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Melding: Improvements in Welsh mental health services 'essential'

Speech to the National Assembly for Wales.

"I am honoured to propose the motion on behalf of the committee, which took the subject to be important in general. The need to improve mental health services is widely recognised, but there has always been a difficulty in ensuring that user and carer participation in the planning of services and in individual assessments is carried out to the optimum level.

As soon as we announced the subject for the review, there was great interest in the community that we had chosen this area for study. We received more than 50 written responses, and we had to hold four committee meetings to take oral evidence. Many people with mental health conditions and many of their carers gave direct evidence to us.

We were proud of them for sharing their experience. In some of those sessions, it was deeply moving for committee members to hear directly from people who are so intimately affected. To mention one project in particular, members of a group of teenagers in Cardiff, supported by Barnardo's, talked about their experience of acute services.

As far as the committee was concerned, there was strong evidence to suggest that we need to do more to improve user and carer participation. The essence of that is effective support. We heard about a couple of pilot projects, backed by the Assembly Government, to employ user-development officers.

Those projects are running in Merthyr Tydfil and Rhondda Cynon Taf. We were impressed by the networks that they were developing. We found clear evidence that their commitment, their contact with various users, carers, local authorities, trusts and local health boards, and the way in which they spread the skills and good practice, has a dramatic effect on the way that participation works.

We also heard evidence that NHS staff and social services staff need to be trained in participation techniques. I should add that the committee and the Assembly needs some training, and if we were to run this review again, we would certainly interact with the users and the carers in a different way and see how we could perhaps improve our participation techniques and how we get out and get that kind of direct experience that informs our work.

However, we should not assume that people who are making decisions and commissioning services—and clinicians, indeed—have a natural ability to engage in effective participation with a range of interests and bodies. They need expertise and encouragement to ensure that they are constantly improving their technique in this area.

We felt that there was quite a lot of good practice, but it was not necessarily common practice. There was also evidence that the good practice tended to be a bit later in the stage of developing policies and that the process, at its initial stage, was much weaker.

It is there that some of the more strategic decisions are made and we need to involve users and carers as early in the process as possible to get maximum benefit. We heard some good examples of areas where practice could be improved quite dramatically.

For example, on the recruitment of psychiatrists, there should be someone on the panel who is a user or carer. What a message that would send to senior staff when they are being recruited—to face a series of questions from a user or carer.

We commended much that has been done by the Assembly Government and 'Stronger in Partnership' is broadly the right way forward. However, it needs to be strengthened in terms of the process at the early stages of participation and developing policies. That is probably the weakest area and the area in which we need more investment and support so that the participation is effective.

Finally—rather sadly, but it is a real challenge—we need to address the difficulty that we have in terms of overcoming stigma.

We need to use this policy area as a way of overcoming stigma and improving the understanding of mental health issues. One concrete suggestion that we have made is that the Government should sponsor an award scheme to celebrate the achievements of people who are living with mental illness or who have recovered from it.

Many of the people who become involved in planning have themselves been directly affected, and it is a great act of generosity by those people that they are prepared to draw on their experience, painful as it sometimes is.

I look forward to this afternoon's debate and to the Welsh Assembly Government's response in due course. I thank all those involved in mental health services, the carers and the users, and finally, the secretariat of the Health and Social Services Committee, which assisted us so ably in drawing up this report."

"Mae'n anrhydedd gennyf gyflwyno'r cynnig ar ran y pwyllgor, pwyllgor a dybiodd fod y pwnc yn un pwysig yn gyffredinol. Cydnabyddir yn eang bod angen gwella gwasanaethau iechyd meddwl, ond bu hefyd anhawster i sicrhau cyfranogiad eithaf ymysg defnyddwyr a gofalwyr yn y broses o gynllunio gwasanaethau ac mewn asesiadau unigol.

Cyn gynted ag y cyhoeddasom y pwnc ar gyfer yr adolygiad, gwelwyd cryn ddiddordeb yn y gymuned ein bod wedi dewis y maes hwn ar gyfer astudiaeth. Cawsom dros 50 o ymatebion ysgrifenedig, a bu'n rhaid inni gynnal pedwar cyfarfod pwyllgor i gymryd tystiolaeth lafar.

Bu i lawer o bobl â chyflyrau iechyd meddwl a llawer o'u gofalwyr roi tystiolaeth uniongyrchol ger ein bron. Yr oeddem yn falch iawn ohonynt am rannu eu profiad. Mewn rhai o'r sesiynau hynny, yr oedd yn deimladwy iawn i aelodau'r pwyllgor glywed yn uniongyrchol oddi wrth bobl y mae hyn yn effeithio mor bersonol arnynt.

Gan grybwyll un prosiect yn benodol, siaradodd aelodau o grwp o unigolion yn eu harddegau yng Nghaerdydd, a gefnogir gan Barnardo's, am eu profiad o wasanaethau aciwt.

