Distant placements found to have led to anxiety, PTSD and suicide in some cases, as use of them increases in England

Mental health patients in England are being harmed by the increase in placements in psychiatric units far from their homes and families, a new report indicates.

Patients have had anxiety and post-traumatic stress disorder (PTSD), while some have died by suicide as a result of their distant placements, according to a Health Services Safety Investigations Body (HSSIB) report, which drew on interviews with patients and their loved ones. The participants spoke of how their experiences had resulted in feelings of anger, frustration and a loss of trust in the mental health system.

Neil Alexander, a senior safety investigator, said “urgent improvements” were needed to reduce harm to patients.

He said: “The reality is patients need to be treated and sometimes it is seen as safer to admit them to an inpatient ward or unit.

“However, as our investigation sadly showed, the harm caused to patients when moved far from home or moved back and forth between settings can be distressing, for them and for their families.

“The investigation emphasised that inappropriate out-of-area placements are a symptom of wider issues within health and social care: financial and resources pressures, long waiting lists for social housing and a lack of true integration between the two.”

The report focused on “inappropriate” placements where a patient has been sent far away because there is not enough space in their local area, rather than because they need a specialist service.

There was a “national ambition” to reduce out-of-area placements, including a target set by the government prior to the Covid pandemic to eliminate their use by 2021. However, data shows that overall out-of-area placements are steadily increasing: in March 2023 there were 793 placements, compared with almost 900 across England a year later.

Dr Layla McCay, the director of policy at the NHS Confederation, said mental health providers “came very close to eliminating adult out-of-area placements before the pandemic. But the significant spike in demand across the sector has since seen them begin to rise again as demand outstrips capacity.”

She added that reducing out-of-area placements was “not only beneficial for patients but can lead to significant savings”, and she hoped these pressures would be addressed in the spending review and NHS 10-year strategy.

The HSSIB report found that out-of-area placements could increase patients’ length of stay in hospital and therefore harm patients. Being far from a support network could elicit feelings of anxiety, while being detained and transported could result in PTSD. It further noted that hospitals often did not maintain oversight of the patients they sent out of area, eliminating the opportunity to return them to their neighbourhood when beds became available.

Patients, families and carers felt their choice and opinions were not documented or taken into consideration when decisions about out-of-area placements were made, while advocacy support was also often not offered, the research showed.

National organisations told the investigators that out-of-area placements might be the only option for someone who was acutely unwell when no bed was available in their local hospital, and might be preferable to someone remaining “unwell and potentially unsafe in the community”. However, they noted earlier autism and ADHD assessments could reduce the number of people inappropriately admitted to inpatient psychiatric units.

One patient interviewed for the report said they experienced PTSD as a result of “being taken away in the middle of the night, in handcuffs, and no one explaining to me why”, with their parent adding that their child was “treated like a criminal”.

Another said their family could not afford to travel from the north of England to the south. “I really miss them and it makes me sad,” they said.