Lynne Neagle AM: Okay, thank you very much. We're going to go on now to some questions about mental health from Siân Gwenllian. Siân.
Sian Gwenllian AM: It's a cause of great concern to us all, of course, in terms of the impact of this crisis on mental health and well-being among our children and young people. So, what assessment has the Government undertaken of the impact on these aspects in young people and what work is being done to understand the impact of the pandemic? What longer term measures will be put in place and what support services will be put in place?
Vaughan Gething AM: Again, I think it's helpful that you've already heard from the education Minister last week, because I think the first of her key principles for returning to school is the impact on the emotional health and well-being of children. So, children's mental health was a central concern and remains so for both myself and the education Minister. Part of the honest challenge, again, is that we don't fully understand the impact on the mental health and well-being of children but we do expect there will have been an impact. So, we're working together with both health boards and our own knowledge and analytical services across the Government to both try to further understand what that is and the difference. Until we have more contact with families, we may not fully understand that, and that's a real point of concern for me. In all of the unknowns within this, the impact on mental health and well-being is absolutely one of them, because we're looking at how we then develop not just a recovery plan for the economy but a recovery plan around mental health, how we support people, and that will have to be informed by the understanding of what's happening when we get more engagement with families about the level of need, and then how we need to think about that. Obviously, it's a key factor for their return to school, but, actually, for the life children and young people lead outside the school environment, and that will be difficult because we're going to phase out of lockdown—it's not going to be a one-hit measure. That absolutely isn't going to happen. We're going to be looking at, at each point, what difference has been made, what more we can do. And, again, there are the efforts we're making to make sure that our online support services and our telephone support services—that we keep on reminding people that they're there and are available, and we want people to make use of them, because I know, as this committee said, we'd much rather be able to support people and intervene earlier rather than wait until there's a much bigger problem in a period of months in the future.
Sian Gwenllian AM: So, in reality, there's been no assessment undertaken because it's difficult to do that. So, the full picture in terms of the outcomes of the crisis—you don't know what they are at the moment as things stand.
Vaughan Gething AM: We can't know, because we don't have that level of contact. There is a development—. I wouldn't say that no work's being done, but I couldn't tell you honestly that that work is finalised and we have a definitive understanding of the picture. If I tried to say that, then I'm sure you'd ask me, 'How on earth can you say that? If you're not having regular contact with people, you can't possibly understand the picture.' And it's much better to say, 'We don't understand the full picture. We know there'll have been an impact. We're working alongside health boards and others, but we'll know more as we carry on having more contact with families.' I'll look at a variety of different areas, again, both to reform the recovery plan, but also then to understand what we need to do at various points in the future, and the picture that we're seeing isn't straightforward and we need to make sure that we don't try to pretend to ourselves or to the public that there is a one-off measure that will allow us to be successful in all the areas that we'd want to be.
Sian Gwenllian AM: But can you give the committee an assurance today that this area of mental health and well-being is going to be a priority for you as health Minister?
Vaughan Gething AM: Of course. Not just on the work we've done in the past; not just because it's one of the key principles for the education Minister about the reopening of schools, but it is a real worry list for me about how we understand the impact on the mental health and well-being of children and young people, and to move forwards, that we don't end up with an entire generation of children and young people who grow up with a range of damage because we haven't thought about what that will look like. So, the mental health recovery plan will of course be of very real importance to me. In amongst all the other priorities I have, I'm certainly not going to allow the mental health and well-being of children and young people to be forgotten.
Sian Gwenllian AM: And how does the current capacity in terms of child and adolescent mental health services compare to service capacity prior to the coronavirus outbreak in Wales? Have you had to shift some resources over from CAMHS, for example, in order to deal with more general aspects of coronavirus?
Vaughan Gething AM: No, we've actually got—. Maybe perhaps it might be helpful, Chair, if Tracey Breheny could say something about the way that we're monitoring the impact we have, in terms of we've got a reporting tool, but also weekly contact with leads in CAMHS services.
Lynne Neagle AM: Tracey.
