Mental health patients in England are being harmed by the increase in placements in psychiatric units far from their homes and families, a new report has found.
Patients have suffered from anxiety disorders and post-traumatic stress disorder (PTSD), while some have died by suicide as a result of their remote placements, according to a report by the Health Services Safety Investigations Body (HSSIB), which drew on interviews with patients and their loved ones. those. Participants described how their experiences had resulted in feelings of anger, frustration and a loss of confidence in mental health care.
Neil Alexander, a senior safety researcher, said “urgent improvements” were needed to reduce harm to patients.
He said: “The reality is that patients need to be treated and sometimes it is seen as safer to admit them to an inpatient unit or ward.
“However, as our research has sadly shown, the harm caused to patients when they are moved far from home or between institutions can be painful, for them and for their families.
“The research highlighted that inappropriate out-of-area placements are a symptom of wider problems within health and social care: financial and resource pressures, long waiting lists for social housing and a lack of real integration between the two.”
The report focused on “inappropriate” placements where a patient has been sent far away because there is not enough space in their environment, rather than because they require a specialist service.
There was a “national ambition” to reduce the number of out-of-area placements, including a target set by the government before the Covid pandemic to eliminate their use by 2021. However, data shows that the number of out-of-area placements is steadily increasing: there were 793 placements in March 2023, compared to almost 900 across England a year later.
Dr. Layla McCay, director of policy at the NHS Confederation, said mental health providers had “come very close to eliminating out-of-area placements of adults before the pandemic. However, due to the significant spike in demand in the sector, demand has since started to rise again as demand exceeds capacity.”
She added that reducing out-of-area placements was “not only beneficial for patients but could also lead to significant savings”, and she hoped these pressures would be addressed in the spending review and ten-year NHS strategy.
The HSSIB report shows that out-of-area placements can increase patients’ length of stay in hospital and therefore harm patients. Being far from a support network can trigger feelings of anxiety, while being detained and transported can lead to PTSD. It further noted that hospitals often failed to monitor the patients they sent out of the area, eliminating the opportunity to return them to their neighborhoods once beds became available.
Patients, families and carers felt their choices and opinions were not documented or taken into account in out-of-area placement decisions, while advocacy was often not offered, the research found.
National organizations told researchers that out-of-area placement could be the only option for someone who was acutely unwell when there was no bed available at the local hospital, and that this could be preferable to someone who remains “unwell and potentially unsafe in the community”. However, they noted that earlier assessments of autism and ADHD could reduce the number of people inappropriately admitted to inpatient psychiatric units.
One patient interviewed for the report said they experienced PTSD as a result of being “taken away in the middle of the night, in handcuffs, and no one explained to me why,” with their parents adding that their child was “treated like a criminal ‘. ”.
Another said their family could not afford to travel from the north of England to the south. “I really miss them and that makes me sad,” they said.