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Mental Health Patients Sent Packing

More than 5000 patients with mental illness have been sent more than 100 km away from their homes for vital treatment, complained experts.

In 2016, Jeremy Hunt, the then health secretary and now chancellor, was reported to have said that "not a single patient from England with acute mental ill health should be in a bed far from home for want of one locally".

This came in response to the final report of an independent taskforce, chaired by the Chief Executive of Mind, Paul Farmer, set up by the NHS as part of its 'Five Year Forward View' to build consensus on how to improve services for people of all ages.

The taskforce called for the practice of sending people out of area for acute inpatient care due to local acute bed pressures to be "eliminated entirely" by no later than 2020/21, NHS England said.

For those needing mental health care or providing mental health care, this target was a welcome one, a target that would "end the pain of separation from families and NHS carers of patients sent to out-of-area (OOA) beds".

This target was supposed to be hit by the end of March 2021, with the practice of sending patients miles away from their homes for treatment having ceased by that time. 

However, 2 years on, the Royal College of Psychiatrists (RCPsych) has pointed out that "thousands of adults with acute mental health needs and requiring inpatient care, have been sent hundreds of miles from home for their hospital treatment due to a lack of beds and specialist care", and decried that there is "no end in sight".

"It is shameful that mental health patients in this country are being routinely let down by this Government who are now 2 years past their target of ending the practice of sending patients out of area for treatment by March 2021 and still failing miserably," said British Medical Association (BMA) Mental Health Policy Lead Dr Andrew Molodynski.

Patients Sent Over 100 km Away

The College's analysis of NHS data showed that an average of 12 new 'out of area placements' (OAP) started every single day from April 2021 to March 2023. In the same period, over half 5335 (56%) of all placements resulted in patients being sent more than 100 km away for vital treatment.

Additional analysis by the College showed that 1 in 14 placements (7.3%) were sent more than 300 km away, and that one patient from Plymouth was sent approximately 605 km away to Darlington in March of this year.

Among the OAPs that were the result of bed unavailability over the past 2 years, more than 2 out of 5 (42.5%) lasted for more than 1 month, with around 1 in 12 (7.9%) having lasted for more than 3 months.

Since the proposed deadline, there had been almost 9000 (8925) new inappropriate OAPs, at a cost of £217.5 million to the NHS, according to an RCPsych spokesperson.

But the practice imposed more than a financial burden, according to the College and the BMA, as these placements, which could stretch for "months on end", continued to cause "significant harm to patients".

Dr Adrian James, president of the RCPsych, expressed how this practice was "unacceptable", and suggested that the practice of sending patients "hundreds of kilometres away from their homes and families" had likely been happening for decades.

"It risks patients' mental health to such a degree that they often remain in hospital for longer," he said.

Dr Molodynski agreed and warned that "sending incredibly vulnerable patients with acute mental health needs hundreds of miles away from home, from family, and from loved ones has a hugely detrimental impact on their ability to recover effectively and places them at increased risk."

Psychiatric Workforce on 'Life Support'

The Royal College of Psychiatrists and the BMA had together written to the Mental Health Minister Maria Caulfield to demand an end to inappropriate out of area placements, and called for urgent investment in mental health services, especially in the community so that more patients receive effective help close to home before reaching crisis point. In addition, more specialists were needed so that patients did not have to go out of area to receive specialist care. 

Last month Professor Subodh Dave, dean of the Royal College of Psychiatrists, said that around 1 in ten consultant psychiatrist posts were vacant, with the College highlighting a current shortfall of 690 consultant psychiatrists across England – which equated to 15% of the current consultant psychiatrist workforce.

Years of understaffing had left the psychiatric workforce on "life support", said Professor Dave. "Our members are retiring or leaving the field, in no small part because of burnout and low morale caused by excessive workloads."

Feedback from College members suggested that chronic workforce shortages, burnout from excessive workloads, and poor work-life balance were contributing to many consultants considering early retirement or leaving the profession entirely – issues that stemmed from working in an "overstretched and understaffed system".

Government Must 'Put a Stop to This Practice'

"First and foremost, we need comprehensive community services to avoid admission wherever possible," underlined Dr James, and added that available beds were needed locally when patients needed admission, something he stressed was "severely lacking" in many areas. 

"Government must keep its promise to put a stop to this practice," he added. "Patients should be offered effective alternatives to hospital admission so they can receive help earlier, from the right specialist, for their specific needs, instead of being sent out of area for treatment.

"When patients require hospitalisation, it is vital that there are properly staffed inpatient wards, which depend on a robust mental health workforce." 

Dr Andrew Molodynski emphasised that the "isolating and dehumanising" practice was a direct consequence of a "fragmented and underfunded" mental health care system that had been "letting patients down for far too long".

Dr James, Dr Molodynski, and Professor Dave, called on the Government to publish the NHS Workforce Plan, backed by adequate funding, as a matter of urgency. 

"It’s time to end the dither and delay," demanded Professor Dave.

If out of area placements continue, it was ultimately "patients who will pay the price," warned Dr James.