‘Critically unwell’ mental health patients sent home due to bed shortages

Mental health professionals are sending ‘critically unwell’ patients home because they cannot secure them hospital care due to a shortage of beds, a survey by the Royal College of Psychiatrists has found.

The pressure on beds has also led hospital managers to tell professionals they will only accept patients who have been detained under the Mental Health Act – a process that imposes a series of restrictions on patients’ liberty – and refuse to take patients who agreed to admission voluntarily, the research found. The same issue was reported by Approved Mental Health Professionals (AMHPs) in a survey published last year.

Under the Mental Health Act code of practice professionals have an obligation to seek the ‘least restrictive’ care possible for patients. In most cases the decision to detain a person under the Act involves three professionals, an AMHP and two doctors. The decision on whether an application should be made to detain a patient lies with the AMHP after they have coordinated a Mental Health Act assessment and consulted with the doctors to get their medical recommendations .

Ministers said inpatient beds should be available for those that need them.

The college surveyed 528 trainee psychiatrists working in mental health services across the UK. The survey found that:

• 28% had been involved in cases where a critically unwell patient was sent home because no bed could be found;
• Over a quarter (24%) said a bed manager had told them that unless a patient was detained under the Mental Health Act they would not get a bed;
• 18% said their own recommendation that a patient should be detained under the Act had been influenced by the fact that doing so might make the provision of a bed more likely. 37% said a colleague’s decision had been influenced by bed pressures;
• 30% had seen a patient admitted to a ward without a bed;
• 80% had seen a patient sent to a bed outside of their local area, with 37% sending a patient to a hospital over 100 miles away.

Investigations in recent months by Community Care and BBC News have highlighted that more than 1,700 mental health beds have been closed since April 2011 and shown how bed pressures are being compounded by cuts to community care teams. We have also shown how the pressure on beds is resulting in acutely unwell adults and children being sent hundreds of miles for care.

Sue Bailey, chair of the Royal College of Psychiatrists said that the survey findings showed mental health services were at a “tipping point”.

“Continued cuts to services can only result in further distress and discomfort for patients, many of whom are young, vulnerable, some of whom are forced to receive care far from home. This situation is simply not acceptable,” she said.

Steve Chamberlain, chair of The College of Social Work’s AMHP leads network, said that more evidence that hospitals were refusing to accept voluntary admissions was concerning.

“The situation compromises staff’s professionalism and their ethics. We are under an obligation to follow the least restrictive alternative to detaining someone under the Act. If we are forced to increase restrictions for administrative purposes it is at the very least unethical. It is directly contrary to a key principle of the code of practice,” he said.

“There is an issue about beds. What we really need is a range of responses to people in crisis and not just inpatient beds. We need effective 24 hour services which can support people in the community. Without those services we are inevitably reduced to going down the route of admitting some people in order to keep them safe.”

Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said the DH had to take action over the crisis.

“Jeremy Hunt has said in interviews that ‘unsafe care is the most expensive thing we could possibly do in the NHS’. This survey of psychiatrists echoes the concerns our AMHPs have been raising over the past year about serious problems with mental health care. Mental health services in parts of the country are in dire crisis. A lack of access to acute beds is putting lives at risk and professionals are being pressured to act unlawfully to take away someone’s liberty to improve their chances of securing a bed,” she said.

“Yet we’ve currently got a devolved, fragmented system where everybody is saying these problems are ‘unacceptable’ but not taking responsibility for addressing them. That cannot continue. At the end of the day we have a national health service and the final responsibility lies with Mr Hunt. The government didn’t show a lack of action when Winterbourne View happened, or the A&E crisis happened.”

Dr Alex Langford, a trainee psychiatrist, said: “The fact that psychiatrists are having to consider [recommending] sectioning patients to secure something as basic as a bed is a huge warning sign of extreme under provision. These doctors are using the only option they have left to ensure very unwell people get the care they desperately need.”

In response to the Royal College of Psychiatrist survey findings, care minister Norman Lamb said: “Decisions about detention must always be taken in the best interests of patients at risk of harming themselves or others. Inpatient beds must always be available for those who need them. We are scrutinising local NHS plans to make sure they put mental health on a par a par with physical health.”