Lack of funding for community based mental health services adds to inpatient bed shortage

In 2013-2014 over 1.7 million adults accessed NHS services for severe or enduring mental health problems. A further 947,000 people were referred into Improving Access to Psychological Therapies services for common mental health problems such as depression and anxiety disorders.

A recent review into the provision of acute inpatient psychiatric care for adults (Improving acute inpatient psychiatric care for adults in England) has found that there continues to be a major problem with admissions in many parts of the country and there are significant numbers of people having to travel long distances for care, certainly this is consistent with what our clients are telling us in numerous cases at Attwaters Jameson Hill Solicitors. We have seen where one client was forced to travel over 100 miles to obtain essential mental health care as a voluntary inpatient at a hospital in Manchester due to a shortage of beds in local hospitals in Leicester. For another of our clients, the distance of treating hospital from his home was well over 60 miles, again due to a lack of available local beds.

The review, which is currently in its consultation period, notes that whilst only about 6% of people using secondary mental health services were admitted as inpatients last year, there continues to be a shortage of beds. To put it into context, the average inpatient ward bed occupancy figure in England in August 2013 was 101%, with some wards running at 138%. These figures are not surprising given that the total number of available mental illness beds has dropped from a peak of roughly 150,000 beds in 1955 to roughly 22,300 in 2012. Between 1998 and 2012 alone there was a 39% reduction in the number of inpatient psychiatric beds in England.

Whilst the figures suggest there is a lack of beds, the Commission found that significant numbers of patients were admitted because of a lack of alternatives, many patients being treated on acute wards could have been treated elsewhere, only adding to the shortage. The review showed that Consultants on 92% of participating wards reported treating patients who could have been treated by other services if they had been available.

The most commonly identified alternative services which were unavailable were crisis houses, rehabilitation services, personality disorder services, day services and general community provision.

A further significant problem identified was delayed discharges. The Commission’s survey shows on average roughly one in every six inpatients in participating acute psychiatric wards was clinically well enough to be discharged but could not be discharged due to other factors, these included a lack of community based services.

It is of interest that most respondents in meetings and the Commission’s survey felt that the number of beds was not the most significant issue and that any new investment should go elsewhere. Over half of the consultants who looked after the beds said that they either had enough beds or that they would have enough beds if improvements were made to other services.

What is clear is that the lack of funding generally for mental health services is having a profound effect on the service provided to those at their most vulnerable. It was noted in the review that many patients felt “disenfranchised and excluded” with the care they receive. Sadly there seems to be a situation where the limited funding for community based services is having a knock on effect, not only adding to the lack of beds available to those that need them the most but affecting the overall service provided to patients.

Due to massively underfunded alternative services one of our clients was left in a situation where he faced a complete lack of coherent community based mental health care. He was seen by a differentperson on every visit and there was a notable lack of communication between the various agencies. There were simply not the resources to provide him with the care that he so desperately needed in the community. Tragically he committed suicide.

The Government has now pledged more funding for mental health services however it is unclear as to how exactly the extra funds will be spent. The Government has previously stated that a major expansion of mental health services for children and mothers of new babies will take place. Obviously this is an extremely important boost to those services; however with the number of people accessing mental health services at an all-time high, it seems now is the appropriate time for the long overdue overhaul of NHS mental health service.