furthermore, a great deal of work has already been done on an all-party basis taking written and oral evidence from key groups: from statutory organisations, and professional and voluntary groups. I pay tribute to all of those who have led the debate.

If the Assembly approves this motion today, I propose to attempt to produce a proposed Order, along with all of the relevant documentation, before the end of the year. I was hoping to do it before the end of November. I would then ensure a three-month consultation period with all the relevant stakeholders from outside the Assembly who would wish to examine the detail.

No doubt, an Assembly committee would also wish to be involved. Subject to any amendments, I would then produce a draft Order, which, if approved by the Assembly, would be sent—by the First Minister, as I understand it—to the Secretary of State for Wales for consideration in Parliament. This timetable might be ambitious, but if you do not have ambition as a politician, you might as well not be here.

In November, I will meet the Chairman of the Welsh Affairs Committee at the House of Commons, as well as Members of Parliament, and members of the House of Lords, because we need them on side if this process is going to work. Once we have done the work here, provided the Assembly is in agreement, we will need to have people in Parliament advocating the case for change in Wales.

It is this sort of issue that could demonstrate the legislative competence Order process working well between Westminster and Wales. It was Westminster that decided on the process that we were going to follow to have new laws for Wales, and I believe that this issue could demonstrate the political maturity that would be of great benefit to patients and their families in Wales.

In the field of mental health reform, Wales could lead the way, thinking beyond the current legislation, and beyond that which has already been achieved in Scotland. We could give people real security, recognising that those with an acute mental illness deserve to be treated as well as, or better than, any other patient dealt with by the NHS.

They often find it difficult to stand up for themselves. We are talking about people whose degree of mental health has reached such a state that they find it difficult to champion their own rights, and must rely on the goodwill and help of others. We need to provide the framework within which that sort of advocacy can take place.

To conclude, we are about transforming services. A twenty-first century Wales does not need to continue with a nineteenth century system of mental health services. As an Assembly, we should grasp the opportunity to start what I consider to be the last great social reform."

"Gofynnaf am gymeradwyaeth y Cynulliad i ddod â Gorchymyn Cymhwysedd Deddfwriaethol gerbron i ddatganoli agweddau o ddeddfwriaeth iechyd meddwl oddi wrth Senedd y Deyrnas Unedig i Gynulliad Cenedlaethol Cymru. Yr wyf wedi dewis y maes polisi hwn oherwydd, ynghyd â llawer yn y Siambr hon, yr wyf yn bryderus iawn am gyflwr y gwasanaethau iechyd meddwl yng Nghymru heddiw.

Yr wyf yn arbennig o bryderus am y ffordd yr ydym yn trin pobl sydd â salwch meddwl a'r diffyg hawliau a roddir i gleifion y mae angen ein help arnynt. Mae hwn yn faes sylweddol o bolisi iechyd Cymru sy'n cael ei lywodraethu gan ddeddfwriaeth y DU. Fodd bynnag, mae'n faes a allai gael ei ddatblygu yma yn unol ag anghenion Cymru, ac yn faes lle gallai cwpl o newidiadau syml iawn newid ffurf y gwasanaethau yr ydym yn eu darparu yn radical.

Gwn fod llawer o Aelodau Cynulliad wedi ymrwymo i weld newidiadau yn y ddarpariaeth gwasanaethau i bobl sy'n dioddef salwch meddwl. Mae'r ystadegau'n frawychus pan ystyriwch chi y bydd un o bob pedwar, un o bob tri efallai, o boblogaeth Cymru'n dioddef rhyw fath o salwch meddwl ar ryw adeg. Mewn gwirionedd, bydd un o bob 40 o'r boblogaeth yn dioddef, ac maent yn dioddef, o salwch meddwl difrifol.

Yn wir, mae'r arwyddion rhybuddio'n bodoli eisoes o ran pobl ifanc: bu cynnydd sylweddol yn nifer y problemau yn y pum neu 10 mlynedd diwethaf. Mae hawliau cleifion yn brin ac, mewn nifer o achosion, mae'r gwasanaethau sydd ar gael o safon isel, a Fictoraidd hyd yn oed.

Mae'n bwysig ein bod yn gosod hyn yn ei gyd-destun. Dychmygwch fod claf yn disgwyl am nifer o wythnosau, neu hyd yn oed fisoedd, i gael diagnosis, ac wedyn yn peidio â chael yr asesiad a'r driniaeth angenrheidiol. Dychmygwch fod y claf hwnnw'n methu cael cymorth a chyngor annibynnol ac yn methu argyhoeddi'r meddyg bod arno angen cymorth.

