Mental health patients forced to travel ‘hundreds of kilometres’ for treatment, despite government pledge

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Lack of local mental health beds leads to patients from the Birmingham and Solihull Mental Health NHS Foundation Trust being sent out of the area for treatment

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Credit: Nicolas J Leclercq on Unsplash

Patients from the Birmingham and Solihull Mental Health NHS Foundation Trust have spent a total of 1,125 days inappropriately placed out of their area in October 2020.

This means they have been sent away from their home for mental health treatment because no local bed has been available for them.

Over the last four years, on average over 95% of mental health beds in the Birmingham and Solihull Mental Health NHS Foundation Trust have been occupied.

This leads to the Birmingham and Solihull Mental Health NHS Foundation Trust being among the trusts sending the most patients out of their area, recent data published by NHS England shows.

Travelling hundreds of kilometres from friends and family to receive mental health treatment can have a negative impact on a patient’s recovery, Vicki Nash, Mind’s Head of Policy and Campaigns, said:

“Too many people with mental health problems are being forced to travel hundreds of kilometres from their friends and family to receive the treatment they need. This can worsen people’s chances of recovery, as well as being expensive for the NHS and the taxpayer.”

While the UK Government has set a national plan to eliminate inappropriate Out of Area Placements in mental health services for adults in acute inpatient care by 2020/21, figures in Birmingham have almost doubled compared to two years ago.

The highest number of Out of Area Placement days in the Birmingham and Solihull Mental Health NHS Foundation Trust was reached in February 2020 before the pandemic started.

The cost of sending patients out of their area

In just one month, the Birmingham and Solihull Mental Health NHS Foundation Trust has spent over half a million on inappropriate Out of Area Placements. Every day a patient spends outside of their area cost, on average, £575 in October 2020.

But the impact is not only monetary.

Vicki Nash, Mind’s Head of Policy and Campaigns, says inappropriate Out of Area Placements need to be reduced as they can be detrimental for a patient’s recovery:

“The NHS has rightly made ambitious commitments for improving mental health care. But while we are waiting for these to be delivered, thousands of people continue to face the traumatic experience of being sent away from home and separated from their support network to get the help they need.”

When staying in units outside their usual area, patients can’t be visited by their care coordinator. A care coordinator coordinates and monitors the patient’s care and should therefore be in regular contact with the patient.

Lack of beds for mental health patients

Patients are sent out of their area inappropriately when no bed is available for them locally.

This is linked with high bed occupancy in mental health units.

Since April 2016, the Birmingham and Solihull Mental Health NHS Foundation Trust has seen bed occupancy rates continuously above 95%.

This matches what the Care Quality Commission reported about the trust in 2019:

“The service experienced bed pressures. Most wards had bed occupancy rates above 100%. Beds were not always available to patients on return from leave.”

In order to maintain patient safety standards, bed occupancy should not exceed 85 per cent. A higher bed occupancy leads to regular bed shortages. These are impacting patient care as directing patients to the bed most suitable for their care is less likely to be possible.

The Covid-19 pandemic has intensified the situation.

“The current pandemic is making this problem worse as increasing numbers of people are presenting in crisis and requiring specialist treatment,” said Dr Adrian James, President of the Royal College of Psychiatrists.

“A lack of beds in adult psychiatric inpatient units is leaving many patients with serious mental illness without the urgent treatment they need.”

Patients sent to private hospitals

The congestion of NHS Trusts leads to patients being sent to private hospitals. This is associated with higher costs.

In the last 12 months, the Birmingham and Solihull Mental Health NHS Foundation Trust has sent patients to 33 different hospitals. Almost all of them were private.

Patients are often sent to the same units with Lakeside View, Priory Hospital Burgess Hill and Cygnet Churchill leading the list of receiving hospitals.

The distance to the units patients are sent to varies. While Lakeside View in Wolverhampton is a 30 minute drive with the car away (35 kilometres), driving to Priory Hospital Burgess Hill and Cygnet Churchill would take over two hours since they are more than 200 kilometres away.

Between November 2019 and October 2020, more than half of the patients were sent to units between 100 and 300 kilometres away from their home.

A national problem

The Birmingham and Solihull Mental Health NHS Foundation Trust isn’t the only trust sending patients out of the area inappropriately.

England-wide, 685 patients were still placed outside their area inappropriately at the end of October 2020.

There is no significant change from two years ago when 645 inappropriate Out of Area Placements were recorded in October 2018. 

During the first lockdown inappropriate Out of Area Placements went down. In April 2020, they reached their lowest point since records began.

This can be due to fewer mental health referrals and restricted access to mental health services because of national restrictions, but also due to fewer providers submitting data. While usually around 95 per cent of providers submit data about Out of Area Placements, the number went down to 79 per cent in April.

The decrease has been only temporary. Since May, inappropriate Out of Area Placements are going up to pre-lockdown levels again.

The number is likely to be higher

Data is only available for adult acute mental health inpatient care and not for Out of Area Placements in other mental health services such as specialist mental health inpatient services or services for children and young people.

Therefore, the actual number of Out of Area Placements is likely to be higher.

What needs to change

To eliminate Out of Area Placements in mental health services, Dr Adrian James, President of the Royal College of Psychiatrists, sees additional beds as a requirement:

“To tackle this problem the government should invest in additional beds in high priority areas to ease the pressures there and invest in high-quality community mental health services to provide help earlier, prevent crises and reduce admissions.”

Vicki Nash, Mind’s Head of Policy and Campaigns said further investments in mental health services are necessary in order for patients to receive the help they need:

“We urgently need to see investment in mental health services reaching the frontline, so that people can get the treatment they need, when they need it, close to home.”

In 2016, the NHS set out how they would improve mental health services by 2020/21 in The Five Year Forward View for Mental Health. An extra £1.6bn for mental health services were promised.

The Birmingham and Solihull Mental Health NHS Foundation Trust did not comment on how they plan to eliminate Out of Area Placements by 2020/21.

Download the data: NHS Digital publishes monthly data on Out of Area Placements in Mental Health Services. The analysis can be found in this GitHub repository.

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