Working Together to Put the Needs of People and Families First

I am pleased to be able to support the publication of ‘Close to Home’ by the National Development Team for Inclusion (NDTi), as an important addition to the debate about the use of out of area and private sector placements for people who have been detained under the Mental Health Act (MHA).

It can be very traumatic for people in mental health crisis to be assessed and detained under a section of the MHA, and this is often made more stressful for them and their families by having to travel long distances to receive treatment in a mental health unit many miles from home and family. Once in an out of area placement, the support and overview arrangements needed to ensure effective discharge planning may not always be in place.

In addition to the implications for people at the centre of the mental health services and their families, a lack of available local beds is also problematic for the Approved Mental Health Professionals (AMHPs), Doctors and other professionals who work together to assess and support people in mental health distress. The AMHP has to identify the hospital that will receive the person who needs care and support when making the decision to detain, while the Doctor often needs to consider if appropriate treatment is available in the mental health unit. In too many occasions, neither of them will know where the bed is going to be and the AMHP is left waiting for a phone call from a hard-working bed manager searching for an available placement. These delays put pressure on the whole system and may increase the distress of people and families needing help.

Out of area placement issues are often seen as being related to the number of beds available locally, or as part of a ‘patient flow’ and 'length of stay’ issue for the inpatient services in the NHS. While these are important issues, NTDi has rightly highlighted that, in order to reduce the use of out of area placements, there is a need to work across the whole mental health system and have an integrated approach to commissioning services. This includes the NHS, Local Authorities, housing providers, the police, accident and emergency centres and the voluntary or independent sector providers in the community. By working together we can develop systems that put the needs of people and families first and improve access to supportive community support services for people who may be a risk of a mental health crisis that leads to hospital admission. In many areas of the country, health and social care agencies have worked with police, A and E Depts, community and housing services to prevent crisis through early intervention and to improve support for people with the mental health and social care support issues that could be better dealt with in the community.

The same is true for the support needed at the other end of the process – the effective discharge of people who have received the care and treatment they require in hospital. People may need to remain on mental health wards due to difficulties funding appropriate community support, housing or specialist placements and this can affect local access to beds.

There are some developments that may improve this situation. The Mental Health Act Review in 2018 recognised the importance of dignity and human rights with good community alternatives and the need to ensure that hospital admission is as therapeutic as possible. The review of rehabilitation services by the ‘getting it right first time’ programme absolutely recognises the importance of the ‘whole system’ approach. The community mental health framework currently being piloted by NHS England is an opportunity for NHS health services to link with personalised and strength based Local Authority community and hospital social work teams and work together to support people in their communities. Finally, the recently set up taskforce for autism, learning disability and young people has the opportunity to improve services and outcomes for some of the most vulnerable people within the mental health system.

This is, therefore, a good time for NDTi to remind us of the issues, the work we need to do, and some of the possible ways forward.

Mark Trewin is Mental Health Social Work Lead at the Office of the Chief Social Worker, Department of Health & Social Care.