Thousands of mentally ill people are being forced to have inpatient treatment miles from home despite a government pledge to end the practice, a royal college has warned.
The Royal College of Psychiatrists said more than 8,000 people have had an out-of-area placement since the deadline for the practice to end passed in March 2021.
An out-of-area placement involves admitting patients to facilities outside of their catchment area, and often means they do not get as many visits from care co-ordinators, family or friends.
In some cases, the practice can be deemed appropriate – for example where there are safeguarding issues – but NHS best practice is to ensure patients are being admitted close to home.
In 2016, the government said it would eliminate “inappropriate” out-of-area placements for adults in acute inpatient care by 2020/2021.
However, data analysed by the Royal College of Psychiatrists found there have been 8,925 out-of-area placements since the deadline passed.
Analysis by the college suggests that, from April 2021 to March 2023, there have been an average of 12 new placements every day, with patients sent more than 100km (around 60 miles) from home in 5,335 cases.
The British Medical Association (BMA) and the college have now written to mental health minister Maria Caulfield demanding an end to the placements and greater investment in mental health services.
Dr Andrew Molodynski, mental health policy lead at the BMA, said: “It is shameful that mental health patients in this country are being routinely let down by this government who are now two years past their target of ending the practice of sending patients out of area for treatment by March 2021 and still failing miserably.
“Sending incredibly vulnerable patients with acute mental health needs hundreds of miles away from home, from family, and from loved ones has a hugely detrimental impact on their ability to recover effectively and places them at increased risk.
“This isolating and dehumanising practice is a direct consequence of a fragmented and underfunded mental health care system that has been letting patients down for far too long.
“It is absolutely crucial that the government prioritises the expansion of inpatient mental health beds in England alongside the expansion of the mental health workforce, so this harmful practice is abolished once and for all.”
When patients require hospitalisation, it is vital that there are properly staffed inpatient wards, which depend on a robust mental health workforce— Dr Adrian James
Dr Adrian James, president of the Royal College of Psychiatrists, said: “First and foremost, we need comprehensive community services to avoid admission wherever possible. We also need beds available locally when patients need admission. This is severely lacking in many areas.
“This unacceptable practice – sending patients hundreds of kilometres away from their homes and families – has likely been happening for decades. It risks patients’ mental health to such a degree that they often remain in hospital for longer.”
Dr James also called for the urgent publication of the NHS workforce plan, a long-awaited blueprint that will assess staffing needs across the health service.
He added: “When patients require hospitalisation, it is vital that there are properly staffed inpatient wards, which depend on a robust mental health workforce. This is impossible without the long-awaited NHS Workforce Plan, which must be published urgently.
“If these placements continue it is ultimately patients who will pay the price.
“Patients should be offered effective alternatives to hospital admission so they can receive help earlier, from the right specialist, for their specific needs, instead of being sent out of area for treatment.”
A Department of Health and Social Care spokesperson said: “Everyone should have access to safe mental health care close to home, and we are committed to ending inappropriate out-of-area placements for adult patients.
“We’re investing an extra £2.3bn per year in mental health services by March 2024 so that an additional two million people can get the support they need and investing an extra £150m to help people experiencing a mental health crisis.”
Gemma Byrne, policy and campaigns manager at Mind, said that it was “time to raise the standard of mental health care”.
She added: “These numbers are further evidence that the mental health care system needs a complete overhaul. The number of people sent far from home for treatment, and the level of care they receive is unacceptable.
“People are being let down by a system that’s supposed to give them the best possible treatment when they are at their most unwell. Across the board, from community to acute care, services are struggling to keep pace with a nation in the grips of a mental health crisis.
“But it does not have to be this way – proper care, close to home, can be made available across the board. It is high time the UK Government made good on its promise to deliver a reformed Mental Health Bill, hand in hand with investment in early intervention and community care, as well as a statutory public inquiry into failings in mental health hospitals. It is time to raise the standard of mental health care.”
If you are experiencing feelings of distress, or are struggling to cope, you can speak to the Samaritans, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch.
If you are based in the USA, and you or someone you know needs mental health assistance right now, call the National Suicide Prevention Helpline on 1-800-273-TALK (8255). This is a free, confidential crisis hotline that is available to everyone 24 hours a day, seven days a week.
If you are in another country, you can go to www.befrienders.org to find a helpline near you.
