Phasing out unacceptable long-distance admissions for severely mentally ill patients and quicker access to acute psychiatric care are two key recommendations made by an Independent Commission for improving services in England.
The Independent Commission on Acute Adult Psychiatric Care was set up by the Royal College of Psychiatrists (RCPsych) in January last year in response to growing concern about the provision of acute inpatient psychiatric beds across the country.
It found that access to acute care for severely ill mental health patients is “inadequate nationally” and in some cases “potentially dangerous”, and that there are “major problems” both in admissions to psychiatric wards and in providing alternative care and treatment in the community.
Around 500 mentally ill people are being admitted into hospitals over 50km away, largely because of difficulties in finding acute inpatient beds or suitable alternatives in their home area. This, says the RCPsych, is a result of system-wide problems across the whole mental health system, including care inequalities, lack of service availability, and hospital bed-blocking because of inadequate residential provision.
The Commission’s report is recommending significant changes to how services are commissioned, organised and monitored across the whole mental health care pathway. Top of the list are a four-hour waiting time limit for admission to an acute psychiatric ward or home-based treatment after assessment and phasing out nationally the practice of sending acutely ill patients long distances for non-specialist treatment by October 2017.
Commissioners, providers and Strategic Clinical Networks in each area should together undertake a service capacity assessment and improvement programme to ensure that they have an appropriate number of beds as well as sufficient resources for community care, and there must also be better and more flexible access to housing for short-term use as well as long-term accommodation.
'End the different standards'
“It is time to end the difference in standards between mental and physical illnesses,” said Lord Nigel Crisp, Chair of the Commission, and formerly chief executive of the NHS in England and Secretary of the Department of Health from 2000 to 2006. “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”.
“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,” added Sir Simon Wessely, president of the RCPsych.
“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.”