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The way ahead for adult acute mental healthcare provision, UK

Faster access to acute care and an end to sending severely-ill mental health patients long distances are among the recommendations made in a new report launched today by an Independent Commission led by Lord Nigel Crisp and supported by the Royal College of Psychiatrists.

The Commission was set up in 2015 to address the issues facing patients in England needing acute care for mental health problems; patients who currently have no guarantee that they will be treated swiftly or even that the care they receive will be of an expected standard.

In 2014/15, 1.8 million people in England used mental health services, with 103,840 being admitted to hospital.

Current estimates suggest that around 500 mentally ill people have to travel over 50km to be admitted into hospital every month. These long distance admissions are mainly due to difficulties in finding acute inpatient beds or suitable alternative services in their home area, and are a symptom of far more widespread problems in the functioning of the whole mental health system.

With system-wide problems including variable quality of care in inpatient units, inadequate availability of inpatient care or alternatives to inpatient admission when needed, and patients remaining in hospital for longer than necessary due to inadequate residential provision, the acute psychiatric care system was well overdue for a review.

The Commission’s report consequently recommends significant changes to how mental health services are commissioned, organised and monitored across the whole mental health system.

The report clearly lays out exactly what is required to address the problems in accessing acute inpatient care for adults, with twelve recommendations that will help to close the gap that currently exists between access to acute mental and physical healthcare provision.

These include:

  • The introduction by October 2017 of a maximum waiting time of four hours for admission to an acute psychiatric ward for adults or acceptance for home based treatment following assessment.
  • Phasing out nationally the practice of sending acutely ill patients long distances for non-specialist treatment by October 2017.
  • More investment in home-based treatment, information systems and staff.
  • That patients and carers are enabled to play an even greater role in their own care as well as in service design, provision, monitoring and governance.
  • The piloting of a Patients and Carers Race Equality Standard in mental health alongside other efforts to improve the experience of care for people from Black and Minority Ethnic communities.
  • Better access to a mix of types of housing – and greater flexibility in its use – to provide for short-term use in crises, reduce delayed discharges from inpatient services, and to offer long-term accommodation.
  • That service providers, commissioners and Health and Wellbeing Boards work together to improve the way the mental health system works locally – sharing information, simplifying structures where appropriate, and finding innovative ways to share resources and deliver services.

Chair of the Commission, and formerly Chief Executive of the NHS in England and Permanent Secretary of the Department of Health from 2000 to 2006, Lord Nigel Crisp said:

“It is time to end the difference in standards between mental and physical illnesses. People with severe mental illnesses need to be able to find care just as quickly as people suffering from physical illnesses – and they shouldn’t have to travel long distances to do so.

“Most of what is needed is already being done somewhere in the country with committed and innovative people – patients and carers as well as professionals – working hard to improve services. This report’s recommendations are designed to get behind their efforts and help them to share their learning and achieve their ambitions.”

President of the Royal College of Psychiatrists, Professor Sir Simon Wessely said:

“Everyone agrees that it is a scandal that patients with serious mental disorders who need admission can end up being sent anywhere from Cornwall to Cumbria in a search for a bed. And yet it continues.

“When I became President of the Royal College of Psychiatrists I asked Lord Crisp to chair an independent commission into the state of acute psychiatric care. He and his team have travelled the length and breadth of the land looking at inpatient services, finding much to like, but still not enough being done.

“The answers lie not in just providing more beds, although there are definitely places where that might help in the short term, but assessing the entire system. In particular we stand alongside Lord Crisp in asking that there is a new pledge for a maximum four hour wait for admission or home treatment by 2017, and that the unacceptable practice of sending seriously sick patients around the country is ended by the same date. If we were talking strokes, heart attacks or cancer, we wouldn’t even have to ask.”