NHS to pilot ways to stop sending mental health patients long distances for treatmentBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5339 (Published 03 October 2016) Cite this as: BMJ 2016;355:i5339
NHS England is to test new approaches to delivering mental health services in a bid to end the practice of patients being sent a long way from their home for inpatient treatment.
Six pilot sites will be tasked with redesigning young people’s mental health services and secure mental health services, with the aim of reducing psychiatric hospital admissions, shortening inpatient stays in hospital, and eliminating “clinically inappropriate” placements out of patients’ local area.
The number of mental health patients sent out of area for treatment has risen in recent years because of a shortage of inpatient beds, causing much difficulty for patients, their families, and clinicians.
NHS England said that the £1.8m (€2.1m; $2.3m) investment spread across the six sites would help reduce the need to send vulnerable people across the country to be treated.
NHS mental health trusts, independent sector providers, and charities will be asked to work together to reorganise services in the pilot site areas. Two of the six sites will focus on increasing the level of crisis care available in the community for children and teenagers, with the aim of reducing admissions to hospital and freeing up local hospital beds.
The other four areas will look at relocating people in secure mental health services closer to their home and improving their social care to help them leave inpatient care and reintegrate into their community as soon as possible.
Each site will be expected to produce a plan by December 2016 setting out proposed new clinical pathways and models of care, projected reductions in occupied bed days, and plans for reinvestment in local community services.
The sites were approved by NHS England at its board meeting on Thursday 29 September and will start work on 1 October.
Jeremy Kenney-Herbert, clinical director for secure services and offender health at Birmingham and Solihull Mental Health NHS Foundation Trust, which is partnering with South Staffordshire and Shropshire Healthcare NHS Foundation Trust and the charity St Andrew’s Healthcare in one of the pilots, told The BMJ that the organisations wanted to provide a more consistent service across the region. To achieve this, Kenney-Herbert said that they were considering the idea of a single accountable care organisation with the aim of reducing fragmented pathways in secure care and expanding services in the community, such as forensic or assertive outreach teams, residential rehabilitation, and supported housing.
He said, “We are trying to reduce the number of people who get sent out of area in the first place, and bringing those who are already out there back over a period of time. We think that that can help reduce length of stay for people in secure care as well.
“We would also like to have a more seamless pathway to help people leave hospital, so if you are out of area it’s very clear who will help you, and there is no wrangling about who should be involved and who should be funding it. It’s also about helping people stay out of hospital . . . expanding or developing forensic outreach services, and improving the availability of appropriate housing for people leaving secure care.”
The six pilot sites
Four sites will focus on adult medium and low secure services:
West Midlands—Birmingham and Solihull Mental Health NHS Foundation Trust (with South Staffordshire and Shropshire Healthcare NHS Foundation Trust and St Andrew’s Healthcare)
South London—Oxleas NHS Foundation Trust (with South London and Maudsley, SW London and St George’s NHS Trust, and NHS London Region Specialised Commissioning.
Thames Valley and Wessex—Oxford Health NHS Foundation Trust (with Berkshire NHS Foundation Trust, Dorset NHS Foundation Trust, Central and North West London NHS Foundation Trust, Solent NHS Trust, Southern Health NHS Foundation Trust, Isle of Wight NHS Trust, Response).
South West—Devon Partnership NHS Trust (with Avon and Wiltshire NHS Foundation Trust, Cornwall NHS Foundation Trust, Dorset NHS Foundation Trust, 2gether NHS Foundation Trust, Cygnet, Partnerships in Care, Livewell, Somerset Partnership NHS Foundation Trust).
Two sites will focus on child and adolescent mental health services (tier 4):
West London—West London NHS Trust (with Central & North West London NHS Foundation Trust, Priory and Like Minded).
North East and North Yorkshire—Tees, Esk and Wear Valley NHS Foundation Trust