A radical overhaul of mental health care is needed to achieve the Government’s goal of shifting treatment from hospitals to communities, a new report from Centre for Mental Health said today.
Care beyond beds finds that inpatient care is too often characterised by unsafe levels of bed occupancy, chronic staffing shortages and dilapidated facilities which risk re-traumatising patients. Black people, neurodivergent people and children are among the most poorly served.
The report says that the NHS ten-year plan must boost investment across the mental health system to drive a ‘safe and sustained shift’ towards community care, and to provide inpatient care which is high quality, close to home and adequately staffed.
It finds that limited community support means that people struggling with their mental health are ‘funnelled’ towards the more acute end of the system. This causes more distress and upheaval, and higher costs for services. This is especially the case for ‘out-of-area’ placements, with patients being sent miles from their homes and support networks to get a hospital bed.
“Every time I have been admitted and then released ‘back into the community’, you have to start all over again… You have to pick up the pieces and come to terms and recover from having been in one of the most scariest and traumatic environments ever. Once returned to ‘normal life’ there is a different level of care for patients.” (Person with lived experience)
“We’re offering people a model of care that doesn’t work, and we’re spending so much money on it. And we don’t have enough money to meet all of the needs that we want to meet. […] So we’ve got a huge opportunity to think really radically differently about how we might use that resource to better meet people’s needs.” (System leader)
The report says that inpatient services are an important part of our mental health care system, but that comprehensive investment in alternatives to inpatient care, such as crisis cafes and houses, would enable more people to get effective care closer to home. Wider use of advance choice documents, peer-led services, and better support with housing, work and money will also reduce reliance on inpatient care.
Andy Bell, chief executive at Centre for Mental Health, said: “The NHS spends as much on inpatient services as it does on community mental health care, even though the vast majority of people access their support through community settings. As the Darzi report says, too many inpatient services are in outdated buildings that make safe and therapeutic care harder to provide.
“Small-scale and incremental change will be insufficient to deliver the system-wide change that’s needed. We need to redesign our mental health system with a wider range of options, including from community and voluntary sector organisations, and a much bigger say for people using services in the kind of treatment and support they can get.
“The new Mental Health Bill promises to modernise mental health care. It must go hand-in-hand with investment in services, staff and better facilities so that people can receive compassionate and effective support in a mental health crisis close to home wherever they live.”
