Mental health patients sent 'out of area' for care left vulnerable and isolated

Thousands of people with mental health problems are being sent to residential rehabilitation services 'out of area', leaving them isolated and less likely to recover, a care watchdog has warned.

A report by the Care Quality Commission (CQC) found the NHS is spending £350m a year to send these patients 'out of area', sometimes more than 60 miles away from their homes and for three years at a time.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the CQC, said: "We are concerned about the high number of beds in mental health rehabilitation wards that are situated a long way from the patient’s home. This dislocation can mean that people can become isolated from their friends, from their families and from the services that will provide care once they have been discharged.

“Our evidence shows that on average, people in ‘out of area’ placements can end up staying in residential rehabilitation for twice as long as they would have done in a local NHS bed, which can increase their sense of institutionalisation, affect their onward recovery, and can be very costly.

“The attention now must be on developing services that are focused on people’s recovery and that are not ‘long-stay’ wards in disguise, that are closer to where people live, and that are well-connected to the wider local system including services that will provide aftercare.”

Through its information request, the watchdog identified 4,397 beds for residential mental health rehabilitation across England – 2,050 in the NHS and 2,347 in the independent sector.

Of NHS patients with complex psychosis and other mental health conditions, two-thirds are sent 'out of area' to private health firms, due to a lack of inpatient services to support patients locally.

The CQC’s report found that those receiving care in rehabilitation services provided by the independent sector are, on average:

• More likely to be further from their homes than those staying in NHS services – 49km compared to 14km

• More likely to stay there for longer – 14.5 months compared to 7.5 months on their current ward in a NHS service

• At a greater risk of having their aftercare compromised because managers are less likely to know which NHS trust would care for them following discharge.

In its report, the CQC has made a number of recommendations, including for local bodies – Clinical Commissioning Groups (CCGs), NHS trusts and local authorities – to review how appropriate their current placements are of patients in residential mental health rehabilitation services.

This is consistent with the Five Year Forward View for Mental Health (published by NHS England in February 2016), which states that people should not be cared for in restrictive settings longer than they need to be and that the NHS should expand its community-based services to support people to live safely as close to their homes as possible.

The CQC carried out its review in collaboration with NHS England and NHS Improvement. The health secretary has accepted the recommendations in the report.

For more information go to: www.cqc.org.uk