Recent statistics reveal a troubling increase in out-of-area mental health placements in the UK, despite previous government pledges to eliminate the practice by 2021.
The rise in these placements has led to longer hospital stays and heightened patient distress, sparking calls for immediate reform.
Recent figures from the National Health Service (NHS) have revealed a significant rise in the use of out-of-area placements (OAPs) for mental health patients in the UK.
This increase comes despite earlier commitments by the government to eradicate the practice by 2021. The rise, documented at 25% from 2022-23 to 2023-24, has renewed concerns about the effectiveness and humanity of mental health care in the UK.
The Rise in Out-of-Area Placements
Data from the NHS shows that the use of out-of-area placements fell almost in half between 2018-19 and 2022-23.
However, there was a sharp increase in 2023-24, with the number of placements rising to 5,500. This resurgence has alarmed mental health experts and advocates, who argue that these placements often lead to poorer outcomes for patients.
Dr. Lade Smith, President of the Royal College of Psychiatrists, has expressed concern over the implications of these placements.
She argues that being placed far from home can slow recovery, as patients struggle with reduced support from family and friends.
“It’s not just about the clinical impact; it’s about the ethical, moral, and economic aspects as well,” she stated. “When people are placed far from home, they often face increased isolation and a slower recovery process.”
Patient Experiences: Isolation and Distress
For many patients, the impact of out-of-area placements is deeply personal and distressing. Rachel, a patient with post-traumatic stress disorder and depression, experienced firsthand the isolation and discomfort of being placed far from home.
Sectioned in 2021, Rachel found that the nearest available bed was 248 miles away. She was moved three more times, each placement being four to five hours from her home.
“It feels quite dehumanising that you’re just a number that they pick up and drop somewhere in the country,” Rachel said.
Despite the care she received, she wonders if being closer to home might have accelerated her recovery. “It’s been incredibly challenging. I felt guilty for not having visitors, and it was a lonely experience,” she added.
Rachel was discharged in April 2024 after nearly four months of treatment. While she acknowledges the care she received as life-saving, she questions whether proximity to home might have made a difference.
Now, as she rebuilds her life, she reflects on the difficulties of her time in hospital but remains hopeful about her future.
Understanding Out-of-Area Placements
An out-of-area placement occurs when a patient is admitted to a mental health unit outside their local area due to the lack of available beds nearby.
These placements can result in extended stays and reduced effectiveness of care, as patients may not have access to their local support networks.
Dr. Lade Smith has emphasized the clinical and ethical issues surrounding OAPs. “These placements can delay recovery and create additional stress for patients and their families,” she explained. “Maintaining local support networks is crucial for effective mental health care.”
Government Commitments and Current Challenges
In 2016, the UK government pledged to eliminate out-of-area placements by 2020-21. While there was a reduction in their use in the years that followed, the recent rise by 25% in 2023-24 suggests that the goal remains unmet.
Dr. Smith attributes this increase to ongoing financial and housing pressures, compounded by the COVID-19 pandemic.
An NHS spokesperson acknowledged the problem, attributing the rise in OAPs to a shortage of available beds and delays in housing support for patients ready to leave hospital.
“It is unacceptable for patients to be treated away from home,” the spokesperson said. “NHS England is committed to eliminating OAPs and is working to address this issue.”
Regional Disparities and Efforts to Address the Problem
The Greater Manchester area has seen the most significant increase in out-of-area placements. Dr. Clair Lake, NHS Greater Manchester’s Deputy Medical Director, described reducing OAPs as a priority.
“We want everyone in our area to have access to safe mental health care close to home,” she said. “We are focusing on improving community services and crisis response to reduce the need for admissions.”
Efforts in Greater Manchester include collaborations with local authorities, housing providers, and the voluntary sector to enhance mental health care accessibility and prevent the need for out-of-area placements.
The Economic and Human Costs
The financial impact of out-of-area placements is also considerable. In 2023-24, NHS England spent £164 million on OAPs, a £49 million increase from the previous year.
Dr. Smith described the expenditure as “eye-watering,” noting that greater reliance on private beds has contributed to the rising costs.
Mental health charity SANE has called for increased emotional and financial support for families affected by OAPs.
Founder and CEO Marjorie Wallace emphasized the need for sufficient local beds to avoid the need for long-distance placements. “We need to ensure that trusts have the resources to provide timely care locally,” she said.
Future Directions and Proposed Reforms
Recent reforms highlighted in The King’s Speech have included a mental health bill aimed at tightening rules on sectioning individuals and improving mental health provision.
Gemma Byrne, Policy and Campaigns Manager for Mind, welcomed these reforms but stressed the need for investment in community mental health and social care services to prevent patients from reaching a crisis point.
A Department of Health and Social Care spokesperson reiterated the government’s commitment to reforming the mental health system.
“We will go further than ever to prioritise mental health,” they said. “This includes updating the Mental Health Act, helping people get back on their feet, and ensuring that care is appropriate, proportionate, and compassionate.”
Conclusion
The rise in out-of-area placements underscores ongoing challenges in the UK’s mental health care system. Despite previous commitments to end the practice, recent data shows a significant increase in patients being placed far from home.
As the government and NHS work towards addressing these issues, the experiences of patients like Rachel and Nikki highlight the urgent need for reform to ensure that mental health care is accessible, humane, and effective.
Efforts to reduce out-of-area placements and improve mental health services are critical to providing better care for patients and supporting their recovery.
The rising costs and emotional toll on patients and their families make it clear that immediate action is needed to address this pressing issue.
