The number of out-of-area mental health placements nationally is a problem the government recognised and set targets to address. However, the COVID-19 outbreak is anticipated to delay this, the end of March NHS report revealed. 

Birmingham, Sandwell and Solihull are no exception to the high numbers of mental health patients treated outside their catchment area of services. The most recent NHS figures (2019) report that approximately 380 acute mental health patients, who experience distressing symptoms requiring immediate and intensive treatment, were subject to such placements. 

An ‘appropriate’ out-of-area placement could be if a patient became unwell whilst away from home, or there were safeguarding concerns including domestic abuse or gang-related issues. Yet, 345 – or around 91% – of the 380 out-of-area placements in Birmingham, Sandwell and Solihull, were attributed to a lack of beds and therefore considered ‘inappropriate.’

It is crucial, even in a crisis, that those who need mental health treatment can access the right care, where possible, close to home

This is despite the government’s target set in 2016 to eliminate inappropriate out-of-area placements nationally by March 2021. According to Birmingham Live, the national figures have increased each year since first publication in 2017. Across England, the figures stand at 8,450 inappropriate out-of-area placements in 2019, up from 8,125 in 2018 and 8,035 in 2017. 

Mental health charities, alongside several MPs contacted across Birmingham, Sandwell and Solihull, have expressed concerns about these increasing figures. The impact of sending mental health patients hundreds of miles from home can detrimentally affect recovery prospects. 

Vicki Nash, head of policy and campaigns at the mental health charity Mind, warned Birmingham Live: ‘We know that in recent years more and more people have been sent hundreds of miles away from their home to receive care. This can worsen people’s chances of recovery, increase their risk of suicide and have a devastating impact on family and friends.’ 

They have also expressed they are monitoring the impact of NHS measures to deal with coronavirus ‘to make sure that the voices, rights and choices of people with mental health problems are not forgotten.’ 

She added: ‘It is crucial, even in a crisis, that those who need mental health treatment can access the right care, where possible, close to home.’ 

Statistics have also revealed the extent of the distance some mental health patients subjected to out-of-area placements must travel. Birmingham Live reported that around five of the out-of-area placements in 2019 were more than 300km away from their mental health service, with a further 80 placements between 200km and 300km away. 

Some of these placements continue for a month and a smaller number beyond 90 days. The cost of this in Birmingham, Sandwell and Solihull was some £560 a day last year to assign a mental health patient a placement outside their catchment. Annually, this cost £8.9 million. 

The NHS insist improvements have since been made which are not reflected in the latest figures for 2019. An NHS England spokesperson told Birmingham Live that ‘steady and sustained reductions in out of area placements in the last six months’ and that through their ‘Long-Term plan significant investment is being made in community mental health and crisis services to help ensure everyone can access mental health care locally by 2021.’ 

Significant investment is being made in community mental health and crisis services to help ensure everyone can access mental health care locally by 2021

However, an NHS report on managing capacity and demand during the coronavirus pandemic, acknowledges that capacity is likely to be impacted by the outbreak. The document, which includes information on inpatient and community mental health, maintains the ambition to eliminate out-of-area placements by March 2021. 

This could result in a need for more out-of-area placements, such as utilising additional independent sector capacity. Advice places patient safety as paramount; it is safer to admit an acutely unwell person to an out-of-area inpatient placement until local care is available, than to turn the person away from admission. 

When approached on his thoughts concerning this issue, Andrew Mitchell, Conservative MP for Sutton Coldfield, told Redbrick: ‘Our manifesto commits us to treating mental health with the same urgency as physical health. There is much to do to ensure that everyone can access the services that they need particularly during this lockdown period. I share the concerns that have been raised about the number of patients that are being referred for treatment outside of their local area.’ 

‘While outside area referral can help reduce waiting times, it is only practical if patients are able to travel to their appointments. Many hospitals and healthcare settings have had to change their services as a result of Coronavirus and I have been in regular contact with our local NHS Trusts to discuss their plans for the weeks and months ahead.’  

‘Longer term, mental health services will receive an extra £2.3 billion, with a particular focus on children’s and young people’s mental health, giving 345,000 more children mental health support and giving more adults access to talking therapies.’

Longer term, mental health services will receive an extra £2.3 billion, with a particular focus on children’s and young people’s mental health, giving 345,000 more children mental health support and giving more adults access to talking therapies

Andrew Mitchell expressed hope that these provisions will help to reduce waiting times and make required services more accessible to patients in their local area. He said he will continue to follow this issue closely in the coming months. 

Sharing a similar yet less hopeful outlook of the situation improving, Steve McCabe, Labour MP for Selly Oak, told Redbrick: ‘No one should be sent far away from their home to receive mental health treatment. It takes vulnerable people away from their support network and the care they need from the professionals who know them. The government needs to invest in frontline mental health services so we can overcome the current shortage of beds and begin to fix the mental health crisis.’

‘Over the past few years I’ve been contacted by many constituents who’ve had their loved ones sent out of the local area due to bed shortages. Unfortunately, I think this will remain an issue until the government really commits to treating mental health on parity of esteem with physical health in our NHS.’ 

I appreciate the recent significant impact of Covid-19, but my colleagues and I have been pressing this issue for many years

‘I welcome the government’s commitment to eradicate Out of Area Placements (OAPs) by 2021, however this is a longstanding promise and I think we all would have hoped they would have made more progress on this issue by now. I appreciate the recent significant impact of Covid-19, but my colleagues and I have been pressing this issue for many years.’ He has described the latest figures as ‘disappointing.’  

Steve McCabe also recognised the ‘significant impact’ of the current crisis on many people’s mental health, describing this as ‘a potential hidden cost of the coronavirus.’ He expressed his confidence in Labour’s new Shadow Minister for Mental Health, Dr Rosena Allin-Khan, in ensuring that mental health ‘is not forgotten’ as we start to emerge from this crisis. However, he emphasised: ‘the government must act with greater urgency.’ 

Like this article? Here are more stories from News:

Birmingham Hippodrome Announces Redundancies and Prolonged Closure

Leaked Messages Undermine UCU Apology

#BLACKLIVESMATTER