Most severely mentally ill patients ‘invisible’ in health care system

Author: Caroline White

Patients with the most severe and enduring mental health problems are effectively “invisible” in the health care system, concludes a new report* jointly published by charity Rethink Mental Illness and the Royal College of Psychiatrists (RCPsych).

This is caused by an absence of national standards in mental health rehabilitation treatment and no agreed definition of what represents appropriate out-of-area treatment, says the report.

A snapshot of the system uncovered by Freedom of Information (FOI) requests submitted for the report revealed that 333 beds for people needing mental health rehabilitation care have been decommissioned in the past five years and that a further 53 are earmarked for decommissioning.

Some 1744 patients are currently staying in a mental health rehab centre away from their local area. Almost half (11 of 23) of clinical commissioning groups (CCGs) that reported having decommissioned beds confirmed that they also had patients placed out-of-area.

Three quarters of trusts and CCGs have no plans to reduce the number of patients with enduring mental health problems being sent hundreds of miles from home.

Fewer than one in four mental health trusts employ a dedicated community mental health rehab team to help these patients in their local area.

Dr Rajesh Mohan, chair of the faculty of rehabilitation and social psychiatry at the College, said: “The findings in our report are deeply concerning. The loss of locally based NHS services in recent times means there are vulnerable people living with severe mental illnesses unable to get the help they need close to home.

“The NHS must stop cutting beds and expand community and acute rehabilitation services so patients across the country can access local rehabilitative support.”

*In sight and in mind: Making good on the promise of mental health rehabilitation. A joint report from Rethink Mental Illness and the Royal College of Psychiatrists, February 2020.

Mental health rehab services can be vital to people living with severe and enduring illness who may not respond quickly to treatment and struggle to manage everyday activities without support. They help people to live more independently and improve quality of life.

The NHS Long Term Plan specifically recognises mental health community rehabilitation within plans for new community services for adults living with severe mental illness, aiming to improve access to high-quality, evidence-based care and reduced waiting times.

Brian Dow, deputy CEO of Rethink Mental Illness, said: “Rehabilitation services can be a lifeline to people living with severe mental illness and provide vital support to help them live a life that is as high quality and independent as possible.

“If people are effectively invisible within a system which is so disjointed and inconsistent, it’s impossible to throw them that lifeline.”

He added: “Placing people miles away from family and community connections which can support their rehabilitation can lead to a delay in recovery and increase the potential for relapse. This will have a devastating personal impact and significantly increase the cost of treatment.

“There is a consensus for change, but we need to bring everyone to the table to define what a good standard of care looks like. The system needs to come together and commit to ending inappropriate out-of-area rehabilitation placements so that people can receive essential treatment in their community.”

The report calls for a more joined-up comprehensive approach between NHS England, providers and commissioners to define and then end inappropriate out-of-area placements, allowing people who need in-patient rehabilitation services to access the support they need from specialist teams much closer to home.

Responding to the report, British Medical Association (BMA) mental health lead Dr Andrew Molodynski commented that the findings “are indeed disturbing” and back up the BMA’s own research on the practice of sending mental health patients many miles away from home for treatment.

“There are too many vulnerable people who are being let down by the system with substandard treatment in facilities far away from where they live,” he said.

“We need to see a more integrated approach to tackling this issue and we urge the government and NHS England to agree to the recommendations of the report and develop a clear timescale for their implementation.”

*In sight and in mind: Making good on the promise of mental health rehabilitation. A joint report from Rethink Mental Illness and the Royal College of Psychiatrists, February 2020.