Dyfodol

We completed a review of the first year implementation of NHS 111 Press 2. 

The review analysed data collected during the period of 01/07/2023 and 30/06/2024; during this time, 103,919 calls were received.

Subjective Units of Distress are measured pre- and post-triage, and findings shared with us tell us that 99% of those calls led to a reduction in distress. The average level of reduction in distress was 28%.

The review highlights and commends the approach in how this service was nationally commissioned and locally implemented. The review gives recommendations to sustain and further develop 111 press 2 - Linking ‘front door services’, crisis sanctuaries and conveyance, psychiatric liaison and primary care mental health services is part of that picture.

Further complementing research work can be found in our section below, which includes our partnership with the Government of Western Australia.

In order to provide appropriate alternatives for children and young people who may otherwise be admitted to adult mental health wards or present in emergency departments, Welsh Government established the Alternative to Admission Programme – inviting and commissioning projects from each Health Board.

The Alternative to Admission Programme looks to:

• Provide alterative safe spaces to undertake health and social care assessments  
• Mitigate the need to undertake assessments in busy emergency departments/Adult Section 136 suites/Adult assessment wards/rooms
• Support CYP to reduce, manage and cope with immediate distress, anxiety and stress
• Build an evidence base to understand the optimum service to meet the needs of CYP in crisis
• Provide access to compassionate and experienced staff who will listen and provide information and assistance
• Connect CYP to appropriate community support networks/groups
  

These projects are in place across each Health Board in various stages of delivery and some involve working with existing third-sector providers of crisis sanctuaries, refurbishment of NHS estates and recruitment of support teams. 

We are currently evaluating this programme.

We have worked closely with the National Centre for Learning Welsh to strengthen Welsh language capability within the psychiatric workforce.

Recognising the importance of language in building trust and improving patient care, a 10-week taster course was commissioned for entry-level psychiatrists, delivered by Learn Welsh North West from February to May 2025. This initiative provided an accessible and practical introduction for clinicians wishing to incorporate basic Welsh into their day-to-day interactions with patients and colleagues. The course was highlighted as an example of good practice in the August 2025 edition of the Welsh Government’s More Than Just Words newsletter, where psychiatry was also identified as a priority sector for promoting Welsh language use. Following the success of this initiative, a further 10-week training course will commence in September 2025 to support participants on their language journey, and we hope to repeat the taster course with a new cohort in early 2026.

Alongside this, We are working with the National Centre for Learning Welsh to encourage psychiatrists with existing foundational or intermediate skills to develop these further by connecting them with Welsh language tutors based within their Local Health Boards.

Our multi-level approach supports the Welsh Government’s More Than Just Words strategy and promotes the principle of the Welsh “Active Offer” (Cynnig Cymraeg), which aims to ensure that patients can receive care in their language of choice without having to request it. By prioritising language learning opportunities, our Dysgu Cymraeg project aims to reduce barriers to care, foster stronger therapeutic relationships and strengthen patient confidence in mental health services.

When the UK National Health Service was founded, mental health care was usually provided in hospitals but from the 1950s onwards, there were calls for more care and treatment to be delivered within the communities where people lived. It became evident that admission to hospital can separate people from everyday life, from their usual routines, and from their family, friends and support networks. An admission into hospital could also sometimes mean losing a job or benefits, a place to live, and skills for daily living. Due to these issues, services began to transition to community-based care, demonstrated by the fact that, across the UK, in 1955, there were circa 150,000 mental health hospital beds, dropping 2/3rds by 2000 to 54,117 and then halving again to 22,475 by 2020, a total of an 85% decrease in 65 years.

Community services remain at the forefront of contemporary mental healthcare, and the lack of accessible, safe, purposely designed and well-equipped facilities will be a limiting factor to its effectiveness, expansion and modernisation.

In 2019, Healthcare Inspectorate Wales and Care Inspectorate Wales undertook a Joint Thematic Review of Community Mental Health Teams (CMHTs) in Wales. This thematic review found that the working environments within most CMHTs required improvement, with some clinical areas 'not fit for purpose'. The thematic review found that, whilst staff were attempting to work ‘effectively’, their working environment did not always facilitate this. The thematic review concluded that significant work was required from Health Boards to improve the provision and maintenance of safe and clinically appropriate facilities for service users and staff.

We conducted a review and issued a spotlight report on all adult CMHT offices in Wales. All Health Boards supported this work to gain greater insight, understanding of variation within and across Health Boards areas, and provide a platform for the planning of longer-term improvement to these core services for the benefit of services users and staff.

Welsh Government and the Royal College of Psychiatrists Wales previously developed joint standards for prison mental health in Wales. This was a commitment within the Prison Partnership Agreement. The standards were subject to a public consultation, alongside complementing standards that were developed for substance misuse in prisons by Public Health Wales.

