1. ITV Report

Concern as thousands of mental health patients on 'locked rehab wards'

Credit: PA

Thousands of mental health patients are being locked into rehabilitation wards, putting people at risk of being institutionalised, a review of England's mental health services suggests.

The Care Quality Commission (CQC) which inspected both NHS and independent care facilities found that there were more than 3,500 beds in locked rehabilitation wards across England.

The report highlighted that some patients are spending more than four years in such facilities.

It also found that a "significant number" of patients treated on such wards could have been cared for in lower dependency settings with fewer restrictions.

Some patients appeared to be spending "longer than would be expected" on high dependency wards with the average length of time patients were locked in being 341 days.

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 health care system."

Mental health charity Mind said there were "pockets of disturbing information" in the report.

Sophie Corlett, director of external relations at the charity, said: "There are some quite worrying things in here from the point of view of people receiving services, some that you would really not expect to be seeing in 2017.

"We have had many years of knowing that being in long-stay, locked accommodation is of no use to you, is expensive to the nation and is a human rights abuse, effectively to take away your liberty and to give you no therapeutic future."

The CQC report also found that:

  • There are long waiting times for memory clinics for dementia and eating disorder services
  • Some mental health crisis teams do not provide 24 hour cover
  • There is a shortage in mental health nurses - from January 2010 to January 2017 the number of nurses specialising in the field fell by 12%
  • There is an "unavailability" of inpatient care for young people with mental health problems. The authors highlighted a case of a 17-year-old who was kept in a police cell for 78 hours because no bed was available
  • Concerns were raised over safety with two in five (40%) NHS services rated as either "requires improvement" or "inadequate" in this area. Issues included inadequate facilities to care for patients, safe staffing levels and the management of medicines
  • Inspectors found a "great variation" on how much physical restraint was used against patients. In some wards, staff are able to avoid the use of restraint to anticipate or de-escalate behaviours or situations which could lead to aggression or self-harm.

"There are signs of a system under pressure," said Paul Lelliott, the lead for mental health and deputy chief inspector of hospitals at the CQC.

"We are concerned about what are called locked rehabilitation wards. The Royal College of Psychiatrists doesn't recognise this as a model of care.

"We were surprised at just how many of these wards there were and how many were locked.

"We also had some concerns about the fact that they weren't that discharge oriented, they weren't actively enabling people to return back to their home environments.

But Mr Lelliott highlighted that a high proportion of organisations were rated as good or outstanding for being caring.

Claire Murdoch, NHS England's national director for mental health, said: "We have already made huge steps forward in improving mental health care nationally, overall mental health funding is up by £1.4 billion in real terms and 120,000 more people are getting specialist mental health treatment this year than three years ago.

"It's pleasing to see that the report identifies that mental health services have the raw material to deliver great things and that almost every service was rated as good or outstanding for care.

"We know that there is more work to do which won't happen overnight, this is why we have a five year plan in place to ensure that transformation is under way so that we can consistently and quickly deliver the best possible care at the right time and importantly, in the most appropriate location, for those who need it."