Anyone who has spent time on an acute mental health ward will know what challenging places they can be for both patients and staff. Vulnerable people with serious mental health problems too often receive poor care in an environment that is unsafe and far from therapeutic.
You would not want to your loved one to be somewhere like that unless there were no other options. So it is scandalous that increasing numbers of people are being left on mental health wards when they are well enough to leave because of the lack of available social care.
NHS England data – obtained by the BBC – found that the rate of delayed discharges in mental health is increasing faster than in other areas of the health service. From November 2015 to October 2016, there was a 56% rise in the number of bed days lost to delayed discharges in mental health trusts. This is almost twice the rate of the increase in acute trusts. There is also a huge financial implication, with the crisis costing the NHS [pdf] more than £170m a year.
Delayed discharges disproportionately affect those who are already socially disadvantaged and addressing this issue should be central to Theresa May’s pledge to tackle “burning injustices”. The latest findings from the independent review of the Mental Health Act [pdf] have identified that people from black and minority ethnic (BME) communities continue to be over-represented as patients on mental health wards and are more likely to have been compulsorily detained. This reflects my own experience of working to reduce delayed discharges in a London mental health trust. The majority of patients were from BME communities and nearly all were on low incomes.
I found that delays were often the result of conflict between local authorities and clinical commissioning groups about who should pay for a person’s care. Frequently, healthcare professionals, patients and their families would push for a higher level of support while commissioners wanted evidence that a less expensive alternative had failed. This sometimes resulted in patients being discharged with an inadequate level of support – and finding themselves readmitted to hospital.
Responsibility rests with a government that has cut spending on services for some of the most vulnerable in our society
It is important to recognise the transformative effect that providing someone with the right care and support can have. Vea (not her real name) was a middle-aged woman of Caribbean descent who had long-standing psychosis and a lifetime spent under the care of mental health services. When I began working with her, she had recently been sectioned after becoming acutely unwell. Before this she had been turning up frequently at the hospital begging for food.
While Vea was in hospital, I visited her housing association flat. It was bare, with a broken window and toilet and no food other than a packet of cereal, which was years out of date. Months later I visited Vea in the supported accommodation I had worked with her community nurse to secure funding for. The improvement in her mental health and quality of life was immense. Without this intervention, I have no doubt she would have soon been back on the ward.
It is too easy to blame commissioners for the delayed discharge crisis in mental health. They are forced to meet increasing demand for social care when their budgets have been reduced by almost 50% [pdf] since 2010-11. Responsibility rests with a government that has cut spending on vital services for some of the most vulnerable people in our society.
The long overdue green paper could have been an opportunity to prove the government is serious about addressing the social care needs of people with severe mental health problems. The fact that it is to solely focus on the needs of older adults means this crisis will continue at the expense of both patients and the taxpayer.
- David Stephenson is a former discharge co-ordinator at an NHS trust