Cuts in acute psychiatric care may have gone too far, inquiry finds

http://www.theguardian.com/society/2015/jul/15/cuts-acute-psychiatric-care-too-far-inquiry

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Cuts to the number of acute hospital beds for adults needing psychiatric care in England may have gone too far, according to an independent inquiry led by a former NHS boss.

Significant numbers of people are having to travel long distances for care, while about three patients per ward – 16% nationally – are clinically well enough to be discharged but face a lack of suitable housing or supported accommodation, it says.

Lord Crisp, who was chief executive of the NHS and permanent secretary at the Department of Health from 2000-06, said the inquiry had heard awful stories of people having to be moved miles from their homes.

This was “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.

Crisp, who released the interim findings on Wednesday, was commissioned by the Royal College of Psychiatrists to head a panel researching the issue.

The report recognises that the problem is more complex than just a shortage of psychiatric beds after long-term cuts in numbers. But issues of out-of-area placements, over-occupancy of beds and rationing of care “suggest the reduction in bed numbers may have gone too far”.

Although the commission had heard many positive stories of care, the report says, it was also clear that many patients and their carers felt “disenfranchised and excluded”. Staff at some units were demoralised but needed greater support, training and motivation.

Concerns over patients with mental health conditions not being treated as well as others in poor physical health have been rising in recent years. A government-commissioned survey published this month revealed that public perceptions of care for people with mental health problems and dementia undermined a generally positive view of the NHS. All political parties are trying to devote more energy to the issue.

The 2010-15 coalition government made it a law that mental and physical health conditions must be treated equally, and the annual contract between the Department of Health and NHS England insists that beds must always be available to those who need them and that no one in a mental health crisis should be turned away.

Luciana Berger, the shadow minister for public health, said: “These findings show the profound challenges facing our mental health services. A lack of services in the community combined with serious bed shortages is putting unsustainable pressure on our mental health wards.”

Dr Martin McShane, NHS England’s director for people with long-term conditions, said: “We are determined to improve mental health services and address the distress and unwarranted costs associated with out of area placements which are unacceptable.

“This is why we have set up a mental health taskforce to establish a clear plan for the next five years. We have already announced the first waiting times and access standards in mental health for both psychological therapies and early intervention for psychosis; these measures will mean fewer patients need to travel far afield for care.”