Patients are being detained under the Mental Health Act after refusing to be admitted to beds at out-of-area hospitals when their local units are full.
That was the warning issued by approved mental health professionals (AMHPs), the group of mostly social workers who coordinate Mental Health Act assessments, after a survey covering AMHP leads from 70 local authorities in England indicated longstanding problems securing beds for patients in need are getting worse.
The survey was carried out by the national AMHP leads network. Almost half (48%) of respondents said patients in their areas had been detained under the act after objecting to a voluntary admission due to the distance of the admitting hospital. The last time the survey was carried out, in 2013, less than a third (32%) reported the issue in their area.
Detaining a person under the act imposes a series of restrictions on their liberty. The decision will be made by an AMHP after receiving recommendations from two doctors and only after less restrictive options, including a voluntary admission, have been considered.
Use of the Mental Health Act has increased in recent years. Earlier this year Community Care revealed a rise in the number of patients sent to out-of-area hospitals, some hundreds of miles away.
Steve Chamberlain, chair of the AMHP leads network, said the situation was “totally unacceptable” for patients and their families, and more were objecting to long distance admissions.
“The decision AMHPs face is does this person need hospital admission now? There may be cases where you can wait until a local bed becomes available, but in others the risk will be so great to the person or those around them that they need to get to hospital urgently and you need to find a bed somewhere.
“Sometimes people are prepared to go to hospital [as a voluntary admission] but to then have to tell them ‘so we all agree you need hospital, but we’re going to have to send you 100 miles away or more’ – it’s no wonder people object.
“It’s a dreadful position for the person and their loved ones. It’s also dreadful for the AMHP because you have to weigh up whether you can wait until a local bed comes up or if the risk is so great that a detention to another hospital is necessary.”
The survey findings, which were presented at the AMHP network’s annual conference in London, also revealed:
- 73% of AMHP leads had seen bed shortages lead to delays in compulsory more than five times in the past six months, up from 42% in 2013. Just 3% said this had never happened, compared to 19% three years ago.
- 76% of AMHP leads said they had admitted a patient to a hospital outside of their local area more than five times in the past six months, up from 60% in 2013.
- 75% said they had been forced to detain a person in a police cell or A&E department for over 24 hours at least once in the past six months, up from 59% in 2013. The survey did not provide a break down for cells or A&E.
One indicator from the survey showed improvement. The number of AMHP leads who had seen Mental Health Act assessments postponed at more than five times due to no suitable bed being available dropped from 37% in 2013 to 26% in 2016.
Chamberlain said the results reflected AMHPs “working hard” to see people in a timely way, only to be faced with “concerning” resource shortages after identifying the care required.
“The survey overall just confirms what we hear from staff on the ground. When you look at the beds situation, we’ve been saying for a long time it would be beyond belief for a person with a heart attack or an asthma attack to be sent to the other end of the country in an emergency. Yet this is happening in mental health.
“We want to work with the Association of Directors of Adult Social Services and others on the resource and commissioning issues, particularly in terms of how local authorities work with other agencies to deal with the problems around beds that keep coming up.”