Thousands of mental health patients are being kept in secure wards for years at a time when they should be being rehabilitated and preparing to leave hospital, a NHS watchdog has revealed.
The Care Quality Commission (CQC) criticised both NHS and for-profit mental health providers for forcing such a large number of patients to endure what it called “outdated and sometimes institutionalised care”, often miles from home. The practice leaves already vulnerable patients feeling isolated and less likely to recover, the CQC warned.
More than 3,500 patients in 248 mental health wards are kept locked-in. In 2015-16 some stayed for 45 days, but others had been there for up to 1,744 days – four and a half years – the care regulator found.
“More than 50 years after the movement to close asylums and large institutions, we were concerned to find examples of outdated and sometimes institutionalised care,” said Paul Lelliott, the CQC’s deputy chief inspector of hospitals.
“We are particularly concerned about the high number of people in ‘locked rehabilitation wards’. These wards are often situated a long way from the patient’s home, meaning people are isolated from their friends and families. In the 21st century, a hospital should never be considered ‘home’ for people with a mental health condition.”
The disclosure prompted a senior doctor to claim that some mental health patients were being subjected to Victorian-era care. Dr Mike Hunter, a consultant psychiatrist and medical director of an NHS mental health trust in Sheffield, likened the procedure to a “Victorian approach” to treatment.
Honestly think we'll look back on the mental health long term out-of-area problem as an early 21st century version of the Victorian approach
— Mike Hunter (@DrMikePsych) July 19, 2017
Lelliott added: “We were surprised at just how many of these wards there were and how many were locked. We also had some concerns about the fact theat they weren’t that discharge oriented, they weren’t actively enabling people to return back to their home environments.”
Stays in such wards should be “a step on the road back to a more independent life in the person’s home community”, and not a long-term treatment option, he said.
Private providers of NHS mental health care lock patients in more often than NHS trusts. Two-thirds of the 3,500 beds are in that sector, despite them treating fewer people with mental ilness than the NHS. That may fuel suspicions among NHS mental health staff that private operators hold on to some patients longer than necessary in order to maximise profits.
Patients kept on locked rehabilitation wards are being denied their human rights, according to the mental health charity Mind.
“We have had many years of knowing that being in long-stay, locked accommodation is of no use to you, is expensive to the nation and is a human rights abuse, effectively to take away your liberty and to give you no therapeutic future,” said Sophie Corlett, its director of external affairs. “To see that there are 3,500 people in effectively institutionalised settings in 2017 is very worrying.”
The CQC revealed the scale of the practice in a major report that, while praising the quality of much mental health care, highlighted a series of concerns it has after analysing inspection reports into the quality of such care provided by both the NHS and private firms since 2014.
Too many patients are being forced to wait too long to receive many forms of mental health care, Lelliott said.
One in five (22%) of people referred to memory services, for a possible diagnosis of dementia, have to wait between 11 and 18 weeks for an assessment, while a further 20% face delays of more than 18 weeks.
Similarly, 18% of mainly young patients with an eating disorder have to wait up to 18 weeks and another 9% cannot see a specialist psychiatrist for more than 18 weeks, despite the risk that such patients can deteriorate quickly during delays.
One in five (19%) older people wait at least 11 weeks to be seen, as do 15% of mothers needing help with problems related to the birth of their baby.
The CQC also voiced concern about the fact that:
- Mental health services are facing serious shortages of both mental health nurses, whose numbers have fallen by 12% since 2010, and psychiatrists, though staff were praised for providing caring and compassionate treatment to patients.
- Available inpatient psychiatric beds have dropped by 4% since 2014.
- Detentions under the Mental Health Act have risen by 26% between 2012-13 and 2015-16.
- Too many patients who become agitated are then physically restrained, often because poorly trained carers do not know what else to do.
- Old and unsuitable premises can present opportunities for patients to self-harm and try to take their own life, unseen by staff.
The CQC report warned: “On too many wards the combination of a high number of detained patients who pose a risk to themselves and sometimes to others, old and unsuitable buildings, staff shortages and a lack of basic training, make it more likely that patients and staff are at risk of suffering harm.”
The findings underline the scale of the tsk facing NHS England, which has promised to transform mental health care by 2021 to cope with rising demand and cut delays in accessing treatment.
Norman Lamb, the Liberal Democrat health spokesman, said: “The evidence is overwhelming that mental health services are at breaking point in many parts of the country. Too many people are left waiting intolerably long for the treatment they need, while others get no help at all.”
The Department of Health said: “As this report identifies, there are many examples of excellent mental health care and nearly all services were rated as good or outstanding for having caring and compassionate staff.
“But we know there is more to do to promise everyone the very highest standards of care.”