Mental health rehabilitation must be transformed so most vulnerable are no longer invisible in the system

Online news
26 February 2020

Patients with the most severe and enduring mental health problems are effectively “invisible” in the health care system, reveals a new report published by Rethink Mental Illness and the Royal College of Psychiatrists (RCPsych).

The report, In sight and in mind, shows that this is caused by a lack of national standards in mental health rehabilitation treatment and no agreed definition of what represents appropriate out-of-area treatment.

A snapshot of the system uncovered by Freedom of Information (FOI) requests for the report revealed:

  • 333 beds for people needing mental health rehabilitation care have been decommissioned in the last five years and a further 53 are earmarked for decommissioning
  • 1,744 patients are currently staying in a mental health rehab centre away from their local area 
  • Almost half (11 of 23) of CCGs that reported having decommissioned beds confirmed that they also had patients placed out of area
  • Three quarters of Trusts and CCGs have no plans to reduce the number of patients with enduring mental health problems being sent hundreds of miles from home.
  • Fewer than one in four mental health trusts employ a dedicated community mental health rehabilitation team to help these patients in their local area.

Dr Rajesh Mohan, chair of the faculty of rehabilitation and social psychiatry at the Royal College of Psychiatrists, said: “The findings in our report are deeply concerning. The loss of locally based NHS services in recent times means there are vulnerable people living with severe mental illnesses unable to get the help they need close to home.

“The NHS must stop cutting beds and expand community and acute rehabilitation services so patients across the country can access local rehabilitative support.” 

Mental health rehabilitation services can be vital to people living with severe and enduring illness who may not respond quickly to treatment and struggle to manage everyday activities without support. They help people to live more independently and improve quality of life. 

The NHS Long Term Plan specifically recognises mental health community rehabilitation within plans for new community services for adults living with severe mental illness, aiming to improve access to high-quality, evidence-based care and reduced waiting times. 

However, the research revealed that most areas do not currently have a plan to reduce the number of mental health rehabilitation patients sent out-of-area, and fewer than one in four mental health trusts employed a dedicated community mental health rehabilitation team.

Brian Dow, Deputy CEO of Rethink Mental Illness, said: “Rehabilitation services can be a lifeline to people living with severe mental illness and provide vital support to help them live a life that is as high quality and independent as possible. 

“If people are effectively invisible within a system which is so disjointed and inconsistent, it’s impossible to throw them that lifeline.

“Placing people miles away from family and community connections which can support their rehabilitation can lead to a delay in recovery and increase the potential for relapse. This will have a devastating personal impact and significantly increase the cost of treatment.

“There is a consensus for change, but we need to bring everyone to the table to define what a good standard of care looks like. The system needs to come together and commit to ending inappropriate out-of-area rehabilitation placements so that people can receive essential treatment in their community.” 

In sight and in mind calls for a more joined-up comprehensive approach between NHS England, providers and commissioners to define and then end inappropriate out-of-area placements, allowing people who need in-patient rehabilitation services to access the support they need from specialist teams much closer to home.

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