A total of 164 women from NHS Wales were admitted to a Mother & Baby Unit between 2021 and 2024. Of these 164, 133 (81%) were admitted to a Mother & Baby Unit in Wales and 31 (19%) were admitted to a Mother & Baby Unit in England.

NHS Wales Joint Commissioning Committee were separately requested assess demand & utilisation, and model & scenario plan for inpatient provision across Wales.

Through our mathematical modelling programme, we supported the evaluation and prediction of demand, analysed historical and current utilisation, modelled new innovations that may affect demand, and gave context to the service within the NHS healthcare system.

In Wales, hospital admissions for those with a primary or secondary diagnosis of an eating disorder increased from 658 in 2018/19 to 900 in 2022/23. Admissions for under-18s with a primary diagnosis of an eating disorder in 2022/23 were double that of pre-pandemic levels and exceeded 5000 bed days. Moreover, in the year 2018/2019, there were 22 inpatient admissions for eating disorder treatment where adults resident in Wales were referred and admitted to units outside Wales, the cost of which was £1,354,884. This figure is higher than the total spend by Welsh health boards on specialist tier 3 adult community eating disorder services in that year. In the year 2022/23, this figure increased to 26, the cost of which was £2,525,330, indicative of rising costs.

We are currently evaluating & predicting the demand, analysing the historical and current utilisation, modelling a series of new innovations that may affect demand, and giving context and understanding of the service within the NHS healthcare system.

We are being supported in this work by partners in NHS Wales, and BEAT.

It's reported that as many as 40% of deaf people experience mental health problems, which is twice that of individuals in hearing populations (Fellinger et al., 2012).

We are currently evaluating and predicting the demand, analysing the historical and current utilisation, modelling a series of new innovations that may affect demand, and giving context and understanding of the service within the NHS healthcare system.

We are being supported in this work by partners in NHS Wales, and the All-Wales Deaf Mental Health and Wellbeing Group.

We commissioned the NHS Benchmarking Network (NHSBN) to produce a Wales Mental Health Report 2023/24, of the benchmarking collection on adult and older people’s and children and young people’s mental health services.

The report relates to the financial year April 2023 to March 2024 and provides current benchmarked data on the provision of mental health services across the wider UK, with the Health Boards of Wales highlighted.

The annual report is a summary of key metrics across community and inpatient mental health services (outlined below). The data collected and presented in the report align with current UK-wide service, policy, and practice priorities to support the delivery of high-quality services.

Key themes

Health inequalities

• Racial inequality

Patient profiles

• Clinical characteristics
• Demographic characteristics

Community Mental Health Services

• Access
• Waiting times
• Caseload
• Contacts
• Productivity
• Workforce
• Finance

Inpatient Mental Health Services

• Bed Occupancy
• Patient Safety
• Lengths of stay
• Detentions under the Mental Health Act
• Workforce
• Finance

Outcomes

• Patient reported outcomes
• Clinician reported outcomes

Workforce

• Workforce per population
• Workforce per 10 beds

It has been estimated that there are 46,800 people living with a diagnosis of dementia in Wales and that by 2055, this will increase to over 100,000. The costs associated with dementia are high, with costs in Wales expected to rise from £1.8 billion to £4.6 billion by 2040.

Recent figures show that dementia was responsible for 3,530 deaths in Wales in 2021 and almost twice as many women died from dementia than men. People with learning disabilities may be at an increased risk, for instance, individuals with Down’s syndrome experience higher risk of developing dementia (22% higher risk for individuals aged 40 and older and 56% higher risk for individuals 60 and older) and of developing it at an early age.

Early diagnosis of dementia provides opportunities for intervention, including in some cases, the use of disease-modifying treatments (DMTs), or interventions that can delay the onset of a full dementia syndrome or change the trajectory of the condition. Early diagnosis therefore has the potential to improve quality of life for individuals and their carers by slowing disease progression and allowing patients the opportunity to take part in their own future care planning.

Advances in early detection – dementia biomarkers, including neuroimaging biomarkers (magnetic resonance imaging [MRI], computed tomography [CT], fluorodeoxyglucose [FDG] positron emission tomography [PET] and amyloid PET scans) and fluid biomarkers (cerebrospinal fluid [CSF] dementia biomarker examination and blood biomarkers) as diagnostic tools – could revolutionise early detection of, and intervention for Alzheimer's disease.

Early and more accurate diagnosis of dementia will require significant health service planning and resource allocation within the Welsh NHS. Therefore, an evidence-based care pathway together with a comprehensive understanding of the professional competences and resources required to allow for early detection and treatment of dementia is essential.

