Cuts to mental health services mean that patients are being sent home in the absence of a bed – or being sectioned to secure one – pointing to a growing crisis in mental health inpatient services, a survey has found.
The survey, by the Royal College of Psychiatrists’ Psychiatric Trainees' Committee (PTC), asked junior doctors working in psychiatry to talk about their experiences of working in mental health over the past 6 months.
Of the 576 trainees from across the UK that responded, 70% said they had experienced difficulty finding an appropriate bed for a patient at least once. In child and adolescent services (CAMHS) that figure was 83%.
Other findings included:
• 80% had sent a patient outside the local area for a bed, 15% doing this more than monthly
• 37% had sent a patient at least 100 miles outside their local area. Of those working in CAMHS, 22% had been forced to send a child 200 miles away from their families
• 37% said a colleague’s decision to detain a patient under the Mental Health Act had been influenced by the fact that doing so might make the provision of a bed more likely, and 18% said their own decisions had been influenced in such a way
• 24% reported that a bed manager had told them that unless their patient had been sectioned they would not get a bed
• 20% have admitted a patient to a bed belonging to a patient who has been sent home on a period of trial leave
• Three in 10 had seen a patient admitted to a ward without a bed – presumably leaving them to camp on a sofa in a communal room
• 28% have sent a critically unwell patient home because no bed could be found.
Growing evidence of crisis
The results of this survey add further evidence to what some have called a growing crisis in the number of available mental health beds in the UK. Previous research by the BBC and Community Care magazine found that the number of patients sent out of area has more than doubled between 2011-12 and 2013-14.
In a separate piece of research in 2013, the BBC and Community Care found that the number of mental health beds had declined by 9% – or 1,700 beds – in two years. This is despite the demand for beds increasing in that time.
Dr Alex Langford, a trainee psychiatrist, said: “This survey investigated for the first time the extent of several practices which occur as a result of the bed crisis.
“These practices signify serious risk to patients due to a crippling lack of resources. The fact that psychiatrists are having to consider sectioning patients to secure something as basic as a bed is a huge warning sign of extreme under provision. These doctors are using the only option they have left to ensure very unwell people get the care they desperately need.
“The survey shows just how pervasively dangerous the disparity between resourcing in mental health and other medical specialities is.”
Dr Howard Ryland, chair of the PTC, added: “Psychiatry is a highly rewarding profession, but the difficulties highlighted by this survey demonstrate how challenging it can be to work in mental health services currently. If these serious shortcomings are not immediately addressed, it will become increasingly difficult to recruit and retain the dedicated psychiatrists our patients need.”
Professor Sue Bailey, president of the Royal College of Psychiatrists, said: “This survey provides further evidence that mental health services are approaching a tipping point. Continued cuts to services can only result in further distress and discomfort for patients, many of whom are young, vulnerable, some of whom are forced to receive care far from home. This situation is simply not acceptable.”
Consequences of cuts
Paul Farmer, chief executive of Mind, said the survey revealed the consequences of cuts to mental health services. "Many people know that if they experience a mental health crisis they need vital support, urgently,” he said. “For some, this means hospital care. Being denied that basic request for help can have tragic consequences.
"The decision to section someone under the Mental Health Act is an incredibly serious one. It is wholly inappropriate to use this power simply to secure a bed for an otherwise voluntary patient. However, with services grossly overstretched and continued cuts to mental health funding, it is no surprise that medical staff feel they have no alternative.
"Today's report demonstrates the very real consequences of making cuts to mental health services, at a time when they're so desperately needed. The government must see this as a wake-up call and recognise that delivering mental health services on a shoestring simply is not a viable option."
In a statement, reported on the BBC, care services minister Norman Lamb said that it was not acceptable to detain someone under the Mental Health Act purely because they need an inpatient bed.
"Decisions about detention must always be taken in the best interests of patients at risk of harming themselves or others,” he added.
"Inpatient beds must always be available for those who need them. We are scrutinising local NHS plans to make sure they put mental health on a par with physical health.”