The count of patients lingering in NHS mental health units in England, despite being medically fit for discharge, has surged to its highest level in at least eight years. In March, "delayed discharges" hit 49,677 days, surpassing figures from any month since January 2016, when NHS Digital began reporting.
According to The Guardian, these discharges climbed from under 17,000 in July 2020, a post-pandemic low. Reasons range from care home placement delays to insufficiently supported housing. The issue, notably prominent at Barnet, Enfield, and Haringey Mental Health NHS Trust, along with East London NHS Foundation Trust, not only prolongs patient stays unnecessarily but also strains hospital resources.
An NHS spokesperson told Asian Voice, “While services are being expanded and transformed thanks to £2.3bn NHS Long Term Plan funding, there is no doubt mental health services are under significant pressure with community crisis services seeing a 30% increase in referrals since before the pandemic, and delays in discharging patients who are clinically ready to leave hospital to places such as social care are affecting how quickly patients can access beds.
“We work closely with colleagues in social care and local government to tackle factors affecting delays, such as housing and care home placements, and our commitment that funding for mental health services will grow faster than the overall NHS budget means we can continue to improve access to transform services, building on the progress made to date which includes seeing one million more patients a year for mental health conditions.”
Emeritus Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, Psychology and Neuroscience at King's College London, Professor Dinesh Bhugra told us, “The reasons for delay in discharge are many. Often patients may not have adequate support at home and overstretched services may not be able to offer proper nursing social support or social care after discharge. Secondly, in many cases, families too need support which may be lacking. Thirdly often there are limited or no facilities to offer patients day care or day centre support. Fourthly discharge depends upon the availability of aftercare whether offered by primary care or secondary care and both are under tremendous pressure. The care is often provided in silos and not in an interconnected manner. There are often no halfway houses where patients can stay for short periods to learn to manage their illnesses and symptoms and gain skills for occupation. Over the past few decades, the number of psychiatric beds has been dramatically reduced so the pressure on beds and staff is truly enormous.
“Services need to look at the delivery of care from several perspectives: crisis homes, halfway houses, hostels, day centres, and day hospitals which can often obviate the need for admission but also can provide a stepwise discharge from increased dependency to independent living. Social care needs to be funded appropriately. Local council budgets have been slashed by up to 40% in the last 14 years so there are fewer opportunities available to look after patients well. NHS is running on the goodwill of the staff who go beyond the call of duty and staff are exhausted and demoralised with rates of burnout tremendously high. These all need a carefully coordinated approach to ensure that inpatient services are not working in silos.”
Speaking to the newsweekly, Dr JS Bamrah, Consultant Psychiatrist said, “Mental health services have long been the ‘Cinderella’ service of the NHS, so that despite the increasing demand, soaring waiting lists, and the misery of suffering patients, resources are stretched and staff demoralised from not being able to provide the high standard they expect to provide, and patients expect from them.
“So while bed numbers have reduced drastically over three decades, in England alone from 67,122 in 1987/88 to 18,171 in 2019/20, the disinvestment from inpatient services has not translated into more funding for community and social care.
“Let me put the current mental health crisis into some context. Around 3.58 million people were in contact with services at some point during 2022/23, just over 6% of the population. The result of this is that mental health crisis teams (that generally manage the riskier patients) and community mental health teams are currently saturated with demand and they cannot often take on patients waiting in hospital beds to go home. They are busy firefighting, and managing the risks of those in the community having a breakdown or being suicidal, so inpatients will be less of a priority because they are in a ‘safe place’. “
Dr Bamrah added, “The solutions are equally complex, and as we have emphasised in a recent BMJ article on the future of the NHS The NHS founding principles are still appropriate today and provide a strong foundation for the future | The BMJ, an incoming new government must declare it a national health and care emergency to relaunch the NHS involving all parts of society, such is the graveness of the situation we are facing. In my over 40 years of service in the NHS, I have never seen so many different services in a state of distress at the same time. Mental health has fared worse than other services because there has been no slack in the system. We need a government that will commit resources to adequate and well-skilled staffing levels, adequate beds, an investment in housing and community services, and support to NHS partners in specialised units, local authorities and the voluntary sectors.
There is no simple solution, but we should start at a point of making that declaration of an emergency to acknowledge that the new government is serious about tackling waiting lists and reducing the burden of mental illness on families, society and statutory services.”
