Reducing demand for mental health inpatient beds in Somerset

Overview

A collaborative approach to admissions avoidance and early supportive discharge in Somerset has reduced demand for inpatient beds for mental health patients in crisis.

Key benefits and outcomes

• 16 per cent decrease in adult and older adult inpatient admissions.
• 18 per cent decrease in mental health A&E attendances.
• 275 suicide attempts prevented.
• ‘Step down’ approach has minimised delays to discharge.

What the organisation faced

In the mid-2010s, Somerset NHS Foundation Trust became concerned at the number of mental health patients being treated out of area. Not only did this have a significant financial impact, but outcomes were observed to be worse upon the patient’s return, with a challenge of reintegration after being away from their personal network and local services.  As a result, the trust sought to reduce the number of out of area placements (OAPs) and bring its patients back to Somerset.

What the organisation did

The trust focused on reducing demand for inpatient beds through two main strategies: admissions avoidance and early supportive discharge. 

A range of services were provided to support people in crisis and help avoid an admission, including a 24/7 crisis safe space, a helpline, a first response and urgent treatment team, crisis beds, and an urgent care hub.  Crucially, a ‘no wrong front door’ policy was introduced to ensure opportunities to intervene were not missed and that patients could be navigated to the right service at the right time, no matter how they tried to access care. 

The ’no wrong front door’ approach relies on a diverse range of services working together as an integrated team.  An important step towards this was the formation in 2020 of Somerset Open Mental Health, which is a collaboration of NHS, local government and an alliance made up of voluntary, community, faith and social enterprise (VCFSE) organisations with Rethink Mental Illness acting as lead accountable body (LAB), as well as individuals with lived experience of mental health needs. Their integrated approach ensures a shared responsibility for all patients, so that the eligibility criteria for one service do not prevent a patient being guided to the care they actually need.

Open Mental Health has also proven important for early supportive discharge, with a with a range of services to support people as they are discharged from inpatient care into community-based provision. These services include traditional approaches such as intensive home treatment, social care and community mental health team support, alongside and a wider range of recovery-based offers through the alliance’s network of partner organisations. 

These small partner organisations, spread across Somerset’s rural and coastal geography, form a mental health ecosystem that provides local access to supportive services, such as housing, debt and employment guidance, peer-support groups and activity-based groups, such as walking and gardening. This is crucial as the county’s larger population centres can be inaccessible due to minimal public transport provision, with some areas supported by as few as one bus per week. The alliance approach enables Open Mental Health to provide meaningful support for people in and around their local communities, with the LAB enabling the NHS to contract with a wide range of small and micro-organisations, by taking responsibility for governance, data, risk and central coordination. 

Results and benefits

Open Mental Health has achieved a wide range of positive outcomes, with Somerset performing well across various mental health performance metrics. 

It has enabled greater agility in service delivery, thanks to local voluntary sector providers who can respond quickly and adapt services without institutional delays. The programme has achieved a 16 per cent decrease in adult and older adult inpatient admissions, and an 18 per cent decrease in mental health A&E attendances.  The interventions provided by the Crisis Safe Spaces prevented 275 suicide attempts. Through its strong collaboration with social care, the ‘step down’ approach to discharge has minimised delays to discharge, enabling people to be supported out of hospital as soon as possible. 

It was also nominated for best mental health innovation of the year in the 2025 HSJ awards.

More generally, Open Mental Health has helped to build an ecosystem of small voluntary sector organisations across Somerset, with 26 receiving grants in 2023, helping to strengthen local services and community identity for residents.

As a result of this transformation, for the last six years the trust has largely managed to avoid out of are placements. At the time of publication, two patients were being treated out of the area.

Overcoming obstacles

Shared ownership is challenging and needs to be led from the top.  System leaders for mental health have dedicated time together every week to discuss practical issues.  This group includes leads from the trust, the ICB, the local authority social care and public health teams and the Open Mental Health VCFSE Alliance LAB.  The focus is always on maximising the value of the time together, approaching this as system leaders rather than performance managers.

With a large number of organisations involved and a shared responsibility there can be tensions around demand and capacity. Locality lead organisations from the VCFSE Alliance were engaged to jointly manage localities with their NHS counterparts. The VCFSE Alliances independent governance and accountability structure encourages collaboration rather than competition between local organisations.  The trust delegates responsibility for managing resources to each locality network, providing clear expected outcomes and leaving the local organisations to work together to deliver these, with clear escalation routes and access to help and support from the LAB and NHS

Another challenge for the community partnership model is the lack of digital and reporting infrastructure within smaller voluntary sector organisations. Many lacked the tools or systems to track and report outcomes in ways required by NHS England. This was also addressed through the LAB model, ensuring that a larger organisation could support its partners with reporting and compliance.

Takeaway tips

• Patients should not be penalised for going to the wrong place – this will only lead to missed opportunities for crises to be managed.
• A single lead accountable body structure means that the NHS can hold a single contract with a single entity, the LAB, whilst enabling a wide range of organisations to be part of a thriving mental health ecosystem to widen reach and ensure that more people can get the support they need, when and where they need it.
• Small, frontline organisations are vital for meeting the needs of patients spread across large, rural areas and providing ongoing recovery and preventative support.
• Strong cross-sector collaboration requires a continued investment in time and positive leadership to develop a psychologically safe, mutually supportive culture.