Cyn belled ag yr oedd y pwyllgor yn y cwestiwn, yr oedd tystiolaeth gref i awgrymu bod yn rhaid inni wneud rhagor i wella cyfranogiad defnyddwyr a gofalwyr. Hanfod hyn yw cefnogaeth effeithiol. Clywsom am gwpl o brosiectau peilot, a gefnogir gan Lywodraeth y Cynulliad, i gyflogi swyddogion datblygu defnyddwyr. Cynhelir y prosiectau hynny ym Merthyr Tudful a Rhondda Cynon Taf.

Yr oedd y rhwydweithiau yr oeddent yn eu datblygu yn rhai da iawn. Gwelsom dystiolaeth glir bod eu hymrwymiad, eu cyswllt gydag amrywiol ddefnyddwyr, gofalwyr, awdurdodau lleol, ymddiriedolaethau a byrddau iechyd lleol, a'r modd yr oeddent yn lledaenu'r sgiliau a'r arferion da, wedi cael effaith ddramatig ar y ffordd y mae cyfranogiad yn gweithio.

Clywsom dystiolaeth hefyd fod ar staff y gwasanaeth iechyd gwladol a staff y gwasanaethau cymdeithasol angen cael eu hyfforddi mewn technegau cyfranogiad. Dylaswn ychwanegu bod ar y pwyllgor a'r Cynulliad angen peth hyfforddiant, a phe baem yn cynnal yr adolygiad hwn eto, byddem yn bendant yn cysylltu gyda'r defnyddwyr a'r gofalwyr mewn ffordd wahanol a gweld sut y gallem o bosibl wella ein technegau cyfranogiad a'r modd yr awn allan i gael y math hwn o brofiad uniongyrchol sy'n dylanwadu ar ein gwaith.

Serch hynny, ni ddylem dybio bod pobl sy'n gwneud penderfyniadau ac yn comisiynu gwasanaethau—a chlinigwyr, yn wir, yn meddu ar allu naturiol i sicrhau cyfranogiad effeithiol ymysg amrywiol fuddiannau a chyrff. Mae arnynt angen arbenigedd ac anogaeth i sicrhau eu bod yn gwella eu techneg yn y maes hwn yn barhaus.

Teimlem fod cryn dipyn o arferion da, ond nad oeddent o anghenraid yn arferion cyffredin. Gwelwyd tystiolaeth hefyd fod yr arferion da yn tueddu i fod ychydig yn ddiweddarach yn y cam o lunio polisïau a bod y broses, yn ei chamau cychwynnol, yn llawer gwannach.

Bryd hynny y gwneir rhai o'r penderfyniadau mwy strategol a rhaid inni gynnwys defnyddwyr a gofalwyr cyn gynted â phosibl yn y broses er mwyn cael y budd gorau posibl. Clywsom rai esiamplau da o feysydd lle gellid gwella'r arferion yn eithaf sylweddol. Er enghraifft, ynghylch recriwtio seiciatryddion, dylai fod rhywun ar y panel sy'n ddefnyddiwr neu'n ofalwr.

Dyna neges y byddai hynny yn ei chyfleu wrth uwch staff adeg eu recriwtio—yn wynebu cyfres o gwestiynau oddi wrth ddefnyddiwr neu ofalwr.

Cymeradwyasom lawer a wnaeth Llywodraeth y Cynulliad ac mae'r ddogfen 'Nerth mewn Partneriaeth' yn fras yn mynd i'r cyfeiriad iawn. Serch hynny, rhaid ei chryfhau yng nghyswllt y broses yng nghamau cynnar cyfranogiad a llunio polisïau. Hwn o bosibl yw'r maes gwannaf a'r maes lle mae arnom angen rhagor o fuddsoddiadau a chefnogaeth fel bod y cyfranogi'n effeithiol.

Yn olaf—sy'n drist braidd, ond mae yn her wirioneddol—mae'n rhaid inni roi sylw i'r anhawster sydd gennym o oresgyn stigma. Rhaid inni ddefnyddio'r maes polisi hwn fel ffordd o oresgyn stigma a gwella'r ddealltwriaeth o faterion iechyd meddwl.

Un awgrym pendant a wnaethom yw y dylai'r Llywodraeth ariannu cynllun gwobrwyo i ddathlu cyflawniadau pobl sy'n byw gyda salwch meddwl neu sydd wedi gwella ohono.

Mae llawer o'r bobl sy'n dod yn gysylltiedig â chynllunio, eu hunain, wedi profi effaith salwch meddwl yn uniongyrchol, a gweithred hael iawn gan y bobl hynny yw eu bod yn barod i ddefnyddio eu profiad, er mor boenus ydyw ambell dro.

Edrychaf ymlaen at y ddadl y prynhawn hwn ac at ymateb Llywodraeth Cynulliad Cymru maes o law. Diolchaf i bawb o'r rhai hynny sy'n gysylltiedig â gwasanaethau iechyd meddwl, y gofalwyr a'r defnyddwyr, ac yn olaf, ysgrifenyddiaeth y Pwyllgor Iechyd a Gwasanaethau Cymdeithasol a'n cynorthwyodd mor fedrus i lunio'r adroddiad hwn."

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