We always have high bed occupancy on our acute admissions units to the extent that we have over 40 people in out-of-area beds, some as far away as 175 miles from home. We recently had a psychiatric unit closed and now our trust is spending millions on out-of-area beds.
The impact this has on patients and families is devastating. Service users and families often find journeys of a few miles to one of our remaining NHS units difficult. Imagine what it’s like when we ask them to travel to out-of-area beds close to 200 miles away?
One family member reported having a 15-hour-round trip to go and visit someone. This means that people are not being visited by families and friends when they need it.
In my experience, right now people have absolutely no chance of an informal admission to hospital (as opposed to a compulsory admission under the Mental Health Act) because there are no beds for them.
So people who could have been admitted voluntarily at an early stage in their crisis are instead left in the community while their mental health deteriorates to the point they may need to be admitted under the Mental Health Act for a long admission.
The beds situation impacts us as approved mental health professionals (AMHPs) and community social workers but is also impacts NHS ward staff too.
They have no say in decisions to move patients from ward-to-ward. Instead these calls are made by managers with nothing to do with the day-to-day running of the ward but focused on crunching numbers.
Shifting people about like this harms continuity of care for patients and it harms any therapeutic work or relationship that staff have built up with patients. It must feel soul destroying.
I’ve noticed wards also seem more chaotic when they are over occupied. Ward rounds, ward business and hospital targets are pushed up the agenda at the expense of one-to-one time with patients.
It damages staff morale. Frontline workers are too stressed to function how they would like to. So sickness rates are high and wards turn to agency staff to fill gaps (again impacting the continuity and consistency of care).
From my point of view as an AMHP and social worker, I have turned up to ward rounds to be told that the patient I was here for has been moved to another ward on another hospital because they had to use a bed for another patient.
In the increasingly rare situation where a bed for someone who needs to be admitted to hospital can be found in our area, we are frequently told that the bed is “an unsafe leave bed”. This means that when we fill the bed a detained person on leave would not be able to return to the ward if they needed to.
People are also being discharged prematurely because of the constant pressure on beds. This has led to re-admissions after only a few days in some cases because inpatient teams – under pressure to free-up beds – have not listened to community staff when they have warned that the person is not ready for discharge.
It’s stuff like this that makes me embarrassed to work in mental health and it’s a shame because I feel like a lot of what I have written about here is outside of my control. I also think that there are a lot of very caring and experienced people working my area. It is horrible that any of us should need to feel ashamed by the circumstances in which we practise.