Mental health crisis services in England are “unsafe” and delivering substandard care to acutely unwell adults and children, an investigation by Community Care and BBC News has revealed.
Our investigation found that professionals are routinely struggling to get emergency hospital care for patients in crisis as the NHS has shut more than 1,700 beds in two years. Adult psychiatric wards are running occupancy levels of more than 100%, meaning some patients are being sent to private hospitals miles from home or admitted to NHS hospitals without a bed.
One patient took her own life two days after professionals tried to admit her to an NHS unit only to be told there were no beds available.
The investigation also found:
- A whistleblower alerted social care regulator the Care Quality Commission after an NHS trust admitted patients to hospital without beds being available as no beds could be found in the public or private sectors.
- The NHS continues to spend millions of pounds sending severely ill patients to private hospitals, often hundreds of miles from home.
- Children and young people are being admitted to adult psychiatric wards due to nationwide pressures on specialist children’s beds.
- Patients admitted to wards are “increasingly seriously ill” placing an extra strain on ward staff.
- Pressures to free-up beds are leading to patients being discharged too early, social workers warn. At one trust bed pressures meant one patient was admitted eight times in 12 months.
- Patients have warned NHS executives that acute services “are in crisis and cannot cope with demand”.
In response, care and support minister Norman Lamb said he was determined to end the “institutional bias in the NHS against mental health”. The minister admitted current levels of access to care “are unacceptable” and said “beds must be available if patients need them”.
The investigation is based on freedom of information requests to NHS mental health trusts and analysis of trust board papers published this year.
Demand outstrips supply
This analysis found that demand for crisis services is outstripping the NHS’s shrinking bed supply. Despite Mental Health Act admissions hitting a record level of 48,000 in 2011/12 (2012/13 figures are due later this month), data obtained from freedom of information requests to 48 NHS Trusts showed at least 1,700 mental health beds have been closed since April 2011.
Three-quarters of bed cuts (1,291 closures) were made on admission wards and psychiatric intensive care units for acutely unwell adults and older people.
The NHS’s remaining inpatient units are overstretched. Ward occupancy data obtained from half of England’s mental health trusts found adult admission wards averaged an occupancy level of 101% on 1 August this year.
Although the Royal College of Psychiatrists recommends occupancy levels of 85%, individual wards were running at up to 138%. Wards are usually managing the excess by filling beds temporarily freed-up when patients are sent on short-term leave, a situation one social worker warned is risky as patients who relapse “are not able to return to the ward if they need to”.
One trust’s complaint log revealed an incident where a patient “on weekend leave was refused re-entry back into the ward on the Saturday even though he was in crisis. The ward informed [the patient’s] carer that his bed had been allocated to another patient and that there was no room for him.”
In other cases patients have been admitted to hospital without a bed being available. A whistleblower contacted the Care Quality Commission after South West Yorkshire NHS Partnership Trust admitted patients without a bed 12 times in five months because no beds could be found in the NHS or private sector.
Patients waited in seclusion rooms until beds became available, an issue also raised at a north London hospital earlier this year. The CQC told South West Yorkshire Partnership Trust the practice was “unacceptable and must not continue”. The trust said “at no point was any service users’ safety compromised”.
Lucy Bowden ended up in the back of a police van due to a lack of beds after voluntarily seeking help. The 33 year old, who has a history of self-harming, was left wandering around the grounds of her local accident and emergency hospital after being told there were no psychiatric beds available.
Eventually the police were called, who had to use their powers under the Mental Health Act to force her local psychiatric hospital to provide her with care. “They couldn’t find anywhere so they were saying I’d have to go in to police custody, in a police station which would mean I’d have to go into a cell. Eventually they found a bed and I had to go into the back of a police van, in the cage in the back. It was horrible,” she said.
NHS spends millions on private care
The bed shortage also means the NHS is spending millions of pounds sending growing numbers of patients to private hospitals, often miles from home, a situation first raised by Community Care earlier this year as social workers warned it was isolating patients from their support networks.
Since our report, Manchester Health and Social Care Trust has spent £1.75m on out-of-area private beds in four months. The trust said plans for additional NHS bed capacity would be in place by the end of the year.
Social care leaders and psychiatrists have warned that the system is “unsafe” and needs urgent reform.
Faye Wilson, chair of the British Association of Social Woker’s (BASW’s) mental health forum, said failure to address the situation risked a “crisis on the level of Mid Staffs”, referring to the Staffordshire hospital care scandal judged to be one of the worst in the NHS’s history.
She added: “If we were treating cancer patients like this there would be a national outcry. Yet here we have a national problem in mental health and it feels like no-one is listening.”
Steve Chamberlain, chair of The College of Social Work’s network for approved mental health professionals (AMHPs) – the group of mostly, but not exclusively, social workers who carry out Mental Health Act assessments, said: “There is no doubt that patient care is compromised by the lack of resources for acutely ill individuals.
“AMHPs and other mental health professionals are finding it increasingly difficult to do their jobs as they are working in a system where the resources needed to keep individuals safe in crisis are just not there. However skilled and committed the professionals, the likelihood of further tragic incidents will just increase.”
Martin Baggaley, medical director at South London and Maudsley NHS Foundation Trust, said: “We are in a real crisis at the moment. Currently the system is inefficient and unsafe. We’re certainly feeling it on the frontline, it’s very pressured, and we spend a lot of our time struggling to find beds, sending people across the country, which is really not what I want to do.”
Many bed closures are justified by the NHS by promises that savings will be reinvested in community services. But Dinesh Bhugra, a psychiatrist who chairs the Mental Health Foundation, said: “Around the country there is a lot of pressure on community teams and lots of staff are going off sick. I cannot see any logical explanation for closing beds.”
Care and support minister Norman Lamb said: “More people are being treated in the right settings for them, including fewer people needing to go into hospitals. It is essential that people get the treatment they need early and in the community but beds must be available if patients need them.”
The minister said the government is working with NHS England to assess how long people wait for treatment with a view to introducing national standards for mental health. The CQC’s impending appointment of a deputy chief inspector of hospitals with mental health expertise would help “root out poor care”, Lamb added.
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Andy McNicoll is Community Care’s community editor