An independent Commission report which examined some of the key factors behind shortages of adult mental health beds in the UK found that 'the so-called bed or admission crisis in adult mental health is very significantly a problem of discharges and alternatives to admission that can only be addressed through changes in services and management of the whole service'.
The Commission, chaired by Lord Nigel Crisp, a former CEO of the NHS in England, and Permanent Secretary of the Department of Health), was established in early 2015 by the Royal College of Psychiatrists to investigate widespread concerns about a shortage of acute adult psychiatric beds.
The Commission’s interim report argues that 'the problem is not just to do with numbers of beds or admission processes', and describes how many patients currently being treated on adult acute wards 'could be treated in other settings if only they were available'. It says many others remain as inpatients even though clinically well enough to be discharged.
The Commission sent surveys requesting a 'snapshot' of bed usage to 56 NHS mental health trusts in England for completion between 12 May and 3 July this year.
The survey found that:
- 92% of wards are treating patients who could have been treated by other services if they had been available. The most common alternative services required are crisis houses, rehabilitation services, and services for patients with a personality disorder.
- Approximately three patients per ward (16%) are clinically well enough to be discharged from inpatient care, but cannot be because of other factors. A lack of suitable housing is a significant factor in preventing discharge in half these cases.
- Consultants responsible for admitting people to majority of these wards felt either that there are enough beds now, or that there would be if more alternatives were available in the community.
Lord Crisp said: “There is undoubtedly a problem with finding beds for some patients, and the Commission has heard awful stories of people having to be moved many miles from their homes in order to find the care they need. However, as our survey and other research shows, this appears to be 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.”
- Many patients and carers feel ‘disenfranchised and excluded’, and there is a need for greater engagement and implementation of best practice.
- The current ‘spectrum’ of pressure and performance ranges from units with demoralised staff ‘trapped in a constant process of crisis management’, to those where staff ‘are able to purposefully deliver high quality care and services’.
- A ‘data and information crisis’ makes it very difficult to understand what is happening throughout the system, measure variation, and bring about improvements.