Commissioners are under significant financial pressure from a surge in referrals to secure mental health services fuelled by the recession and crowded prisons.
There is a pressure on secure services across the North West service and NHS Manchester is working closely with providers and the North West specialised commissioning team to manage the demand
The rise is being linked to recession related crime and mental health problems, sparking fears that budgets will worsen as the effects of the economic downturn deepen.
In Yorkshire, referrals to low and medium services rose by a fifth over 18 months, from 482 in April 2008 to 572 in August 2009 - creating a £1.7m year to date overspend.
A report by the region’s specialised commissioning group reveals there were 7,189 more secure bed days in this period than were planned for.
The most pressured PCTs are now not admitting patients to private sector low secure providers unless it is unavoidable.
NHS Leeds’ £8.8m overspend is linked in board minutes to three areas, including forensic mental health services.
NHS Sheffield is £3.3m overspent based on month six figures, due to prescribing, continuing care, secondary care and secure mental health.
Birmingham East and North forecasts a £3.4m overspend on low and medium secure services. Board papers say detailed work is being carried out to address length of stays and discharges.
Medway, East Kent and West Kent PCTs also report more specialised mental health referrals.
It costs around £180,000 to place someone in secure services for a year but only around £40,000 to keep someone in prison. The Bradley review, published in April, highlighted offenders’ poor access to mental health services.
NHS Manchester’s month six financial report refers to “continuing significant overspends against mental health and continuing care budgets” offset by “underspends against budgets for prison services”.
Specialised mental health commissioning budgets are predicted to account for £7.1m of a £9.1m mental health overspend.
A spokeswoman said: “There is a pressure on secure services across the North West service and NHS Manchester is working closely with providers and the North West specialised commissioning team to manage the demand. We are in the process of ongoing reviews across the offender pathway.”
Sainsbury centre deputy chief executive Andy Bell said he feared financial pressures would tempt the NHS to raise thresholds for transferral to secure services from prisons.
He said: “There is without question a cost saving in providing better care to people who fall through the gaps.”
A specialised commissioner confirmed thresholds were “moving about a bit”. The fact that the biggest increase was among male patients moving to low secure units suggested unemployment and rising crime were factors, the commissioner said.
In October a Local Government Association survey of more than 170 town halls in England and Wales found many parts of the country reporting rises in crimes such as burglaries. Around three quarters of respondents cited the recession as a “very or fairly significant factor”.
Elsewhere, a specialised mental health commissioner said: “Prison overcrowding definitely puts additional pressure into the system. I anticipate that health will push back and potentially increase their thresholds.”
They said commissioners would also have to push hard against a strong provider interest in secure services. Mental health foundation trust applications often contain plans to expand secure services, many of which are also provided by the independent sector.