It is an easy to accept argument that when help and support is needed, then this is best provided as early as possible, by local services, and on an individual basis. This is likely to prevent problems getting worse, and indeed likely to alleviate many situations arising at all. The argument for local, small services is backed up by events in recent years.
After the Winterbourne View investigation in 2011, subsequent reports identified the need for more local services, and the fact that distant, far from home services, are in general less likely to be effective, indeed in many cases harmful. Promises were made on the back of these reports to fund smaller scale, local services rather than have large institutions which by definition have a wider catchment area.
The Department of Health issued a recent guidance document on the Government’s ambition to ‘eliminate inappropriate out of area placements (OAPs)1 in mental health services for adults in acute inpatient care by 2020 to 2021’. The guidance identifies and defines out of areas placements, and situations where it may be best for the person.
In Scotland, the national strategy for people with learning difficulties (Keys to Life) emphasises the promotion of community involvement and respecting people’s choices about the services they need.
Is it working?
Sadly, in general, local help for serious mental health problems is a dwindling ambition. Reducing funding has meant the closure of many local services, and an overall reduction in mental health beds year on year.
The Independent newspaper recently published an article critical of this situation. They found that figures point to a 40% increase over the last two years in the number of people being treated out of their local area. One person was found to have been sent from Somerset to a hospital in the Scottish Highlands, 587 miles away. The BMA has called on the Government to take urgent action on better resourcing. Out of area placement can have serious implications for the person’s health and recovery. or have even more tragic consequences, they said. One consultant psychiatrist was quoted:
“There have been tragic cases where coroners have ruled that the difficulties families have visiting a relative receiving care, as well as poor communication between hospitals in other regions and local mental health services contributed to deaths.”
It was reported that visits by family take an average of 7 hours return by car to out of area placements, and 13 hours by public transport.
The Government is committed to the parity of mental and physical health services, and has vowed to end inappropriate placements by 2020. At the moment, this strategy is going backwards, with the problem increasing rather than getting better. Increased local advocacy and a commitment to improved funding by local health authorities, and by central Government itself, may begin to address the problem. It is to be hoped that Government targets will be met, in the interests of anyone who might need support. More local and smaller services will be not only cheaper, but more preventive, effective and helpful to their communities.