Dychmygwch fod y claf hwnnw'n gorfod derbyn bod ei ddymuniadau unigol yn cael eu hanwybyddu, oherwydd na wnaeth y GIG ymyrryd yn ddigon buan. Yn awr dychmygwch fod y claf hwnnw'n dioddef o ganser. Mae'r cyfan yn edrych yn wahanol iawn pan feddyliwn am wasanaethau i rai sydd â chyflwr corfforol. Petai un o bob pedwar o'r boblogaeth sydd â chyflwr corfforol yn cael gofal a oedd ym marn y Cynulliad yn wael neu o safon isel, byddai gwaedd o brotest.

Fodd bynnag, oherwydd ein bod yn delio â phobl y mae eu cyflwr yn un seicolegol, bron nad yw'n hawdd anwybyddu'r prinder gwasanaethau. Am y rhesymau hyn, yr wyf am i'r Cynulliad gael mwy o awdurdod i bennu hawliau cleifion a'r gwasanaethau a gânt.

Sail fy nghynnig yw ymgorffori mewn cyfraith hawliau penodol cleifion. Dylem ddeddfu i ddarparu hawl i asesiad a hawl i gael triniaeth mewn lleoliad therapiwtig cyn i orfodaeth ddod yn unig ddewis diogel. I lawer o bobl, mae eu hiechyd meddwl yn dirywio i'r fath raddau fel mai ataliad yw'r unig ddewis diogel iddynt hwy fel cleifion ac i'r cyhoedd.

Fodd bynnag, i lawer o gleifion, gellir mynd i'r afael â'r sefyllfa hon os daw ymyriad cynharach a hawl i driniaeth yn arfer safonol. Yr ydym wedi cael llawer iawn o dystiolaeth. Dangosodd Hafal inni yn ei gyflwyniad y bydd tua hanner y bobl sydd yn y pen draw yn cael triniaeth yn erbyn eu hewyllys wedi gofyn am gymorth cyn i orfodaeth fod yn angenrheidiol.

Dylem ddarparu hawl i gael eiriolaeth annibynnol. Mae Deddf Iechyd Meddwl 2007 yn darparu eiriolaeth ar gyfer y bobl hynny a ataliwyd eisoes, ond nid oes unrhyw hawl i gael eiriolaeth annibynnol cyn y pwynt gorfodaeth. Mae hwn yn fwlch sylweddol yn y ddeddfwriaeth y dylem fynd i'r afael ag ef.

I'r rhai sy'n dymuno cwyno am y gwasanaethau a gânt, gellir hawlio eiriolaeth annibynnol, ac fel y dywedais, ceir hawl hefyd i'r rhai a ataliwyd eisoes, ond nid yw'r hawl yn bodoli cyn i'r wladwriaeth ei gwneud yn orfodol ichi gael eich atal ac i driniaeth gael ei darparu. Gallai hyn gael ei ddatrys yn hawdd gan y Cynulliad.

Nid bwriad y cais hwn am ddeddfau Cymreig newydd yw beirniadu'r gwaith a wnaethpwyd gan y Senedd ar Ddeddf Iechyd Meddwl 2007, ac nid cais ydyw chwaith i groesi llwybrau i faes cyfiawnder troseddol. Cais manwl ydyw i ganiatáu i'r Cynulliad ychwanegu rhywbeth at y fframwaith deddfwriaethol cyfredol.

Er y byddai fy neddf newydd arfaethedig yn caniatáu i'r Cynulliad ddeddfu i ennill yr hawliau newydd hyn—ac yr wyf yn hyderus y gallwn lunio'r Gorchymyn cymhwysedd deddfwriaethol yn y fath ffordd fanwl fel ei fod yn gwneud hyn—mae angen inni feddwl ymhellach na deddfwriaeth, gan y byddai unrhyw hawliau newydd yn gosod safonau newydd, a thu hwnt i hynny byddai'n rhaid i Lywodraeth y Cynulliad sicrhau bod adnoddau ar gael i ddarparu gwasanaethau gwell i'r rhai sydd â salwch meddwl.

Mae arnom angen mwy o hyfforddiant i glinigwyr, mwy o fuddsoddi mewn therapi gwybyddol ymddygiadol i'r rhai sydd â lefelau is o salwch meddwl—a dyma'r trywydd a ddilynir yn Lloegr ar hyn o bryd; mae'n rhywbeth y dylai'r Gweinidog ei archwilio yng Nghymru—mae angen inni weld ymyriad cynharach, cynllunio mwy cyson, a chydlynu gwasanaethau.

Mae angen gwneud hynny i gyd, a gobeithiaf y byddai'r Gorchymyn cymhwysedd deddfwriaethol arfaethedig, y ddeddf newydd arfaethedig, yn gosod y safon er mwyn cyflawni hynny.

