1. Big Mental Health Survey: Senedd Briefing
26 September 2018

2. The Big Mental Health Survey is a major new research project to understand people’s experiences of mental health support provided by primary care and the voluntary and community sector (VCS) and experiences of discrimination in the community

3. Headlines
Participants had a better overall experience of care provided by voluntary organisations than primary care
However, young people and those experiencing severe and enduring mental health problems had a worse experience of all kinds of care
A large proportion of mental health service users also have a long-term physical health condition but less than half felt able to discuss their physical health at the same time as their mental health
Primary care services need to improve the information they provide about support and treatment options
1 in 6 people prescribed medication weren’t given enough info about their purpose
2 in 5 people prescribed medication weren’t given information about side effects
1 in 3 people referred to talking therapy or specialist services weren’t given enough information

4. Method
The Big Mental Health Survey was co-produced, with five focus groups (two held in Wales) held to allow people with lived experience to prioritise question topics
The Big Mental Health Survey was conducted between July – September 2017, and was available online and in paper form
It was promoted via social media channels, and supporter lists of leading mental health charities – including Mind, Hafal, Rethink Mental Illness, MQ, Centre for Mental Health, and others
Paper questionnaires were distributed by local Minds and Mind retail shops

5. 8,339
people with experience of mental health problems shared their experiences of primary care and voluntary sector services, along with their experiences of discrimination

6. Profile of respondents

7. Participant questionnaires Service Design Case Studies
Disproportionately female sample and slightly under-represented BAME communities. BAME rates are understandably lower in Wales

8. Participant questionnaires
Good spread of ages – especially given younger profile of Mind’s supporters and service users
Service Design Case Studies
Stakeholder Interviews
Participant Interviews

9. Also asked about symptoms – e.g. 7% had experienced suicidal thoughts
Anxiety and depression most common but also high rates of severe and enduring MH problems (20%).
Participant questionnaires
Service Design Case Studies
Stakeholder Interviews
Participant Interviews
Also asked about symptoms –
e.g. 7% had experienced suicidal thoughts

10. Key Findings

11. Primary Care Services

12. Only a small % of respondents use an online booking system to make GP appointments. However, the majority would like to do so. This may reflect ease/ convenience but also a desire for privacy and avoiding stigma or discrimination

13. Participant questionnaires
Service Design Case Studies %
Primary care services perform consistently worse than the voluntary sector – esp. person centred and recovery-orientated care
When we looked at service values such as being person centred, recovery orientated, and providing holistic care these are extremely important concepts but are difficult to quantify and measure. Therefore, during the survey development process we co-produced with people with lived experience of mental health problems what these values feel like.
We can see here that when comparing primary care services and voluntary sector services the two perform fairly consistently when considering practical considerations such as being listen to and have concerns taken seriously. However, when we start to compare the values questions that is where we start to see the differences between primary care and voluntary sector services.
What is important to consider is that these values, such as finding out about you as an individual and being helped to stay hopeful about the future are related to overall positive experiences of accessing that service. This highlights that it isn’t just a nice thing to have it is actually the right thing to do and does have an impact on peoples overall experience of care.
Stakeholder Interviews
Participant Interviews

14. Service Design Case Studies
Less than half of respondents felt able to discuss physical health issues in the same appointment.
This reflects limited appointment time, as well as lack of holistic care

15. Participant questionnaires
1 in 3 who were prescribed medication said they received no information.
When prompted, more than half would have liked more information about side effects
Participant questionnaires

16. Participant questionnaires
Service Design Case Studies
Less than a third of people felt that they were given enough information about support services they were referred to
Stakeholder Interviews
People reported receiving the least information about voluntary sector services they were referred to

17. Participant questionnaires Service Design Case Studies
A quarter of respondents felt that the care they received did not meet their needs.
However, very few people (8%) were given an opportunity to provide feedback.
When asked about their overall experience of care, around a ¼ felt that the care they received did not meet their needs. Furthermore, around 50% of respondents said that they did not have an opportunity to provide feedback about their experiences, but would have liked to have been able to.

18. Voluntary and Community Sector Services

19. Big Mental Health Survey
84%
had positive experience of Mind & local Mind services
78%
had positive experience of voluntary sector (non-Mind)
74%
had positive experience of primary care

20. This year’s survey…

21. The survey is running again between July – October 2018
To boost the response rate from Wales this year we have:
Paid for advertising to target people in Wales
Targeted promotion through Welsh organisations
Currently we have:
More than double the number of responses from people in Wales this year (and still a month to go!)

22. Recommendations

23. 1. Before the appointment: inclusive systems
Recommendations for Welsh Government:
- Lead on ensuring everyone who visits a GP surgery should have the opportunity to feedback on their experience as a whole. Feedback systems should be dynamic, easy to use and anonymised

24. 1. Before the appointment: inclusive systems
Recommendations for Local Health Boards, GP clusters and individual practices:
- Ensure online appointment booking processes are available for all GP practices through My Health Online, with no requirement for patients to disclose the reason for their appointment if they are uncomfortable doing so. Surgeries should ensure patients are informed about the booking systems available to them
- Facilitate longer appointment times/double appointments for people who feel their support needs require a longer consultation

25. 2. During the appointment: Approach from primary care staff
Recommendations for Welsh Government:
- Promote a system of holistic care in which the links between physical and mental health are explored by primary care staff, and people seeking care are encouraged to reflect on these links

26. 2. During the appointment: Approach from primary care staff
Recommendations for Local Health Boards, GP clusters and individual practices:
- Encourage and train staff to tailor mental health support options around the physical health and lifestyle of the individual

27. 3. After the appointment: Outcomes
Recommendations for Welsh Government: - Strengthen measures of patient outcomes within primary care mental health services, centred on how well patients feel their treatment is meeting their needs

28. 3. After the appointment: Outcomes
Recommendations for Local Health Boards, GP clusters and individual practices:
Promote community based and third sector services in GP surgeries and pharmacies, including in waiting rooms and online
- Ensure staff in GP surgeries know what services are available locally for them to refer people to. Review the current effectiveness of Local Primary Mental Health Support Services in carrying out this function.

29. 4. Beyond the surgery: The role of community pharmacies
Recommendations for Welsh Government:
Explore how the role of community pharmacy teams within clusters and Local Primary Mental Health Support Services can be strengthened, and how community pharmacy teams can alleviate pressure on GP surgeries through medicines management and wellbeing support for people with long-term physical conditions
- Ensure the training that pharmacists receive on supporting people with mental health problems fully equips them to carry out this role

30. 4. Beyond the surgery: The role of community pharmacies
Recommendations for Local Health Boards, GP clusters and individual practices:
Promote the option of speaking to pharmacy staff about mental health treatment options to the public and within primary care services
- Ensure pharmacy staff are informed about services in the community they can refer people to, such as third sector services and social prescribing