People with long-term mental health needs are facing stays of many years in inpatient services because of a lack of community services to help them to recover, according to a briefing paper published today by Centre for Mental Health.

Long-stay rehabilitation services, by Emily Wright, reviews evidence from Care Quality Commission inspection reports of inpatient rehabilitation services in England. It finds that while many people receive high quality care close to home from rehabilitation services, a minority spend periods of many months and sometimes years in hospital. Some are placed far from home in locked wards and become isolated from their families and dislocated from their local health and care services.

Rehabilitation services work with an estimated 10-20% of people with a severe mental illness who need more intensive or longer term support than other services offer.

The briefing paper concludes that these services, and the people they help, have been ignored in mental health policy for more than a decade. As a result, local community and inpatient services have diminished, leaving some people in long-stay hospital care.

The briefing paper calls on the Government and the NHS to provide clear direction for the development and improvement of local community and hospital services for people with complex mental health needs. And it calls on NHS providers and clinical commissioning groups to ensure they offer local services to people requiring rehabilitation support and that they maintain contact with people admitted to hospitals out of their local area.

Centre for Mental Health chief executive Sarah Hughes said: “Rehabilitation services have for too long been on the sidelines of mental health policy nationally. Many people receive excellent quality care from rehabilitation services and have good outcomes. But some experience very long stays in locked wards, far from home and with little voice in their care and support. It is time for both national and local policymakers and commissioners to focus on rehabilitation services and ensure that high quality care is available to everyone.”

Helen Killaspy, Professor of Rehabilitation Psychiatry, University College London and immediate past Chair, Royal College of Psychiatrists’ Rehabilitation Faculty, said: “The Centre’s report into long stay mental health facilities highlights the negative impact of ongoing disinvestment in local mental health rehabilitation services across the country. Rehabilitation services work with people with severe and complex mental health problems, a group that is one of the most marginalised in society.

“There is good evidence that local rehabilitation services facilitate successful community living for the majority of people with complex needs, yet many have been placed in facilities that are operated outside the NHS, often many miles from home, due to closures and cuts to local services. This dislocates them from family and their local care team and is more expensive than local provision. People often end up staying in these ‘out of area’ placements much longer than needed which is counterproductive to their recovery. This practice is clinically inappropriate, wasteful of public resources and needs to end.”


Read Briefing 51: Long-stay rehabilitation services