We are currently working with the National Collaborating Centre for Mental Health (NCCMH), Alzheimer's Society Cymru, and stakeholders across Wales through an Expert Reference Group to develop a care pathway and competence framework.

We are currently giving an evaluation of the Mild Cognitive Impairment (MCI) Clinic that was previously being held by Aneurin Bevan UHB.

This work compliments the work into development of a care pathway and competence framework.

We have proposed a programme to pilot the implementation of ptau 217 Blood Biomarker Testing in Memory Clinics Across Wales for Early Alzheimer’s Disease Diagnosis. The proposal outlines a pilot project aiming to improve the early and accurate diagnosis of Alzheimer’s disease (AD).

The pilot responds to diagnostic inequities and inefficiencies in the current system, which relies on invasive lumbar punctures or costly and inconsistently accessed FDG PET imaging. The introduction of a minimally invasive, cost-effective blood test would be validated by the University College London (UCL).

Smoking contributes to poor mental health and increases inequalities in physical health and premature mortality. Smoking is a leading contributor to the 7–23-year lower life expectancy among people with severe mental illness (SMI) compared to the general population.

In partnership with the Public Mental Health Implementation Centre, we developed a framework to help reduce smoking rates among people with mental health conditions in Wales. The framework identified three priority areas for action: 

1. Address misperceptions about smoking in mental health settings.
2. Improve implementation of quitting strategies in mental health settings.
3. Address the lack of data on smoking and quitting among people with SMI.

In Wales, obesity is one of the top three contributors to the loss of healthy years of life. Weight gain and obesity are major causes for the 7–25-year lower life expectancy for people with severe mental illnesses. This is because obesity is linked to many chronic illnesses, including heart disease, diabetes, and cancer, which cost upwards of £700 million to the NHS in Wales each year.

In partnership with the Public Mental Health Implementation Centre, we developed a framework for action that identified eight priority areas for action in Wales:

1. Provide leadership and direction to deliver healthy weight management support for people with mental health conditions.
2. Develop and implement targeted policies, strategies, pathways and support for healthy weight management for people with mental health conditions.
3. Identify people with mental health conditions who are at high risk of weight gain through screening and physical health checks and intervene early.
4. At a local level, be clear where weight management support is provided and increase understanding of roles that different professional groups can take in supporting healthy weight management.
5. Support the delivery of a suite of evidence-based healthy weight management programmes.
6. Improve the provision of medication reviews for people using psychotropic medications that can cause weight gain.
7. Consider the broader context of healthy weight management, including the food environment, access to green space, and opportunity for safe physical activity.
8. Optimise the collection and use of data to evaluate the effectiveness of weight management approaches and measure outcomes.

There is a growing body of evidence demonstrating the positive impact of physical activity on mental health outcomes, particularly in relation to common mental health conditions such as depression and anxiety. Several studies have shown that regular physical activity can significantly reduce symptom severity and improve overall wellbeing. In the UK, the National Institute for Health and Care Excellence (NICE) recommends group-based exercise as a sustainable and effective intervention for individuals experiencing mild to moderate depression (NICE CG91, 2009). Complementary public health initiatives reinforce the value of even brief sessions of physical activity, such as a 10-minute brisk walk, in enhancing mood and emotional resilience.

In partnership with the Public Mental Health Implementation Centre, we are currently developing a framework for action for physical activity & mental health in Wales.

This will be shared with Welsh Government in December 2025.

Buvidal is the only licensed UK version of long-acting injectable buprenorphine (LAIB). Introduced in 2019, it was rolled out widely in Wales during the pandemic.

The benefits, beyond allowing people to manage on a monthly, pandemic-saving dose, were quickly apparent. It reduced craving and anxiety, reduced drug-related deaths, was strongly associated with the reduction in hospital drug-related admissions and allowed patients to return to their families and their lives, including successfully detoxifying.

It is now the most prescribed Opiate Substitution Treatment in Wales (nearly 50%) and further roll-out in primary care, secondary care, hospital liaison, prisons and the third sector could bring further benefits, with the benefits fitting with the aims of the WG priorities for Mental Health. 

A hub and spoke national delivery of the complementary psychological support service (BPSS). While Buvidal treats opiate dependence effectively, 50% of users experience resurfacing trauma symptoms, impacting wellbeing, increasing risk of relapse, and limiting long-term recovery.  

In March 2023, Cardiff and Vale APB funded a 2-year pilot to deliver a rapid-access, tiered psychological service—the BPSS—for individuals on Buvidal, supporting them through all stages of treatment. The BPSS aim was to create a scalable, stepped-care model that addressed psychological barriers to recovery and improved quality of life. Because patients treated with Buvidal were, clinically, in a significantly better position to engage with treatment, the outcomes were significant, showing statistically significant improvements in psychological wellbeing, functioning, and reduced hospital admissions, reinforcing the need for psychological support as a core element of Buvidal treatment. Cost-effectiveness was also shown (less than £6,000 per Quality Adjusted Life Year (QALY)).

