• Warning follows investigations into the death of Linsay Bushell who was an inpatient at a unit run by Mersey Care FT
  • Coroner says “lessons have been learned” by the trust but warns NHS England of future deaths if more services are not commissioned
  • Funding request for specialist care was rejected by Liverpool CCG

A coroner has warned national health leaders about a lack of commissioned services to support patients with borderline personality disorder.

It comes after investigations into the death of Linsay Bushell, who was an inpatient at a unit run by Mersey Care Foundation Trust for nine months in 2014.

Staff recognised there was a “real and imminent risk of self-harm or suicide”, and in October that year Ms Bushell was found dead with a ligature around her neck.

A “prevention of future deaths report” by the Liverpool and Wirral coroner said mistakes were made around Ms Bushell’s care but “lessons have been learned” by the trust and several new measures have been introduced.

However, the report to NHS England and health secretary Jeremy Hunt, published this month, added: “In my opinion there is a risk that future deaths will occur unless action is taken…

“The court heard evidence that 40 to 50 per cent of mentally disordered female patients suffered from emotionally unstable (borderline) personality disorder rather than mental illness, and yet there was no provision or priority for therapeutic psychological services to be commissioned in the NHS England area.”

A review by Mersey Care found staff had sought commissioner funding for Ms Bushell to be treated by a specialist out of area provider, but the request was “rejected” by Liverpool Clinical Commissioning Group, the coroner said.

In 2014, the CCG and Mersey Care were working to change the funding arrangements for out of area care to give the FT delegated responsibility for allocating resources, and a subsequent review of Ms Bushell’s care shortly before her death concluded that an out of area placement should be supported. The delay meant she remained in a unit that did not meet her needs, the coroner said.

In its response, NHS England referred to commitments made to invest and increase access to psychological therapies in the Five Year Forward View for Mental Health.

This document, published in February 2016, admitted that provision of psychological therapies for adults with “common mental health problems” was meeting only 15 per cent of the need, and set an aim to reach 25 per cent by 2021.

HSJ asked NHS England if any action had been taken so far and requested details of any planned funding increases, but did not receive a response.

Mersey Care said it has “yet to have conversations” with NHS England or the CCG about the commitments, but it “looks forward to doing so”.

Liverpool CCG said: “Whilst the CGG did not turn down funding of this placement, we do recognise that this happened at a time when a new system was being introduced with Mersey Care in order to support faster decision making and better management of cases like this… We accept that decision making may have taken slightly longer during this transition period.”

Sue Mizen, chair of the medical psychotherapy faculty at the Royal College of Psychiatrists, said no specific funding has been attached to the personality disorders’ work stream under the forward view, and there are just 60 specialised inpatient beds in England – all in the North East or London.

She said: “There is no training strategy for staff in health and social care to better understand this group of people with a very common mental health problem, so the response people get is largely driven by the individual prejudices of the member of staff they meet.

“Sometimes they get an excellent service, but sometimes it is woefully poor. It is a lottery and there is at present no coherent plan.”

Dr Mizen said work on a service specification for inpatient services started four years ago but “repeatedly put at the bottom of the priority list” and a clinical reference group only recently reconvened.

Among the measures implemented by Mersey Care was the creation of a “personality disorder hub” in the community. Forty patients who regularly attend emergency departments in the area have since been identified, the coroner said.