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27th August 2015

Mental health care & support plans in Wales: Outcome-focussed plans are here

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At the risk of teaching Grandma to suck eggs, let’s consider some of the current requirements for care and support planning in the field of mental healthcare in Wales.

In recent years, we have had the Mental Health Measure Wales (2011), and the Social Services and Wellbeing Act (2014), which should guide our practice. However, let’s be honest with ourselves:

There has been no overarching care legislation in Wales for 13 years, during which time new demands have arisen and existing demands have changed beyond all measure. We are also in a vacuum between the publication of the Social Services and Wellbeing Act in 2014, and its enactment in 2016. Within this void, it can be difficult to grasp what every piece of service-specific legislation actually means for us.

So let’s look at our care-planning responsibilities in the context of one person, at the level of service-delivery:

Rob is 23 years old, and from the South Wales’ valleys. Without trying to consider every conceivable facet of his support needs, let’s identify some ‘current’ key principles:

Rob is now recovering from a psychotic illness and previous poly-substance misuse. He became dependent upon hospital care, but following treatment during the acute phase of his illness he has spent some time at a Supported Living setting in Cardiff. He is now more able to look after himself, and would like to move back to his home town and live more independently. How can this be in his support plan?

Traditionally, his Problem and Goal Statement would have been phrased thus:

“Problem”: Rob would like to live more independently

“Goal”: Rob to move in to supported accommodation

Aspirational statements with laudable but vague goals may once have been the staple of Welsh care plans. This should have changed with the Welsh Mental Health Measure (2011), and this move towards greater specificity that will be enacted as a result of the Social Services and Wellbeing Act from next April (2016). So let’s consider how those statements could be improved in the context of the Mental Health Measure:

Strengths: Rob has learnt to cook and clean for himself 1and says2 he would like to “get my own space at Croeso,” a supported housing project in Pontypandy3

Action: Bill4 (project worker) in conjunction with Rachel (CPA care coordinator) to introduce Rob to the Croeso Housing project5 by 31/09/156 to see whether he may wish to apply for a vacancy there

Risks and contingency plan: Rob’s mental health has improved over the past six months but he continues to be at risk of relapse so Bill and Rachel are to help him monitor his early-warning signs7.

Outcome: Rob to be in a position by October to consider whether the Croeso project is the right place for him to live more independently8.

So what’s different in this approach?

  1. As well as identifying problems the care and support plan looks to build on strengths – this is more collaborative and motivational for the service user
  2. Rob’s contribution to the plan, in his own words, helps it become bespoke to him and maximises opportunities for motivating him. His signature should be on the document too, if he is comfortable to endorse it
  3. The greater level of detail, e.g. provider and place helps the plan to ‘come alive’
  4. Naming the workers involved in taking these actions heightens accountability...and increases the likelihood of it happening!
  5. Greater specificity again – see point 3
  6. A date gives a firm timeframe against which the actions have to take place, with a review date identified
  7. Risks and contingencies are considered
  8. The outcome is considered against the overall objective of independent living

‘SMART+’ care and support plans

The SMART+ acronym helps us to remember the key ‘current’ principles. Plans must be:

S – Specific (Who is doing What, Where, When and Why – The 5 W’s)

M – Measurable

A – Achievable

R – Realistic (…and Review date)

T – Time-scaled

+ – Considered in terms of Risk and Contingencies.

So, how SMART+ are your care and support plans?

Paul Rees – QCS Expert Welsh Care Contributor

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