685 patients were still inappropriately placed outside their area for mental health treatment in England at the end of October 2020.

This means they have been sent away from their home for mental health treatment because no local bed has been available for them.

Being sent out of area and seperated from friends and family can be detrimental for a patient's recovery, Vicki Nash, Mind’s Head of Policy and Campaigns, said:

“The NHS has rightly made ambitious commitments for improving mental health care. But while we are waiting for these to be delivered, thousands of people continue to face the traumatic experience of being sent away from home and separated from their support network to get the help they need.”

While the UK Government has set a national plan to eliminate inappropriate Out of Area Placements (OAPs) in mental health services for adults in acute inpatient care by 2020/21, the number is only slowly decreasing.

Recent data published by NHS England shows that inappropriate Out of Area Placements are as high as two years ago.

There is no significant change from two years ago when 645 inappropriate Out of Area Placements were recorded in October 2018.

During the first lockdown inappropriate Out of Area Placements went down. In April 2020, they reached their lowest point since records began.

This can be due to fewer mental health referrals and restricted access to mental health services because of national restrictions, but also due to less providers submitting data. While on average 90 per cent of providers submit data about Out of Area Placements, the number went down to 79 per cent in April.

The decrease has been only temporary. Since May, inappropriate Out of Area Placements are going up to pre-lockdown levels again.

The cost of sending patients out of the area

In October 2020, the total number of days patients have spent placed outside their area inappropriately was 19,835 days — this equals 54 years.

In just one month, the NHS trusts have spent over £10m on inappropriate Out of Area Placements. Every day a patient spent outside their area costed on average £577 in October 2020.

But the impact is not only monetary.

Travelling hundreds of kilometres from friends and family to receive mental health treatment can have a negative impact on a patient’s recovery, said Vicki Nash, Mind’s Head of Policy and Campaigns.

“Too many people with mental health problems are being forced to travel hundreds of kilometres from their friends and family to receive the treatment they need. This can worsen people’s chances of recovery, as well as being expensive for the NHS and the taxpayer.”

When patients are transferred to a unit outside their usual Community and Mental Health Team (CMHT) network, they can't be visited by their care coordinator. A care coordinator coordinates and monitors the patient's care and should therefore be in regular contact with the patient.

Lack of beds for mental health patients

Patients are sent out of their area inappropriately when no bed is available for them locally.

This is linked with high bed occupancy in mental health units.

In order to maintain patient safety standards, bed occupancy should not exceed 85 per cent. A higher bed occupancy leads to regular bed shortages. These are impacting patient care as directing patients to the bed most suitable for their care is less likely to be possible.

The Covid-19 pandemic intensifies the situation.

“The current pandemic is making this problem worse as increasing numbers of people are presenting in crisis and requiring specialist treatment,” said Dr Adrian James, President of the Royal College of Psychiatrists.

“A lack of beds in adult psychiatric inpatient units is leaving many patients with serious mental illness without the urgent treatment they need.”

The congestion of NHS Trusts leads to patients being sent to private organisations. In October 2020, 79 per cent of receiving organisations were private.

Sending patients to private units is associated with higher costs.

The trusts that are sending the most patients out of their area

In October 2020, 58 NHS Trusts had at least one patient placed out of their area. But some trusts are sending more patients away than others.

The top five sending trusts accounted for more than a third of England’s total Out of Area Placement days and costs.

In four out of the five trusts, on average over 90 per cent of their mental health beds were occupied between July and September 2020.

Trusts struggling to reduce Out of Area Placements

In 2016, NHS England set out how they would improve mental health services by 2020/21. In The Five Year Forward View for Mental Health, they said to eliminate inappropriate Out of Area Placements and promised an extra £1.6bn for mental health services.

But the figures show that the trusts are struggling to reduce the number of days patients are spending in treatment outside their area.

While Lancashire and South Cumbria NHS Foundation Trust and Devon Partnership NHS Trust have seen a decrease in Out of Area Placement days, they are still far off from the target of zero inappropriate Out of Area Placements.

A spokesperson from Lancashire and South Cumbria NHS Foundation Trust said that the Covid-19 pandemic will delay reaching the national target:

“Lancashire and South Cumbria NHS Foundation Trust do not expect to achieve this target due to the COVID-19 pandemic, which happened after the national strategy was set in place. As a mental health Trust, we are committed to the elimination of out of area placements.”

In Birmingham and Solihull Mental Health NHS Foundation Trust, the total days patients have spent outside their area inappropriately have gone up in four consecutive years.

Birmingham among top sending trusts

The Birmingham and Solihull Mental Health NHS Foundation Trust is among the trusts sending the most patients out of their area.

In October 2020, all patients that have been placed out of their area inappropriately accounted for a total of 1,125 days.

Compared to two years ago, the figure has almost doubled — when instead they should be going down to reach the government’s aim to eliminate inappropriate Out of Area Placements by 2020/21.

The highest number of Out of Area Placement days was reached in February 2020 before the pandemic started.

Since April 2016, the Birmingham and Solihull Mental Health NHS Foundation Trust has seen bed occupancy rates continuously above 95 per cent.

This matches what the Care Quality Commission reported about the trust in 2019:

“The service experienced bed pressures. Most wards had bed occupancy rates above 100%. Beds were not always available to patients on return from leave.”

Care Quality Commission

Where are the patients sent to?

In the last 12 months, the Birmingham and Solihull Mental Health NHS Foundation Trust has sent patients to 33 different hospitals. Almost all of them were private.

Patients are often sent to the same units with Lakeside View, Priory Hospital Burgess Hill and Cygnet Churchill leading the list of receiving hospitals.

The distance to the units patients are sent to varies. While Lakeside View in Wolverhampton is a 30 minute drive with the car away (35 kilometres), driving to Priory Hospital Burgess Hill and Cygnet Churchill would take over two hours since they are more than 200 kilometres away.

Between November 2019 and October 2020, more than half of the patients were sent to units between 100 and 300 kilometres away from their home.

The number is likely to be higher

Data is only available for adult acute mental health inpatient care and not for out of area placements in other mental health services such as specialist mental health inpatient services or services for children and young people.

Therefore, the actual number of out of area placements is likely to be higher.

What needs to change

To eliminate Out of Area Placements in mental health services, Dr Adrian James, President of the Royal College of Psychiatrists, sees additional beds as a requirement:

“To tackle this problem the government should invest in additional beds in high priority areas to ease the pressures there and invest in high-quality community mental health services to provide help earlier, prevent crises and reduce admissions.”

Further investment in mental health services are necessary in order for patients to receive the help they need, said Vicki Nash, Mind’s Head of Policy and Campaigns:

“We urgently need to see investment in mental health services reaching the frontline, so that people can get the treatment they need, when they need it, close to home.”

NHS England and the Birmingham and Solihull Mental Health NHS Foundation Trust did not comment on how they plan to eliminate Out of Area Placements by 2020/21.