Professor Wendy Burn on ensuring that patients can get the care they need in local facilities
Imagine you are in such mental torment that you want to take your own life. Then you are bundled into an ambulance to travel hundreds of miles from home overnight, all because there are no beds for you any closer.
So far that you have no idea where you are, nor do your family and friends. Already in a vulnerable state, you feel even more disorientated, isolated and desperate.
And when your family are informed, they discover that they will have to travel for several hours to see you, if they are even able to make this journey.
What have you done to deserve this?
This is what happened to someone we heard from this week who had been detained under the Mental Health Act because they were very ill, feeling suicidal and needed a mental health bed.
Most distressingly, this patient told us that knowing that there was nowhere for them to be treated locally added to their feelings of worthlessness and suicidal thoughts.
This is not a one-off. I hear stories like this from patients, their families and staff over and over again.
I have known patients who would have agreed to admission to their local hospital but have to be detained under the Mental Health Act because they refuse to go to a hospital far away. Around 750 people at the end of each month find themselves far from their local area to receive treatment that they should be able to receive near home. As many as 750 lives displaced, and 750 recoveries set back.
It is counterproductive, unfair, and compounds the person’s mental ill-health. Being treated by staff you know, and who know you, must be better.
Care away from home costs more. Having ambulances spend many hours travelling hundreds of miles is not a good use of resources.
Promise of help from NHS England’s plan to greatly expand community mental health services is welcome. But it will be sometime before patients will feel the benefits, leaving some areas, and the people they support, in particular difficulty in the meantime.
New independent research commissioned by the Royal College of Psychiatrists identifies 13 areas which are experiencing significant struggles managing levels of demand with the bed capacity available in their area. Seven of those have ongoing difficulties with having to send patients out of area to receive care and six persistently have extremely high levels of bed occupancy.
The research has shown that more beds are needed and that is why we are calling for additional beds across these areas, aligned with workforce and service delivery plans so they are properly staffed and resourced.
I’m proud to say mental health services in the UK have been transformed in a generation.
When I started my NHS career long-term institutional care was the norm for people with mental illness. Now, admissions to inpatient mental health facilities are comparatively rare.
Any solution to high bed occupancy and patients being sent out of area must consider how beds are used. No area is the same in terms of the needs of people it serves, the geography it covers or its existing services and staff. This all needs to be factored in when considering the causes and potential solutions to inpatient bed pressures
But this revolution is incomplete. Mental health beds in England have been cut 73 per cent from around 67,100 in 1987 to 18,400 today. Meanwhile corresponding investment and growth in community mental health services has not been sufficiently prioritised. The commitments in the NHS long-term plan to expand crisis and community services are very welcome but it will be five years before these are fully implemented. We can’t wait that long.
Due to pressures many services have had to raise thresholds for admitting patients in recent years. Meaning only the sickest get help.
And as many local authority social services and supported housing that provide critical support frameworks for people with serious mental illness have been hollowed out, people are often left to reach a point of mental health crisis before they are admitted.
What is more tragic is that it is not unusual that these people then can’t be admitted to a bed nearby and join one of the hundreds exiled to places far from home.
I’m aware that this call may seem off trend. In an ideal world a hospital bed is not where anyone should be, we believe that everyone should be treated in the least restrictive setting. We cannot lose sight of that goal.
We understand “more beds” is no answer in itself. But starving inpatient services, with the affected patients as collateral damage, is not a viable or ethical plan.
There is no switch to flick. No simple roadmap. A lot of long, slow, unglamourous changes need to be made.
Any solution to high bed occupancy and patients being sent out of area must consider how beds are used. No area is the same in terms of the needs of people it serves, the geography it covers or its existing services and staff. This all needs to be factored in when considering the causes and potential solutions to inpatient bed pressures.
In the medium term, local areas should use the breathing space which the extra bed capacity would bring, to undertake service capacity assessments and establish the baseline for demand, identifying peaks and troughs.
Subsequently areas should introduce interventions to reduce demand or increase capacity such as strengthening crisis teams, auditing whether care received by patients is concordant with National Institute for Health and Care Excellence guidelines, improving bed management or taking steps to reduce delayed discharges.
Importantly areas should also be given space to study the results of the individual interventions so that the adverse effects of any interventions are captured, learned from and necessary adjustments made.
As local areas are in the midst of developing five-year plans to deliver the long-term plan, it is essential that the issues of bed capacity and out of area placements are addressed now, giving areas firm foundations on which to build, and to complete the revolution which begun all those decades ago.
Right now, our politicians are racking up the miles on their campaign trails. When the votes are counted many more miles will have been covered by distressed and vulnerable patients on the mental health beds trail. We need politicians to promise in their election manifestoes to commit extra resource to end the costly, counterproductive practice of sending patients far away from their homes and to ensure that they can get the care they need in local facilities.