Mental health patients in England are being harmed by the rise in psychiatric unit placements far from their homes and families, a report indicates.
Some patients had experienced anxiety and post-traumatic stress disorder (PTSD), while others had died by suicide as a result of their distant placements, according to a Health Services Safety Investigations Body (HSSIB) report, which drew on interviews with patients and their families.
The participants said their experiences had resulted in anger, frustration and a loss of trust in the mental health system.
Neil Alexander, a senior safety investigator, said “urgent improvements” were needed to reduce harm to patients. “The reality is patients need to be treated and sometimes it is seen as safer to admit them to an inpatient ward or unit,” he said.
“However, as our investigation sadly showed, the harm caused to patients when moved far from home or moved back and forth between settings can be distressing, for them and for their families.
“The investigation emphasised that inappropriate out-of-area placements are a symptom of wider issues within health and social care: financial and resources pressures, long waiting lists for social housing and a lack of true integration between the two.”
The report focused on “inappropriate” placements where a patient had been sent far away because there was not enough space in their local area, rather than because they needed a specialist service.
There was a “national ambition” to reduce out-of-area placements, including a target set by the government before the Covid pandemic to eliminate their use by 2021. However, data shows out-of-area placements are steadily increasing: in March 2023 there were 793 such placements across England, compared with almost 900 a year later.
Dr Layla McCay, the director of policy at the NHS Confederation, said mental health providers “came very close to eliminating adult out-of-area placements before the pandemic. But the significant spike in demand across the sector has since seen them begin to rise again as demand outstrips capacity.”
She added that reducing out-of-area placements not only benefitted patients but could lead to significant savings, and that she hoped these pressures would be addressed in the spending review and NHS 10-year strategy.
The report found that out-of-area placements could increase patients’ length of stay in hospital and therefore cause harm. Being far from a support network could elicit feelings of anxiety, while being detained and transported could result in PTSD.
It noted that hospitals often did not maintain oversight of the patients they sent out of area, eliminating the opportunity to bring them back when beds became available.
Patients, families and carers felt their choice and opinions were not documented or considered when placement decisions were made, while advocacy support was also often not offered, the research showed.
National organisations told the investigators that out-of-area placements might be the only option for someone who was acutely unwell when no bed was available locally, and might be preferable to someone remaining “unwell and potentially unsafe in the community”. However, they noted that earlier autism and ADHD assessments could reduce the number of people inappropriately admitted to psychiatric units.
One patient said they experienced PTSD as a result of “being taken away in the middle of the night, in handcuffs, and no one explaining to me why”, with their parent adding that their child was “treated like a criminal”.
Another said their family could not afford to travel to see them. “I really miss them and it makes me sad,” they said.
A Department of Health and Social Care spokesperson said the government was changing the Mental Health Act and recruiting 8,500 mental health workers to improve treatment.
“Patient safety is paramount, and anyone receiving treatment in an inpatient mental health facility deserves safe, high-quality care, and to be treated with dignity and respect. We are grateful to HSSIB for this report, which highlights important concerns that can help us to improve inpatient mental health services,” she said.
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