Cyn amlinellu sut y mae arnaf eisiau delio â'r cynnig hwn, diolchaf i'r Gweinidog a chroesawaf ei hymrwymiad ac ymrwymiad fy nghyd-Aelodau ym Mhlaid Cymru a'r Democratiaid Rhyddfrydol. Yr wyf yn gadarn o'r farn y byddai cefnogaeth hollbleidiol yn dangos yn rymus i Senedd y Deyrnas Unedig ein bod yn ystyried tynged y rhai sy'n dioddef o salwch meddwl yn fater difrifol, a bod eu hawliau a'u rhyddid hwy yn cael eu hanwybyddu'n aml.

Ymhellach, cyflawnwyd llawer iawn o waith eisoes ar sail hollbleidiol gan gymryd tystiolaeth ysgrifenedig a llafar a roddwyd gan grwpiau allweddol: a roddwyd gan sefydliadau statudol, a grwpiau proffesiynol a gwirfoddol. Yr wyf yn rhoi teyrnged i bawb sydd wedi arwain y ddadl.

Os yw'r Cynulliad yn cymeradwyo'r cynnig hwn heddiw, bwriadaf geisio gosod gerbron Orchymyn arfaethedig, ynghyd â'r holl ddogfennau perthnasol cyn diwedd y flwyddyn. Yr oeddwn yn gobeithio gwneud hynny cyn diwedd mis Tachwedd. Byddwn wedyn yn sicrhau cyfnod ymgynghorol o dri mis gyda'r holl randdeiliaid perthnasol o'r tu allan i'r Cynulliad a fyddai'n dymuno archwilio'r manylion.

Mae'n siwr y byddai pwyllgor Cynulliad hefyd yn dymuno cael rhan. Yn amodol ar unrhyw welliannau, byddwn wedyn yn cynhyrchu Gorchymyn drafft a fyddai, pe câi ei gymeradwyo gan y Cynulliad, yn cael ei anfon—gan y Prif Weinidog, fel y deallaf fi—at Ysgrifennydd Gwladol Cymru i'w ystyried yn y Senedd. Efallai fod yr amserlen hon yn uchelgeisiol, ond os nad oes gennych uchelgais fel gwleidydd, waeth ichi beidio â bod yma.

Ym mis Tachwedd, byddaf yn cyfarfod Cadeirydd y Pwyllgor Materion Cymreig yn Nhy'r Cyffredin, yn ogystal ag Aelodau Seneddol, ac aelodau Ty'r Arglwyddi, gan fod angen inni eu cael o'n tu os yw'r broses hon i weithio.

Unwaith yr ydym wedi gwneud y gwaith yma, ar yr amod bod y Cynulliad yn cytuno, bydd angen inni gael pobl yn y Senedd yn eiriol o blaid yr achos dros newid yng Nghymru. Mater o'r math hwn a allai arddangos y broses Gorchymyn cymhwysedd deddfwriaethol yn gweithio'n dda rhwng San Steffan a Chymru.

San Steffan a benderfynodd ar y broses yr oeddem am ei dilyn i gael cyfreithiau newydd i Gymru, a chredaf y gallai'r mater hwn arddangos yr aeddfedrwydd gwleidyddol a allai fod o fudd mawr i gleifion a'u teuluoedd yng Nghymru.

Ym maes diwygio iechyd meddwl, gallai

Cymru arwain y ffordd, gan feddwl ymhellach na'r ddeddfwriaeth gyfredol, ac ymhellach na'r ddeddfwriaeth a gyflawnwyd eisoes yn yr Alban. Gallem roi gwir ddiogelwch i bobl, gan gydnabod bod y rhai sydd â salwch meddwl difrifol yn haeddu cael eu trin cystal neu'n well nag unrhyw gleifion eraill yr ymdrinnir â hwy gan y GIG. Cânt anhawster yn aml i amddiffyn eu hunain.

Yr ydym yn siarad am bobl y mae eu graddfa o iechyd meddwl wedi cyrraedd y fath gyflwr eu bod yn cael anhawster i hyrwyddo eu hawliau eu hunain, ac yn gorfod dibynnu ar ewyllys da a chymorth eraill. Mae angen inni ddarparu'r fframwaith a fydd yn galluogi i eiriolaeth o'r fath ddigwydd oddi mewn iddo.

I ddiweddu, yr ydym ynglyn â'r gwaith o drawsnewid gwasanaethau. Nid oes angen i Gymru'r unfed ganrif ar hugain barhau gyda system gwasanaethau iechyd meddwl o'r bedwaredd ganrif ar bymtheg. Fel Cynulliad, dylem ddal ar y cyfle i ddechrau'r hyn a ystyriaf yn ddiwygio cymdeithasol mawr olaf."

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