DESIGN IN MENTAL HEALTH CONFERENCE 2019
Do some service-users need to be in inpatient care? However, while the physical care environment played a very important part in recovery, Sir Norman Lamb noted that there were ‘other key issues at play’, which those responsible for mental healthcare and politicians and policymakers needed to confront. He elaborated: “In 2017 the Care Quality Commission highlighted that, at that time, the mental healthcare system in England had around 3,500 beds in what are wonderfully described as ‘locked rehabilitation wards’ – something I would suggest is a contradiction in terms. The CQC also said many of those occupying such beds didn’t need to be there, and were capable of living independent lives with sufficient support in the community. It doesn’t take long to think through the implications – if, in this day and age, we are locking up people who have committed no crime, and who don’t need to be locked up, that seems to me a fundamental breach of their human rights, which we should not be prepared to tolerate.” Often, in addition, Norman Lamb emphasised, the ‘quality of the experience’ for such individuals was not good, while in many instances the care provided offered little therapeutic value.
Out-of-area placements One of the other significant issues facing public mental healthcare sector was ‘out- of-area’ placements – as the speaker put it, ‘people in effect being shunted around the country because there is no bed available in the local NHS Trust’, often resulting in patients / service-users being sent to locations hundreds of miles from their home. He said: “Fortunately, there is a commitment to eradicate this problem, and in the West Midlands I worked with
consultant psychiatrist for the homeless at Sheffield Health and Social Care NHS Foundation Trust), they had ended the use of facedown restraint; if one large mental health Trust can do it, others surely can? Yet it is still endemic within the system.” The speaker continued: “We know – through a lot of learning – that by applying the right approach to positive behaviour support, stopping a deterioration of stress and anxiety within an inpatient unit, that it is very often possible to avoid using restraint, so again, I ask: ‘If we now know this, can we justify using this practice to such an extent right across the system?’ I don’t think we can; it surely amounts to a breach of human rights.”
Matthew Patrick, until July this year the CEO of the South London and Maudsley NHS Trust (SlaM), told Sir Norman Lamb he could ‘envision a time when we will have re-thought the role of the mental health Trust – away from institutional care, towards being much more of a centre of excellence’.
Simon Gilby, chief executive of Coventry and Warwickshire Partnership NHS Trust, and others, to seek to confront this problem. I should incidentally say,” Norman Lamb told delegates, “that it is great to see Simon here in the audience, and to return to a region where I experienced some great clinical leaders and people with a real passion for mental health.” The speaker noted, however, that at the end of August 2018 there were still some 760 people in England in out-of-area placements – ‘an unacceptable scenario’ in his view. He said: “Such practice would not happen with somebody who had suffered from a stroke, but occurs routinely in metal health.”
Consultant clinical psychologist, Warren Larkin, told Norman Lamb: “We need to be thinking much more profoundly about how we stop children and teenagers needing to go into inpatient care in the first place.”
THE NETWORK | OCTOBER 2019
Use of force and restraint Moving to discuss what he dubbed ‘another issue close to my heart’, the speaker turned his attention to the use of force and restraint, which he believed was ‘endemic within the system’. He told the conference: “In 2016-2017 there were 59,909 uses of restraint. That will include very many situations where there is a gentle controlling of the individual, but also a significant number of ‘facedown’ restraints.” He added: “I issued guidance when I was a Minister intended to end the use of facedown restraint, because it is frequently associated with harm to the individual, and sometimes loss of life. I remember Tim Kendall, NHS England’s National Clinical director for Mental Health, telling me that in Sheffield (where Professor Kendall has been Medical director for 13 years, and continues as
High occupancy, stressed staff ‘On top of these issues’ the NHS mental healthcare system was seeing very high occupancy rates, ‘stressed staff’ – with healthcare providers often having to use agency personnel – and problems with delayed discharges due to inadequacy in social care support, and a lack of places for people to be discharged to. Sir Norman Lamb said: “As a result of all of this, I decided to research the issue a little further, via Freedom of Information requests to look at lengths of stay countrywide. We discovered that they are highly variable, but without any apparent therapeutic justification. We also looked at international comparisons, and found that although England has lower bed numbers than other comparable countries, stay length is significantly longer. We are thus tying up a lot of money in inpatient care.” Those 3,500 beds in locked rehabilitation wards were, the former Minister said, costing the NHS ‘between £700 million and £800 m per year’.
Simon Gilby, chief executive of Coventry and Warwickshire Partnership NHS Trust, has made it a key priority to reduce the number of out-of-area placements in the area within his Trust’s remit.
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