Mental health beds crisis ‘driven by discharge delays’, finds report

The problems social workers and other professionals have securing beds for mental health patients is mainly driven by discharge delays and cuts to community services, not bed closures.

That’s the message from an interim report published today by the commission on acute adult psychiatric care in England. The commission was set up by the Royal College of Psychiatrists to probe the factors behind “major problems” securing hospital admissions for mental health patients in parts of the country.

There was a 39% reduction in the number of inpatient psychiatric beds in England between 1998 and 2012, the commission’s report said. It found that bed closures “may have gone too far” but concluded that any ‘beds crisis’ was “very significantly a problem of discharges and alternative to admission” and tackling those issues should be the priority.

One of the key drivers of the inquiry was reports that mental health patients were being sent hundreds of miles for beds due to their local units being full.

Lord Crisp, the former NHS chief executive who chairs the commission, said the commission had heard some “awful stories” of people being moved miles from their homes to find the care they needed.

“However…this appears to be largely due to there being significant numbers of patients ready for discharge but with nowhere else to go and others who have only been admitted because there weren’t suitable alternatives for them outside hospital,” he said.

To understand the pressures on beds the commission carried out a ‘snapshot’ survey of bed usage in acute admissions wards at 44 of England’s 56 mental health trusts. This exercise found:

The wards had an average bed occupancy of 104%, way above the Royal College of Psychiatrists’ recommended 85% occupancy rate for safe care.

Around one in six patients per ward could have been treated in different settings, such as crisis houses or rehab services, if they had been available.

• Another 16% of patients were identified as having their discharges “inappropriately delayed”. This was most commonly due to housing issues or a lack of capacity in community teams to take patients on to their caseloads.
• 38% of consultant psychiatrists on the wards said that there were not enough beds.
• 28% of the consultants said there would be enough beds if improvements were made in other services.
• 28% felt there were enough beds in their local area.

Healthwatch England has previously raised concerns that the pressure on trusts to free-up beds has seen some patients discharged too early and without enough support. Experts have warned that mental health patients are at the highest risk of taking their own lives in the first two weeks after being discharged from hospital.

The Royal College of Psychiatrists’ commission heard evidence from staff that restructuring of community teams due to funding cuts had left some services “no longer operating as originally intended”. Some community psychiatric nurses were left carrying “huge” caseloads and some crisis resolution teams – the services designed to provide intensive home treatment as an alternative to admission – only had time to assess, rather than treat, people.

“Furthermore, while bed numbers have continued to decline across the country as a whole in some areas this appears to have happened in parallel to reductions in community mental health services,” the report said.

“Changes in bed numbers are largely obvious and transparent, whereas cuts to community services are often invisible because they are not reported on national datasets”.

The commission is seeking views on its interim findings. A final report will be published in early 2016.