By Anna Lewis, Managing Director of Adult Services at Sussex Partnership NHS Foundation Trust
The recent profile around access to inpatient care for people with complex mental health needs is framed around ‘beds’. In fact it’s about people. It is our responsibility to remember the huge personal impact that an ‘out-of-area’ admission can have on individuals at a time when they are likely to be feeling vulnerable and afraid.
Yet it’s too convenient and too simplistic to see this as a ‘front door’ problem than can be fixed by simply opening more hospital beds.
Beds never made anyone better. What does is providing people with accessible, high quality and compassionate care in the right place and at the right time. This is the point that gets overlooked in much of the hospital focused comment on the issue.
There’s a wealth of evidence showing the negative impact that a prolonged hospital stay can have on individuals, their recovery and their opportunities for independent living. No matter how hard we try, hospitals are restrictive and alien environments that can disconnect people from daily living and lead to loss of skills over time. All the more reason, once people have received the inpatient treatment they need, to help them reclaim their independence, supported in ways they find helpful and sustainable in the community.
Over the last 30 years, we have made the shift in mental healthcare from long term hospital care towards more early intervention, prevention and support at home. Yet there are still far too many factors that can result in people becoming stuck in hospital when they no longer have a need for it – problems with housing, social care and follow-up support to name a few.
This end of the acute care pathway, as well as what happens in between, demands as much attention from providers, commissioners and policy makers as what happens for people when they need admission to hospital.
And so we find the ‘parity of esteem’ debate rear its ugly head again. Within acute care (for physical health), there is a financial incentive, written into law, for health and social care providers to work together and ensure access to care is not delayed. There is no equivalent arrangement in place within mental health. While partners work hard at local levels to try to manage the consequences of this, this is a two tier mechanism that creates a financial imperative to fix a problem in one part of the system but not another.
Continuing to use out of area placements is a short-term solution to a systemic problem. It will perpetuate demand upon the health service by failing to get to grips with the underlying causes. And, most important of all, it means the care we provide to people will, in far too many cases, fall short of the standard they should be entitled to expect in a responsible and caring society. It’s time to stop talking about beds, and start talking about what lies beneath – the answers to that fall way beyond mental health services.