Mental Health

15.07.15

Other services causing mental health bed shortage – Crisp Commission

Delayed discharges, unsuitable living conditions and inappropriate services are behind excessive bed shortages for mental health patients, an inquiry has found.

The interim report from the Commission on Acute Adult Psychiatric Care found that 92% of consultants in the 122 acute wards surveyed said they treated patients who could have been treated elsewhere if other services had been available.

The commission was chaired by Lord Nigel Crisp, a former chief executive of the NHS in England and permanent secretary of the Department of Health from 2000-06.

One in every six patients was also reported to have been clinically well enough to be discharged but could not – mostly because of a lack of suitable housing.

Each ward reported an average bed occupancy rate of 104% while some ranged as high as 147%, with most of them operating above the Royal College of Psychiatrists’ recommended 85% occupancy rate.

Two in every five consultants claimed there were not enough beds and nearly 30% believed there would be enough beds if improvements were made in other services.

The main contributing factors were found to be availability of housing and quality and resourcing of community teams.

The crucial role of housing in recovery is hampered by the fact that only 59% of mental health patients under the Care Programme Approach were said to be settled in accommodation.

The report says: “Looking behind the figures, there is a large number of individuals who are in pain and distress and whose suffering also affects their families and communities. Evidence from patients, carers and staff is that not all are receiving the care they need.”

Lord Crisp told the BBC: “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.

“Inpatient services play a vital role in mental health and the commission has been impressed by the determination and skills of many staff who care for patients within these wards. However, it is essential that these important services are used as effectively as possible.”

The remit of the commission, which was set up by (but independent from) the Royal College of Psychiatrists, was limited to England and Northern Ireland.

A consultation has been opened on the commission’s findings, with a deadline of 1 September for comments.

Summary of findings from patients, carers and staff

  • There is no need for more acute beds in many mental health hospitals, if the beds they currently have are used more effectively and efficiently.
  • Inpatient care should be seen as a last resort, with patients receiving high-quality care in the community for as long as possible.
  • More resources should be put into the community to develop and improve services.
  • Services for black and minority ethnic people with mental health issues should be sensitive to their needs and the needs of their carers.
  • All nurses need regular updating and additional training and development in terms of how to treat patients with mental health challenges, for example CBT training.
  • All mental health professionals, particularly those located in inpatient care, should have in-depth training to address and extinguish stigmatising and discriminatory attitudes and behaviour.
  • There must be greater investment in a range of therapeutic interventions and activities for patients both in hospital and community settings.
  • Carers must be more involved in the care of patients, and given support and help to manage relatives and friends in the community.
  • In many places the whole inpatient care environment should be radically changed in order to become a safe space which is conducive to healing.

(Source: Improving acute inpatient psychiatric care for adults in England)

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