NHS England (London) has developed the Mental Health Compact which sets out the minimum expectations for mental health patients requiring an inpatient admission to an acute psychiatric bed. The Compact outlines the roles and responsibilities of individual organisations along patient pathways to admission and details principles for a London-wide approach to capacity management and escalation (when required) to prevent the sometimes, lengthy waits to inpatient beds.
In South London, in particular, work is underway with acute and mental health providers to review activity, service models and pathways to understand recent increasing demand and any system-wide capacity constraints. This is to develop a common understanding of the challenges and enable joint working to improve flow through mental health and emergency care pathways, meet the needs of people presenting with mental health problems and reduce system pressures.
The Five Year Forward View for Mental Health is clear that everyone should be able to receive the care they need in the least restrictive setting and as close to home as possible. This means a local acute inpatient bed should always be available if required. To support this aim NHS England and NHS Improvement have put in place a clinically-led national programme of support for areas experiencing high bed pressures and consequent reliance on acute mental health out of area placements. The programme supports areas to identify and address the key causes of their capacity pressures, focusing on effective pathway management and the availability of community-based alternatives to inpatient care. South London is one of 16 areas which have received support from this programme to date, and every sustainability and transformation partnership nationally now has a trajectory in place to eliminate acute out of placements due to local bed pressures by 2021.
The Care Quality Commission reported in January on the reasons for the rise in detentions under the Mental Health Act 1983. Its report, ‘The rise in the use of the MHA to detain people in England’, found that changes in mental health service provision and bed management were one reason for the rise, with “delays in admission due to a bed not being available may mean that a patient, who might have consented to be admitted informally at an earlier stage, may deteriorate and become unwilling or unable to agree to an admission, and therefore need to be detained under the MHA”. This report is available at the following link:
The Government has asked Professor Sir Simon Wessely to lead an Independent Review of the Mental Health Act 1983, to make recommendations on legislation and practice to improve how the Act functions in a modern mental health system. The Independent Review is considering how to address delays in the system and it will report in the autumn. It published an interim report in May, ‘The Independent Review of the Mental Health Act interim reports’, which is available at the following link: