The bed or admission crisis in adult mental health is largely caused by problems with discharges or alternatives to admission – and this can only be addressed through service change and management of the whole service, an Independent Commission report has found.
The Commission, chaired by Lord Nigel Crisp, former chief executive of the NHS in England, was established in early 2015 by the Royal College of Psychiatrists to investigate widespread concerns about a shortage of acute adult psychiatric beds. It was prompted by reports of patients either having to travel hundreds of miles to access a non-specialist bed because of local shortages, or not receiving care at all.
An interim report by the Commission argues that the problem is not just to do with numbers of beds or admission processes and describes how many patients currently being treated on adult acute wards could be treated in other settings if only they were available.
It also states that many others remain as inpatients even though they are clinically well enough to be discharged.
A survey of wards undertaken by the Commission in England found that:
• 92% of wards are treating patients who could have been treated by other services if they had been available. In practice, this applies to about three patients per ward (16%). The most common alternative services required are crisis houses, rehabilitation services and services for patients with a personality disorder
• About 3 patients per ward (16%) are clinically well enough to be discharged from inpatient care, but cannot be because of other factors. A lack of suitable housing (ranging from local authority housing to supported accommodation) is a significant factor in preventing discharge in 49% of these cases
• Consultants responsible for admitting people to the majority of these wards felt either that there are enough beds now or that there would be if more alternatives were available in the community.
The report also found that while there were many positive stories of care, many patients and carers feel disenfranchised and excluded and there is a need for greater engagement and implementation of best practice.
In addition, there is a spectrum of pressure and performance, ranging from units with demoralised staff who are trapped in a constant process of crisis management to those where staff are able to purposefully deliver high quality care and services. There is also a need for greater staff support, training and motivation in order to improve care and services, the report said.
“There is undoubtedly a problem with finding beds for some patients, and the Commission has heard awful stories of people having to be moved many miles from their homes in order to find the care they need,” said Lord Crisp. “However, as our survey and other research shows, this appears to be largely due to there being significant numbers of patients ready for discharge but with nowhere else to go and others who have only been admitted because there weren’t suitable alternatives for them outside hospital.
"Inpatient services play a vital role in mental health and The Commission has been impressed by the determination and skills of many staff who care for patients within these wards. However, it is essential that these important services are used as effectively as possible.
“We are publishing this report about services in England both to draw attention to these significant problems and to consult on how improvements can be made.”