A survey showing that more than a third of people hospitalised in mental health crisis feel they were sent home too soon is “no surprise”, experts have told Community Care.
The research, published this week by charity Mind, revealed a range of problems people had experienced around discharge planning from mental health hospitals.
National Institute for Health and Care Excellence (NICE) guidelines stipulate that plans should be made for people’s ongoing care from admission or as early as possible from when they go into hospital.
But nearly two in three people (66%) surveyed by Mind said they were not given a written care plan while one in four (23%) said they were unaware of any plan at all.
The findings follow the government’s announcement in October of an independent review of the Mental Health Act 1983, which is due to report back in autumn 2018.
Mind surveyed more than 1,200 people who had been discharged from hospital following a mental health crisis.
As well as more than a third of people saying they had left hospital too soon, a fifth said they had received no notice that they were going home. One in three who had been in hospital more than a month said they had been given less than 48 hours’ notice.
Research published in 2014 found that during the first three months after discharge, patients were at a “particularly high” risk of taking their own lives.
Despite this, fewer than half (44%) of the people Mind surveyed said that managing their mental health or self-care had been considered in their plans for leaving hospital.
Half (51%) said their accommodation needs were considered in any plans, and less than one third (29%) said money and benefits were considered.
Mental health experts contacted by Community Care said without exception that Mind’s findings came as “no surprise”.
Andy Bell, deputy chief executive at the Centre for Mental Health, said the survey results “reflect to a large degree perennial problems” in the system.
“You could probably have seen responses like this at any time in the last 20 years,” Bell said, “and it’s hard without a time series to pick out the precise impact of current [financial and resource] issues in different places, and how much practice is not up to the expected standards.”
Bell said that it was essential the commitment to expanding crisis resolution services in the NHS England-commissioned Mental Health Five Year Forward View was implemented properly.
“It’s often forgotten that planning for discharge is as much a part of that work as gatekeeping and preventing hospital admission when they can,” he said. “We need to ensure that, as crisis teams go back up to nationwide coverage, they include discharge planning and support as a fundamental part of what they do – this survey shows it cannot be optional.”
Pressure on ‘leave’ beds
Steve Matthews, who blogs as the Masked AMHP, said that ‘leave’ beds, which are supposed to be kept open for people making short stays at home, were being filled by others, exacerbating the situation.
“You have a patient supposedly [staying at home as part of] a planned discharge, and then can’t come back to hospital – so they are simply discharged before they’re ready,” he said.
Matthews described recent examples of people being discharged and inadequately supported, leading them to relapse and be readmitted to hospital.
He said shortages of both beds and staff were contributing to a “complete disregard” of the Care Programme Approach (CPA), which is meant to provide for a smooth transition between health and social care services for people with mental health needs.
Another AMHP, ‘AsifAMHP‘, said service cuts and welfare reforms meant that trying to ensure housing and benefits were in place for people who had been in hospital was becoming ever more difficult, even for staff willing and able to put in the effort.
“The CPA and the old Community Care Act were clear that discharges should be properly planned but in the chaos we are working in, how do you practically do that?” he said.
“If people have good social networks, [friends and family] will step into the breach but it’s very hard for people who are isolated,” he added. “Ten or 15 years ago there were more ‘other services’ to pick things up.”
‘Left to cope alone’
Paul Farmer, Mind’s chief executive, described the picture painted by the survey as “shocking”, adding that it was “a tragedy that so many people, so very recently leaving the care of hospital are being left to cope alone” and at potential risk to their lives.
“Whether you’ve been in hospital for days or months, when you come out you need the right care and support to help you stay well,” he said.
“Leaving hospital and coming home can be daunting – you need to feel prepared and confident you will get the support and services you need to help pick up the pieces and continue getting better,” Farmer added. “Providers must urgently make the improvements needed for everyone in their care.”