Too many patients are locked into mental health rehabilitation wards far from home, a review of England’s psychiatric services suggests.
The Care Quality Commission said there were 3,500 beds in locked facilities across the country, but it believes more people could and should get care in residential settings close to home.
The report said safety on mental health wards was another major concern.
NHS England said progress was being made with higher funding for care.
‘Kept in for 341 days’
Claire Murdoch, head of mental health for NHS England, added that while there were reasons for optimism, improvements – in line with the priorities set out by the NHS five-year plan – were needed.
The Care Quality Commission (CQC) looked at all specialist mental health services across England – inspecting NHS care and services provided by the independent sector.
It said almost all services were rated as good or outstanding for having caring and compassionate staff and that there were many examples of excellent care.
But the report found several areas of concern.
CQC chiefs said in particular that locked rehabilitation wards (of which two thirds are run by independent providers) did not provide the right model of care for the 21st Century.
They said some patients spent too long on these wards – with an average length of stay of 341 days.
And this leaves patients at risk of being institutionalised, with the end goal of being rehabilitated back into the community being missed, the report warns.
Dr Paul Lelliott, lead for mental health at the CQC, said: “We weren’t expecting to find this many [locked rehabilitation beds].
“We can’t say exactly how many of the people on these wards don’t need to be in locked facilities, but we do suspect that quite a high proportion of people in these services could, and should be, moved back to be much closer to home and be cared for in residential settings that provide much more independence, and also be supported by community services rather than being in hospital.”
Inspectors also said about a third of services needed improvement when it comes to safety.
And one in 20 were deemed inadequate for safety, meaning real and sometimes immediate concerns for patient safety, according to CQC chiefs.
Inspectors pointed to “old and unsuitable buildings” – for example buildings with blind spots in corridors where patients at risk of self harm could not be observed.
Adding to safety concerns were nurse shortages – with a 12% drop in mental health nursing staff between January 2010 and 2017.
Commenting on the report, Brian Dow, from the charity Rethink Mental Illness, said there was a huge level of commitment from people in the sector to deliver a high level of care but that there was an “awful long way to go”.
He added: “There is fairly large number of services that the CQC says need improvement and that raises big questions about what is happening in this system.
“Is there enough money in there? Do we have the right kind of people able to deliver the care? Are people involved in their own care and are people supported and trained to deliver the care?”
Meanwhile, Ms Murdoch told the BBC she thought the report was a “really fair” assessment of the state of the nation’s mental health services.
She added: “It sets out the fact that most providers of mental health care are now either moving towards the good category or are good and moving towards outstanding – so it is showing improvement. But quite rightly it also looks at what needs to improve next.”