Exploring alternatives to hospital-based mental health care
Anna Iskander-Reynolds, Julia Doyle, Andy Bell, David Woodhead and Frederico Cardoso
Inpatient care should be part of a holistic system of support that seeks to provide care in a mental health crisis quickly, compassionately, and close to home. But too often, it is characterised by coercion and restriction in environments that risk re-traumatising patients rather than helping them to recover.
Care beyond beds was commissioned by NHS England to support a bold vision for the future model of mental health services – including alternatives to inpatient care. Drawing on qualitative research and a review of relevant literature, it finds that experiences of inpatient settings are often marked by unsafe levels of bed occupancy, chronic staffing shortages and dilapidated facilities. Black people, neurodivergent people, children, and people from the LGBTQ+ community are among the most poorly served.
Limited community support means that people struggling with their mental health are funnelled towards the more acute end of the system, causing further distress and higher costs. 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.
The option of an inpatient bed may always be needed to keep people safe at times; as long as it is close to home, adequately staffed, and of a high quality. But for many people, there may be alternatives, either to stay at home or to receive care in an intermediate space. Care beyond beds explores the alternatives to inpatient provision, including crisis houses and cafes, peer support, and crisis planning interventions.
Care beyond beds shows that small-scale, incremental improvement to inpatient care will not be enough to create the systemic change needed. A radical overhaul of the system is required, with a reorientation to meeting people’s needs far earlier, closer to home, in settings that are therapeutic and accessible.
The next five years could be an opportunity to engender that systemic change. With proper investment as part of the NHS ten-year plan, integrated care boards have the power to build better systems of support that will reduce reliance on hospital beds, taking the pressure off local inpatient services and making out-of-area placements unnecessary.
Lead author Anna Iskander-Reynolds and chief executive Andy Bell set out some of the key findings of the research
