Mental health patients detained in hospital wards for up to 21 years

This article was taken from: https://www.theguardian.com/society/2019/apr/23/nhs-mental-health-patients-locked-in-secure-ward-rehabilitation-years

By Sarah Marsh at The Guardian

Guardian finds many people confined far from families, sometimes for decades

A patient locked in a secure ward for more than 21 years is among hundreds of people with mental health problems being kept in what one MP has called “old-style asylums” in NHS hospitals, an investigation can reveal.

Keeping people in so-called “locked rehabilitation wards” has been condemned as “outdated and sometimes institutionalised care”, by the NHS watchdog, with many patients housed far from their homes. This is despite a 2017 report by the Care Quality Commission (CQC) that said the model of care had no place in a modern healthcare system.

Using freedom of information laws, the Guardian has found that:

• At least 435 patients spent time in locked rehabilitation wards in 2018, up from 404 in 2015.
• One patient at Birmingham and Solihull mental health NHS foundation trust spent 7,914 days – more than 21 years – in one of the wards.
• The average length of stay in a locked unit at Sussex Partnership NHS foundation trust was 602 days, almost two years.

There is no set definition of a locked rehabilitation ward, but it generally means a unit where patients are unable to leave as and when they want. They started being used about 10 years ago, mainly provided by the private sector to treat people who were considered high risk to others, so with serious conditions such as psychosis.

But critics have condemned the approach “which has no place in modern Britain”, according to MPs. A report from the CQC in 2017 warned that the practice leaves already vulnerable patients feeling isolated and less likely to recover.

Rajesh Mohan, chair of the Royal College of Psychiatrists’ rehabilitation psychiatry faculty said that a lack of clear definition of “locked rehabilitation” care means, there are no agreed quality standards and it’s hard to “say whether a person’s liberties are deprived”.

“If the principle of care is based on locking the doors, people cannot leave the building, then you cannot have voluntary patients at all there … It means restrictions are applied to everyone rather than there being a focus on recovery,” he said.

Liberal Democrat MP Norman Lamb said: “They are like old-style asylums that have no place in modern Britain. What we are doing is a fundamental breach of people’s human rights.

“It is a complete contradiction in terms: locked rehabilitation ward. Their [the CQC’s] conclusion was that many people in these wards don’t need to be there. That means that there are lots of people who are capable of living independent lives with support who are locked up.”

Mohan said that in the last 10 to 15 years more than a third of NHS rehabilitation services have been wiped out. “The need for these services has not gone away. People with lots of complex and enduring symptoms need rehabilitation treatment and the private sector stepped in to bridge this service gap, but people may become isolated in these units for long periods of time.”

He said he would not describe these services as old-style asylums but the problem is people end up in these units for too long as there is no step-down provided and no community services to support people leaving wards.

“People in rehabilitation units should be able to move on to less restrictive rehabilitation settings. But that will only happen if they have places to bedischarged to, such as supported accommodation with 24-hour supported community care. There will be some people whose illness and symptoms are very severe, but that does not mean they should be stuck in hospital for 21 years. There needs to be more focus on community rehabilitation teams and high quality supported housing.”

The Guardian found that 404 patients in NHS hospitals were in locked rehabilitation wards in 2015, rising to 435 in 2018. A freedom of information request sent to all mental health trusts resulted in 11 trusts saying they had such wards, compared with 32 who said they did not. Thirteen trusts did not respond in time.

Central and North West London NHS foundation trust had the highest number of patients, with 104 staying in secure wards in 2018. The longest stay of a patient was 2,914 days – six days shy of eight years.

The trust said it runs specialist rehabilitation services for people with “complex mental health problem” and are one of the largest providers because they cover a large local and neighbouring area.

”We’re very different from old style asylums; our facilities are hospitals, modern and bright … The majority of people stay between six and 18 months … There are a few people who need to stay longer (eg Home Office restriction orders), and we work to identify other options for them.”

Birmingham and Solihull Mental Health NHS foundation trust had a patient stay for 7,914 days, more than 21 years. Another patient stayed for 6,174 days, almost 17 years.

They did not comment on these individual cases but said: “There remain a small number of patients within our locked rehabilitation wards in Solihull who have required long-term treatment in a hospital setting. There are currently no alternative settings in Solihull offering appropriate residential care for this group, who need specialist support. Cases are reviewed regularly.”

At Sussex partnership NHS foundation trust the average length of stay in a locked unit was 602 days, almost two years. The trust said: “Our priority is always to ensure that the people who need our specialist services receive the best possible care, at the right time and, crucially, in the right setting and that they remain in that setting only for as long as they need to.”

In 2017, a report by the CQC found that more than 3,500 patients in 248 mental health wards were kept locked-in, the majority in private mental health hospitals.

The report stated: “Our inspectors were concerned that some of these locked rehabilitation hospitals were in fact long stay wards that risk institutionalising patients, rather than a step on the road back to a more independent life in the person’s home community.

“We do not consider that this model of care has a place in today’s mental healthcare system.”

Paul Lelliott, deputy chief inspector of hospitals at the CQC, said: “These findings echo our own concerns highlighted last year that some people in mental health rehabilitation wards experience long stays in services, some situated a long way from the patient’s home. Rather than helping people get well these factors can increase their sense of institutionalisation and slow down recovery.

“Rehabilitation wards are an essential element of a comprehensive mental health service but they should live up to their name and be focused on helping people recover rather than being ‘long-stay’ wards in disguise. ”

An NHS England spokesperson said: “As the CQC make clear, ‘inpatient’ rehabilitation wards are a key part of good mental healthcare and while no one should stay any longer than necessary, in a tiny number of cases, it might remain the safest and most appropriate treatment setting for both the individual patient and wider community. Patient confidentiality of necessity means individual details must be kept private, but absent this specific information known to patients and their clinicians it behoves commentators not to jump to ill informed generalisations.”