The vision would be to ensure that across Wales, all people on Buvidal will have access to flexible, tiered, trauma-informed psychological support.

Those with co-occurring needs often fall between services and, as a result, have increased morbidity and mortality associated with this poor access to appropriate treatment. There is also increased health and social cost due to higher rates of hospital admissions (both mental health and physical health as well as longer-term placement costs for example there are high rates of co-occurring conditions within mental health rehabilitation settings), higher rates of homelessness/problems with housing and a higher level of criminal justice interventions.

Whilst the Co-occurring Framework does not indicate historical dual diagnosis roles are of benefit in terms of encouraging the implementation of the Co-occurring Framework, there has been some indication that repurposing the co-occurring practitioner role with clear direction for that worker can be successful. 

The practitioner can then focus upon leading and supporting the implementation of the principles of the Co-occurring Framework from within mental health services as the lead service. This includes providing support and education for staff from both Mental Health and Drug and Alcohol services, facilitating and supporting joint working, reducing stigma and improving joined up care for service users, allowing them to have a clear understanding of their care and how their needs will be best supported.

The role is for a band 7 RMN, which allows for significant autonomy (they should have significant experience of adult mental health services and or drug and alcohol services and ensure via robust education and supervision that they expand their knowledge and understanding of both to allow them to be the expert and support the wider team to deliver joined up, non-judgemental and good quality care. They will primarily be based within a CMHT with the suggestion of 1 per county/CMHT. The primary role is not one of a care-coordinators and shouldn’t be viewed as such for all individual with co-occurring needs however a small case load of <10 could be considered for those with high levels of complexity but should not be a substitute for effective joint working.

The role primarily focuses on bridging both services, spending time in both CMHT and CDAS bases each week to act as a point of contact/advice on cases a support referral to each service/attend SPOA meetings and support/coordinate joint working. They should act as a leader and educator ensuring up to date knowledge and understanding of differing ways of working between services to ensure services to provide seamless care for the individual via routine joint assessments and co-ordination of joint medical reviews etc when necessary as well as an educator for upskilling both services.

Compared with prior to the inception of these posts there has been a significant reduction in the number of learning reviews following serious incidents that site lack of adherence to the co-occurring framework as a care and service delivery problem, this is evidence in itself that there is benefit from investment in these posts.

The Welsh Government Treatment Framework for ARBD (2021) recognised the impact on health and social care provisions of a lack of specialist services (e.g., prolonged lengths of stay, long-term residential care). Among its recommendations, it advocated the establishment of dedicated ARBD community services in each Health Board alongside regional inpatient centres of excellence to support appropriate diagnostic assessment, research and evaluation on clinical and service delivery models.

ARBD is a neurocognitive disorder that can be arrested and potentially reversed with early interventions. As a result of the cognitive difficulties, approaches to assessment, diagnosis and intervention, need to be adapted and delivered by appropriately trained clinicians.

The establishment of two regional centres for Wales (one North and one South) providing:

• Specialist inpatient beds for individuals with ARBD (or likely ARBD) who require further assessment (clinical and functional) to inform placement and care planning
• A hub for clinical research (developing evidence-based diagnostic procedures and clinical interventions)
• A hub of expertise supporting the development of community ARBD services in each health board area
  

The clinical provision within the unit should include, but not be limited to, specialist medical and nursing interventions, occupational therapy, neuropsychology, modified psychosocial interventions and social work. Links should be made with NHS and third sector alcohol services, relevant medical specialities (such as gastroenterology, neurology, adult and older adult mental health), SALT, housing, social services and local university research departments.

Service provision for ARBD in Wales is patchy and the lack of robust treatment pathways has a significant impact on morbidity, affecting both acute and continuing care NHS expenditure. Wilson et al (2012) demonstrated a reduction in acute hospital admissions in a cohort of 41 patient of 85% with the implementation of a stepped-care, community rehabilitation model.

A review of patients from two health boards in South Wales, (Lewis et al 2023) compared outcomes in 23 successive patients, newly diagnosed with ARBD, discharged from an acute hospital. In the health board with dedicated ARBD community service the average total stay was 42 days (23 excess bed days, i.e. after the acute medical condition was stabilised; excess costs of £17, 921). In the health board without an ARBD community service, the average total stay was 94 days (64 excess bed days; excess costs of £49,378). Further analysis considered the potential impact of a specialist ARBD unit on excess bed days. Even in the health board with a dedicated community service for ARBD, a specialist unit was predicted to provide an average saving of £8,721 per patient.