Tracey Breheny: Of course. Thanks, Minister. Yes, on that question, we moved pretty quickly at the beginning of the pandemic phase to put in place, as the Minister said, a weekly monitoring tool of all local health boards, so through that tool, we look at that every week in terms of collecting information. Whilst national reporting's been stood down, we are picking up assurance through that tool on things like staff sickness in CAMHS services, referral numbers and so on, so we do have that tool in place, and at the moment, that's telling us that the system can meet the capacity; has the capacity to meet need.
Sian Gwenllian AM: Have CAMHS staff been shifted over to do other work during this virus outbreak?
Tracey Breheny: There has been some movement, as I'm saying, around health boards, particularly where in the first phase of the epidemic the concentration was on in-patient provision, providing critical care, but my understanding is from the latest tool that we looked at last week, those staff are gradually not just returning to work from self-isolation or whatever, or from different parts of the system.
Sian Gwenllian AM: And then, what about the capacity for CAMHS primary mental health services? Has there been a reduction in that capacity since the beginning of the pandemic in terms of in-patients? Because that's what I'm hearing, that there has been such a reduction, but how are those patients then treated and served?
Tracey Breheny: In terms of in-patient capacity, that is in the system in both the north Wales and in the south Wales unit at the moment. There were some discharges of young people, but we've had the assurance that that was only undertaken where it was clinically safe to do so and where the community support was in place.
Sian Gwenllian AM: And finally in this section from me, given that schools are of course closed and that schools are so very important in terms of signposting young people towards services, how can young people access appropriate services—online services, for example? How are they signposted towards those services at the moment?
Vaughan Gething AM: Well, we've not closed off general practice and, as you know, we've expanded the ability for people to access services in an online manner. We've expanded a range of telephone advice services, so the telephone advice service we already provide, we've made sure that's maintained, and both myself and the deputy Minister have referred to that on a number of occasions. I think the real struggle and the real difficulty is actually how you punch through different messages when the broader news agenda is so overwhelmingly focused on headline messages in other areas. That is, again, a worry for me, but the communications we have within the health and care system, people should know where to refer people to and how to provide access to both telephone and online support that continues to be available, and actually, as I say, we've expanded that right across our healthcare system. That's what I’m keen to see continue into the future. Whatever the post-COVID-19 world is, I don't want to miss out on the progress we have made in the online provision of services. Of course, most children and young people expect to be able to access services in an online manner already.
Sian Gwenllian AM: But, of course, there will be some who are missed; they may fall between two stools because they won’t know where to turn.
Vaughan Gething AM: Yes, and that, again, comes back to our challenge of how we help children and young people in their context, with their families, to know where support and advice and guidance is. Many people are defaulting to their general practitioner if they can't find advice somewhere else, so that's why there's the information we're providing through general practice to signpost people, so those pathways haven’t been closed off. It's about making sure that people have alternative means that they’re prepared to use at this point in time. If we go back to where we started this evidence session, we were talking about the difficulty of families who don't want to engage in a traditional person-to-person contact or being in the same room as someone else or allowing people into their home. So, there's a real challenge about how we make the service available, but then encourage people to take it up, so that we don’t see much greater harm that we have to try and resolve at a later point.
Lynne Neagle AM: Okay, thank you. I've got a supplementary from Suzy Davies, and can I remind Ministers about concise answers, please? Suzy.
Suzy Davies AM: Yes, thank you. Just as we're speaking about children and young people's mental health, I wonder if you can confirm whether you've seen the United Nations Convention on the Rights of the Child's reports about what they call the grave physical and psychological effect on children and young people, and whether the operational guidance you've given out is responding to that in any way, or maybe there was something in that that you hadn’t thought of and you can respond to as we go along.

Summary: Vaughan Gething pointed out that due to the school lockdown, children as well as their parents would face difficulties at home learning and social-contacting. In case they would suffer from potential mental health problems, the government have to carry out a mental health recovery plan. Sian Gwenllian then mentioned that the CAMHS, as well as all the schools, should follow up the mental states of children and offer telephone and online support.