New guidance calls for reduction in ‘out of area’ mental health treatment

The number of NHS mental health patients being sent to care facilities away from their local area should be reduced, new draft guidelines have recommended.

The National Institute for Health and Care Excellence (Nice) said that patients with complex psychosis and related severe mental health conditions should have access to services close to their homes where possible.

The use of rehabilitation facilities “out of area” – outside the health area where the patient lives – should be reserved only for the most complex cases, said Nice.

Paul Chrisp, director of Nice’s centre for guidelines, said that more patients being placed closer to home could “improve their quality of life” and “reduce costs to the NHS”.

Nice said that exceptions could be made for people with psychosis and brain injury or psychosis and autism spectrum, who require highly specialised care.

The guidelines could also be deviated from for patients who have a “clear medical or legal requirement” to remain outside of their area.

Patients placed “out of area”, as well as their families and carers, should be told of the reasons, what steps will be taken to return them to the local area and what advocacy support they have access to, Nice added.

Mr Chrisp said: “Evidence suggests that people placed in out-of-area inpatient rehabilitation units have a longer average stay than those placed in rehabilitation facilities closer to their homes.

“It also suggests that receiving rehabilitation locally makes it easier for people to maintain contact with their families, communities and local support networks or activities, such as peer support groups.

“This can lead to an earlier discharge when they are well enough to be moved back home or live with family or friends.”

To reduce the risk of patients becoming “institutionalised”, Nice recommends that inpatient rehabilitation units operate with a “maximum expected length of stay” – to be used as a guide rather than absolute.

Other recommendations include community rehabilitation, maintaining a patient’s social networks, engaging in community activities including leisure, education and work, and treating physical conditions.

According to Nice, 80% of those referred for mental health rehabilitation have a primary diagnosis of schizophrenia, schizoaffective disorder or other psychosis.

A further 8% have bipolar affective disorder, and the remaining 11% have other diagnoses.

Around two thirds of all those mental health patients are male.

Nice said that while mental health rehabilitation care includes both inpatient and community services, there is “significant” national variation in how they are provided.

In June, a British Medical Association (BMA) investigation revealed that at least 18 areas in England had no NHS mental health rehabilitation wards, leading to some patients being sent hundreds of miles to receive treatment.

The study also included spending figures for mental health rehabilitation beds among 78 of the 176 Clinical Commissioning Groups (CCGs) in England between 2016/17 and 2018/19.

Among these CCGs, spending in the private sector increased by around £21 million during that period – from £165,022,000 to £186,324,000.

Spending on NHS mental health rehabilitation beds rose by around £2 million – from £139,422,000 to £141,594,000 – during this period.

A consultation on the Nice recommendations is open and stakeholders can have their say until February 5 next year.

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