NHS faces mental health crisis; 'risky' patients sent home

Thousands of patients who need psychiatric care in the UK are being detained in expensive private hospitals or being denied treatment, owing to a massive shortage of NHS beds.

The National Health System psychiatry is engaged in perpetual crisis management, with patients being sent home at night or on long-term leave to clear ward space, according to inspectors from the Mental Health Act Commission.

The team of 100 commissioners inspected 2,369 wards in England between October 2004 and December 2005.

The 11th biennial report, In Place of Fear, says, "over half of all wards are full or have more patients than beds, with staffing shortages and unpleasant ward environments undermining the therapeutic purpose of inpatient admission".

With private beds costing up to £5,000 a week, the overflow into the private sector is costing the NHS millions of pounds a year.

The inspectorate, the official watchdog that protects the rights of patients detained under the Mental Health Act, 1983, says that three quarters of wards breach occupancy safety margins. More than half the wards are overflowing, sometimes with two patients for every bed.

The NHS has lost over 50,000 mental health beds over 30 years with the closure of the Victorian asylums and the move to community care.

The report says that since 1997 there has been a threefold increase in the number of NHS patients detained in private hospitals, up from 700 to almost 2,300.

NHS beds dwindled in number by about 20 per cent from 1994 to 2001, to approximately 32,000. However, the overall decrease was only five per cent, as private and independent hospitals expanded into the NHS market.

Prof Chris Heginbotham, the commission's chief executive, said: "Commissioners find serious abuses of patients' rights every week - which in 2006 is inexcusable. We are especially worried about the complacent and often lax use of the Mental Health Act; some [hospitals] demonstrate a lack of understanding of the significance of depriving people of their liberty."

With the increased use of the Act, there are now 14,000 detained patients, a rise of 2,500 since 1997, the highest number since the Act was introduced in 1983.

The report highlights the inquiry in 2004 into the death of David "Rocky" Bennett, a schizophrenic who died after a struggle with staff at an NHS hospital in Norwich.

The inquiry called for systems to ensure the attendance of a senior doctor in case of an emergency within half an hour. But smaller private hospitals have arrangements that "could not possibly expect the attendance of a doctor within half an hour". The report cites the case of a single consultant psychiatrist offering simultaneous “24-hour” cover to five independent hospitals, some of them over 40 miles apart.

The report says the consultant psychiatrist cover may consist of an arrangement for a consultant psychiatrist, mostly retired, to attend the hospital and see patients after 6 pm one day per week, or at weekends.

The result of delay in setting up community teams and lack of access to early care would be that patients are often so ill that they require urgent hospital care.

Prof Kamlesh Patel, the commission chairman, said: "The NHS should provide reassurance to everybody that they will receive appropriate and dignified care if they fall ill. It is in this respect more than any other that mental health services are failing to match the standards of the rest of the NHS."