‘There is so much to gain from an integrated local and national mental health crisis care service’
Delayed transfers of care happen when someone in a mental health crisis remains in hospital or a mental health bed for longer than they clinically need to be there.
For a service user, the impact of an extended hospital stay can be profound. It can significantly affect their confidence and, consequently, their ability to go back to living independently in the community. This can lead to a further crisis and a return to inpatient care. And when wards become too full, it delays or prevents other service users in crisis from getting an appropriate bed when they need it. People can be placed ‘out of area’ to receive treatment – often a necessary evil to make sure patients receive crisis care as soon as possible. But this can also increase the likelihood of an extended stay, and the associated problems for the person’s recovery.
In a bid to tackle the problem, NHS Providers last year convened the Right place, right time commission – a panel of experts in health, local government, social care and housing – to review evidence around why delayed transfers of care occur and what can be done to address them.
The commission found that delays were caused by a number of factors, for example: insufficient resources (including funding and staff); a rise in Mental Health Act cases; a lack of co-ordinated community-based support (such as housing, primary care and social services); and inadequate information about service users’ needs – which often present unique and complex physical and mental healthcare challenges.
But the commission also found that delayed transfers are often preventable. Its report drew on some examples of good practice, where members have successfully worked with other services to find local solutions that meet specific population needs.
In the first example, Leeds and York Partnership NHS Foundation Trust’s Accommodation Gateway programme enabled service users to have a say in determining the best housing placement for them. The programme has reduced delayed discharges, improved service user experience, and provided local partners with a more co-ordinated and efficient process for managing and meeting service users’ accommodation needs.
Elsewhere, Northumberland, Tyne and Wear NHS Foundation Trust’s bed management and transfers system has, since its introduction 18 months ago, significantly improved co-ordination between primary and secondary community mental health services, made services more responsive to people in crisis, and significantly reduced the number of out of area placements.
Commissioners for the London Borough of Waltham Forest have piloted the provision of ‘care navigators’ to support service users for a period of 12 to 10 months after they are discharged from a mental health service. This has bossted post-discharge treatment, improved primary care appointment attendance, and reduced the incidence and duration of crises.
Over at Camden and Islington NHS Foundation Trust, members have been working with a social housing charity and the local council to provide more tailored clinical and support care for people with complex mental health care needs, leading to fewer admissions, shorter stays, and reduced costs.
These positive models, among others, helped inform the commission’s work and its recommendations for tackling the problem of delayed transfers of care. Its report sets out a series of calls to action for all parts in the system, including national bodies, local government, social care, housing and mental health service providers. Specifically, it identifies three crucial changes that we believe will bring about significant and rapid improvements in transfers of mental health care, as well as helping to deliver the core principles and outcomes of the Crisis Care Concordat.
First, people with lived experience of mental illness should be involved in service design and care planning. Second, there shoudl be a more co-ordinated approach among local partners to care planning, housing placements and service users’ journey along care pathways. Finally, commissioners should ensure that teams are available in both community-based mental health care and crisis resolution home treatment, to support people who no longer need to stay in hospital.
We believe the work carried out by the frontline ‘Right place, right time’ experts complements the Crisis Care Concordat’s achievements to date. We have already seen some significant developments in mental health crisis response, which show what can be accomplished when stakeholders at both national and local level work together towards a single common goal – to improve the experience of mental health service users.
But, much wider-reaching benefits can be reaped by cutting delays in mental health care transfers, which currently absorb one in 20 bed days and cost the NHS £2 million a year. And with the recommendations from the Mental Health Taskforce and the Commission on Acute Adult Psychiatric Care expected soon, we urge ministers and policymakers to draw on this framework, to ultimately better support people in a mental health crisis.