The practice of dispatching patients with severe mental health crises to beds hundreds of miles from their home and families has become endemic in the NHS. It’s a shameful state of affairs on so many levels.It’s one which must be brought to an end.Our analysis shows that more than 5,000 adult patients were sent to so-called ‘out of area’ beds in 2016-17, after year-on-year rises since 2014. But these figures do nothing to account for the human cost.Let me start by coining a thankfully fictitious comparison with ‘physical’ healthcare. How would the country react if stroke patients in London could only be found beds in Darlington?Our TV screens would be filled, I suspect, with rightly outraged families and friends, describing a new low for the NHS. It simply wouldn’t be tolerated.But it’s rare to see outrage at this pernicious practice in mental health care.As in physical medicine, mental health patients can urgently require a hospital bed at any time of the day or night for urgent safety and treatment.When NHS beds are available, they can be readily admitted. But the search for an out of area bed takes much, much longer. It can even take days. The hours and hours we doctors, nurses and social workers spend on this hunt takes us away from caring for other severely ill patients.Meanwhile, patients must wait and wait, suffering the degradation of being held in police cells or remaining in tense situations at home, before being taken miles in locked ambulances to unfamiliar places.The huge distances often involved rule out regular visits from friends and relatives at the very time when their support matters most.The private hospitals the NHS frequently use can refuse admission unless patients are detained under section, leaving doctors with unenviable ethical dilemmas.As most available beds are private, there’s an added cost to the NHS. Last year £160m was drained from the service to pay for these beds.But most importantly, out of area admissions have opened up a ‘safety gap’ in patient care.Unfamiliar hospitals and staff lack the detailed knowledge of patients, held by their doctors back home. They’re less familiar with the risks patients pose to themselves and the treatments that have worked well in the past.Communication breakdown between unfamiliar and home hospitals is also more likely, as the tragic case of David Knight shows.The reasons behind this increasing reliance on out of area beds are complex.We have thankfully de-institutionalised psychiatry in Britain, creating a community care system which is much envied worldwide.But decades of cuts to mental health beds has simply gone too far. It’s plainly shocking that large parts of the country, such as Leicestershire, Derbyshire and parts of north London, have been left with no NHS beds for female patients in need of intensive psychiatric care.It’s easier to slash NHS mental health beds to keep waiting lists down in A&E and for routine operations. And the budget cuts just keep on coming.The government says this endemic shortage of NHS mental health beds can be solved by further improving community care.But this is naïve. While better community care is welcome, it will not ease the bed crisis completely.The scale of the bed crisis uncovered by our research and the horror of human suffering it so clearly causes, demands a complete re-think of adult mental health care in England.Serious re-consideration should be given to boosting the number of beds in the NHS.The current situation is shameful. As a wealthy country we can do much better.
Andrew Molodynski is the BMA consultants committee mental health lead
Read the feature: Far from home, far from hope
Thanks, Andrew, for your accurate summary. My take on it from Cornwall is that the cuts in COMMUNITY PROVISION has led to an increase need for beds. We have the same number of beds as we had 10 years ago, when we never sent anyone out of county. But cuts to community teams have led to us sending patients 'up country' and we now have anywhere between 0 and 15 people in hospital out of county with 54 beds in Cornwall.
It may be a mistake to argue for more beds when if we had adequate community teams we may be able to cope.
Sorry, last comment from Cornwall was from Dr Richard Laugharne, consultant psychiatrist.
Some time ago there were hospitals in extremely nice locations that catered for patients with mental illnesses. They didn't need getting rid of, but modernising and standards of treatment and accommodation bringing up to date. ( ie St Lawrences, Bodmin) Now the community cannot cope, with the result that a lot of mentally ill patients end up in prison as a substitute for a hospital.
I do wonder if changes in service structure to the functional role and non sectorised community teams has exacerbated the problem as currently no clear continuity between inpatients and community in some areas. This appears to lead to delays in treatment both when patients are admitted as well as well discharged due to the fact we keep re-evaluating patients in each setting. Our out of bed use appears to have occurred following these changes. Unfortunately there appears to be less and less communication between inpatient units and community teams.
Thanks for a timely article. For older people, the out-of-area transfer is even more traumatic. When on-call where i work (orthern England) I have had to transfer elderly patients out-of-area more often than working age adults. Our Trust has closed many WAA and OP beds, but failed to realise that the population of older people is growing by an estimated 3% every year, and now the Trust wonders why OP beds are always at >100% occupancy!!