The BMA is warning that the Government’s failure to meet its promise to stop sending mentally unwell patients far from home for their care, is continuing to harm some of society’s most vulnerable people.
The latest data reveals that 1,260 new patients have been inappropriately sent for inpatient care miles from their homes in the three months up to August. This means these patients are not being given the care and treatment they need near their home, family, and friends, despite the Government’s pledge to end this harmful practice by April 2021. Poorly resourced NHS mental health services mean this practice is becoming increasingly common. While the pandemic disrupted much of the health service, NHS England was not on track to meet the target even before Covid-19. The number of new Inappropriate Out of Area Placements2 rose by nearly 10% in the two months preceding lockdown, and the data also shows that the number of detentions under the Mental Health Act are at their highest level in four years, currently standing at 53,239.
Dr Andrew Molodynski, BMA mental health policy lead, said: “It is nothing short of appalling that, despite consistent warnings from the BMA and the wider mental health community, the Government is still allowing mentally unwell patients to be cared for miles from home, still failing to provide the mental health beds that are so desperately needed and failing to fund the workforce we need to provide the care People should feel that if their mental health deteriorates, they will be safely cared for and have a bed if they need it. Unfortunately, the current system is unable to offer that guarantee.”
“Those working in mental health care across the country know only too well the dire situation services are in, as patients, many with very severe and debilitating mental health problems, continue to suffer needlessly because of years of underinvestment.
“The backlog of care created by the pandemic means many have waited far too long for treatment and as such we are seeing an increase of demand alongside an increased severity in cases. This is in the context of a system that was already struggling to cope before the Covid-19 pandemic.
“It is heart-breaking that many of these patients are not getting the urgent and often lifesaving care they need or are being placed so far away that their loved ones cannot visit. No one should be placed in this terrifying position.
“The Budget was a wasted opportunity to reverse the Government’s shameful track record on mental health, and it must urgently act to provide investment in services for adults, children and young people, and provide the beds that are lacking.”
The BMA has estimated that at least 1000 extra beds are required to meet overall mental health demand, and research from the Centre for Mental Health has recently reported that poor mental health has an economic and social cost of £119 billion per year. The BMA has previously called for increased investment of at least £4.6 billion per year by 2023/24 for mental health care in England. It is also calling on the Government to urgently develop a strategy to eliminate the harmful practice of sending patients out of area as a matter of priority, considering the increased demand from the pandemic and the fact the previous target of eliminating the practice by April 2021 has been missed by a considerable margin.
More than one in eight medical mental health posts in NHS hospitals in England are currently vacant3, and more beds are no use without staff, which is why the BMA is also calling for an amendment to the Health and Care Bill to publish regular and detailed workforce assessments to inform current and future needs-based recruitment.
Dr Adrian James, president of the Royal College of Psychiatrists, said: “Being treated far from home, sometimes hundreds of miles away, because the right bed isn’t available locally is disastrous for patients and their loved ones. It’s extremely disappointing that the target for eliminating inappropriate out-of-area placements hasn’t been met.
“The pandemic has led to more people in crisis and reduced capacity on many wards. The Government must urgently invest in additional beds in the areas that need them most and maintain funding for post-discharge support.
“Efforts to expand community services must also continue so that people with mental illnesses can get the right support earlier on, reducing the likelihood of reaching crisis point.”
A psychiatrist based in Thames Valley said: “I recently had to admit a patient to hospital and because there were no female psychiatric intensive care beds in the whole of England, she had to remain in a ‘holding room’, very similar to a police cell, for 4 days until arrangements could be made. This is clearly a distressing and dehumanising experience that should simply not be happening in modern mental health care.”
A consultant psychiatrist based in Suffolk said: “There has been chronic underinvestment in mental health services for older adults, whose full needs are often made ‘invisible’ by dedicated unpaid carers. However, since the pandemic staff shortages have become critical and staff still standing are exhausted.
“We regularly have elderly patients sent a 4-6-hour drive away from their hometown for a bed. As a result, very often, these patients received limited family visits which in turn makes them feel isolated and cut off, and this has a negative impact on recovery.
“We were previously able to spend time encouraging depressed patients to eat and drink while still unwell, we now find it physically impossible to do this. As a result, those patients often don’t eat or drink properly and have to be moved from their psychiatric care to medical wards in an ordinary hospital, or even to the emergency department. Mental health care simply cannot go on like this.”
This comes amid concerns that the impact of the pandemic and the backlog of care is putting a particular strain on the mental health of patients and is increasing demand on services. The charity Rethink Mental Illness has expressed alarm at the effect of the pandemic while highlighting recent NHS statistics showing a significant increase in the number of people referred to mental health services with suspected first episodes of psychosis during the pandemic – over 9,440 referrals were made in April 2021, a 29% increase compared to pre-pandemic levels in 2019.
Alexa Knight associate director for policy and practice at Rethink Mental Illness said: “The increase in people presenting to services with suspected first episodes of psychosis points to the significant and increasing levels of distress across the population, with the number of referrals to mental health services forecast to increase in the wake of the pandemic. When people are at their most vulnerable and unwell, they must be able to access treatment close to home, where they can have the support of family and the community in their recovery. Despite calls for action from across the mental health sector, the Government’s own target to end Out of Area Placements has not been met. Faced with the prospect of increased demand and overstretched services, we must see an end to Out of Area Placements and act quickly on the warning signs.”