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.
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I agree that long term hospital stays can create problems in readjusting to normal life but the system seems to have gone to far the other way discharging patients too early leading to readmission pretty quickly eg in my case 3 weeks ago readmission within 24 hours of discharge, on a section 2. This conveyor belt of patients creates more admin work in itself and less staff time for patients and therefore, less benefit of being in hospital.
But would patients need to be in hospital if they got appropriate help in the community. The trend is for only short ‘episodes of treatment’ – some trusts quote 6 months maximum help in their literature. What happens to the patients who don’t recover in that time – they go downhill again and need more help than perhaps if they had had continuing care. I was discharged from the community mental health service about a year ago because they couldn’t help me anymore. Six months later they wrote an apology to say my mental health had suffered as a result of their decision to discharge.
If I hit crisis point I find it difficult to access the crisis team – they are just overwhelmed by the number of people needing their help. It can take hours to get through to speak to someone, they don’t always switch on the answerphone because they don’t have time to pick up the messages. It is now very difficult to get a same day visit at home if you are struggling. Services are very much reactive rather than proactive. When I hit crisis point my ‘crisis plan’ is pretty useless – there frequently isn’t a bed available (stay too short anyway), the crisis team are overstretched, the respite bed I used have access to is now an acute ward overflow bed limited to 2/3 nights only and what real use is a couple of visits from my CPN to prevent my situation tipping over into a suicide attempt.
Basically the entire mental health service is failing people and the problems stretch beyond the NHS into social services, benefits cuts etc. There is not enough funding to meet demand and more beds alone is not the answer. Perhaps more early intervention treatment would help but not enough funding is going in that direction either with people waiting months to get access to talking treatments and young people are not always able to talk to some one like a school nurse when perhaps self harm or eating is becoming a problem. Right across the board someone needs to have an overview of all the services which touch mental health issues. Joined up thinking.
The commentary is misguided and fails to describe the current crisis in mental health and the dire financial situation including the lamentable loss of a large amount of beds since 2010. This puts the strain of managing the most seriously ill unfairly on community services. Under resourced and stretched community teams are often asked to plug the gap. When an incident happens these teams are often blamed despite being in a no win situation.
Beds matter. Ask the many medical directors and chief executives including the SLaM medical director, President of the RCPsych, Mind and Rethink. It is an essential part of managing a patients risks including those regarding their health, safety and the safety of others. Sending patients many miles away is barbaric and unsafe. Ask patients.
There needs to be further independent studies done to explore the current crisis to better inform management. Management need to be also held to be robustly held to account for decisions made as is the case in other regulated healthcare professions.
Beds matter. Patients need them. Stop spending fortunes sending then away to private beds. Quality care must be paid for and properly resourced.
Having worked in the field of Mental Health for 15 years,commencing in 1995, Managing Community Services, ranging from Residential, Daily Support and Domicillary Support. I witnessed quality sevice provision to vulnerable adults with enduring mental health needs. Also those whom seemed to be marginalised due to alcohol or drug issues. Staff/Support workers had time to spend with their clients to offer time for practical and most importantly emotional support. Based on the individuals needs and in partnership with the Care Co-ordinators. Staff had their own client case load, this enabled relationships to be formed, based on trust and fostered a true knowledge of the individual, which in turn often assisted to recognise signs of relapse and ensure that intervention was provided sooner rather than later, to alleviate the need for compulsory addmission and the upset that can be caused to the individual and their families. I also held my own case load, and as a Social Worker, qualified in the area of Mental Health I valued working with people to assist in enhancing their lives in some way.
4 years ago when the ‘cuts’ started to impact on the service provision, where suddenly individuals could no longer have the support worker that they had come to know but could have a much reduced contact visit with a person available. If the client was not in the visit was ‘lost’. No longer would a return visit be in ‘the price’. Mental Health is such a complex issue and so very different for each person. A non contact could be a serious concern. No time to follow up, no time to care, no time to call to the family to make sure all was well. Not surprising the beds are full! the doors are revolving, and the individual is left with a sub-standard level of care. Not to mention the impact on the mental and physical health of the person.
It will get much worse before it gets better, rings a bell……….. I could continue.. I left the job as I could no longer offer what was considered an excellent service by CQC but most importantly by those that we worked along side to ensure at the very least the individual could have what we all want and need as a basic, a right to a home, good health both mental and physical, social inclusion, and to be treated with dignity and the respect we all wish to have.