We need to bring mental health care closer to home

It has long been recognised in the mental health sector that sending patients out of area due to a lack of local capacity within the system can cause significant negative emotional, economic and health impacts on patients and carers. It can also be an inefficient use of NHS funding, in a time where budgets are tighter than ever.

Inappropriate out of area placements (IOAPs) are the symptom of pressures across the mental health pathway. Challenges in delivering crisis and community-based support that keeps people out of hospital, unequal distribution of inpatient beds and delays to discharging patients, particularly driven by lack of appropriate housing or other residential placements', all play a role in keeping IOAPs stubbornly high in too many areas.

The toll of IOAPs

Last year’s Health Services Safety Investigations Body (HSSIB) 2024 report into IOAPs warned that these placements can trigger anxiety, psychological stress, post-traumatic stress disorder in patients, and even raise the risk of suicide.

“Families can feel helpless and guilty, unable to care for their loved ones when they need them most”

IOAPs also place a profound toll on families and carers. The cost of time away from work, train fares and hotel stays can be significant. Children miss crucial periods of education, widening academic gaps that sometimes cannot be closed. Families can feel helpless and guilty, unable to care for their loved ones when they need them most. They can also be excluded from the decision-making processes around admission, leaving patients without a familiar voice to advocate for them.

Our Mental Health Network members are acutely aware of the potential negative impact of IOAPs for patients and families and have been implementing varied approaches to tackle them. Our recent report, produced jointly with the Royal College of Psychiatrists, highlights some of this innovative work, including through better coordination of referrals, improving patient flow and reducing re-admissions. 

Reducing IOAPs

For example, in the East of England a new single referral route into intensive day services has significantly reduced IOAPs for children and young people, and a specialist supported housing service in Oxfordshire has kept IOAPs low and readmissions at only two per cent after 90 days. In Greater Manchester, a live admissions data dashboard, purposeful admission and preferred provider framework helped to almost eradicate IOAPs.  In Hertfordshire, a specialist children’s home blending health and social care has cut A&E visits and hospital admissions. Strategic, system-level conversations with independent sector providers have helped identify the most effective and efficient use of NHS funding, bringing people closer to home. 

The financial cost

As well as the immense emotional and financial cost of IOAPs to patients and families, the financial cost to the system is substantial, rising by 80 per cent in just under a decade. The true figure is likely to be far higher than the £164 million reported in 2024, as this does not include placements for children and young people, or figures for around 30 per cent of trusts.

The government’s 10 Year Health Plan offers an opportunity to address the challenge of IOAPs through the principles of prevention and community. The £120 million investment into emergency mental health centres, alongside the expansion of 24/7 neighbourhood health pilots, assertive outreach teams and increased early intervention support for children and young people through Young Futures Hubs and Mental Health Support Teams should, over time, reduce the demand that leads to IOAPs. 

“… despite the NAO reporting that only one in three people in England are able to access mental health care who need it, we are seeing concerning trends in mental health funding”

However, despite the NAO reporting that only one in three people in England are able to access mental health care who need it, we are seeing concerning trends in mental health funding. The proportion of NHS funding that mental health receives – currently 8.7 per cent - has reduced over the past two years and is likely to drop further with changes to the Mental Health Investment Standard, given the centrality of responding to mental health need to deliver a left shift in care. This means that mental health is likely to be underfunded against the ambitions of the government’s 10 Year Health Plan. 

“We cannot continue to send people miles away from their homes and support networks, it is wrong for patients and bad for NHS budgets”

It is not right to invest more money in models that result in too many people reaching a stage of requiring inpatient care where earlier, more personalised, and a more holistic approach to support may have prevented admission. Historic underfunding and increasing demand on secondary services, along with a national focus on short-term planning, means implementing services that will decrease demand over the long term have hindered the sector’s ability to do this.

The sector can, with support of national policy, accelerate community service transformation and preventative strategies. One of the consequences of this will be reduced IOAPs.

We cannot continue to send people miles away from their homes and support networks, it is wrong for patients and bad for NHS budgets. But, we know that members are committed to making change happen. We look forward to progressing this change in the coming year.

Emma Paveley is senior policy manager for the NHS Confederation’s Mental Health Network