Mental health patients at risk of suicide discharged from NHS without adequate support

Patients coping with severe mental health conditions that mean they are afraid they could harm or kill themselves are being discharged from NHS care, unprepared and without support in the community.

The Independent has heard from patients who say their mental health has deteriorated because of the discharge process, which has left them feeling powerless and damaged their faith in services meant to keep them safe.

Others grappling with addiction issues have been ejected from inpatient care and told to get clean before the NHS is able to treat their psychological issues.

Psychiatrists said falling numbers of mental health beds and the loss of specialist units for more complex patients have created pressures to discharge, which cash-strapped community services have not been able to meet.

“When I was in the hospital, they were chucking people out at a rate of knots when they were clearly unwell,” said Jenny, who has spent more than two decades in and out of the mental health system and asked to stay anonymous.

“They didn’t prepare for me being discharged at all. Then I self-harmed really badly because I wasn’t safe to be home yet. I still don’t feel safe now, I’ve got no care plan, nothing.”

She has a complex diagnosis including personality disorder, depression and alcoholism, and tells The Independent she doesn’t feel the services offered in the community benefit her condition.

“They are telling me that I am not engaging [with treatment] which is the new buzzword that they use along with recovery,” Jenny said she is now considering discharging herself from treatment entirely.

“I have finally had enough, they are actually causing me more stress and anxiety,” she said.

Dr Ranga Rao, a consultant interested in addiction and dual diagnosis and the Royal College of Psychiatrists’ lead for acute inpatient care, said a lack of support outside hospital could increase pressures elsewhere.

“If I see somebody on the ward, and I’m aware there’s a problem with beds, I wouldn’t discharge them any sooner if there’s isn’t a discharge [plan] which I’m reassured will be safe, viable and effective.

“Because if I don’t, they’ll be picked up by a different part of the system, by the ambulance, or the police, or worse, something else will happen.”

“But there is an issue of access to beds,” he added. While acute beds in hospital have been falling for decades, government austerity measures have particularly hit specialist and community services, meaning those patients are increasingly forced into general beds.

Drug deaths hit a record high in 2016 in England and Wales, yet councils cut £43m from addiction budgets in the following year and numbers in treatment are at a record low.

Specialist addiction care is now provided by private or voluntary sector organisations and Dr Rao says that means patients’ notes are often missing key information.

As a trainee 20 years ago in Manchester, Dr Rao says his hospital had a 16 bed inpatient alcohol detox unit where social interventions were offered alongside medical treatment – but these have now “disappeared across the country”, he said.

This makes building a complete picture of the services across England more difficult, it also means complex patients can easily fall between the cracks of the different providers.

“When I spoke to the consultant, they would only tell me that he needs to address his drug issues before they can give him psychiatric help,” Caroline, whose adult son was sectioned under the Mental Health Act after a suicide attempt, told The Independent.

“They let him out just before Christmas – in a stressed state after being in prison, rehab, then over here with us, then in hospital.

“They let him out in the community and what does he do? Goes straight out and takes drugs.”

Now 40, her son’s addiction and mental health issues have been closely linked since his teens. After his last stay in hospital, Caroline and her husband say they no longer believe the UK mental health system can save her son.

“We’re back on the merry-go-round again,” she said. “The NHS psychiatric hospitals, at great expense, just keep them there and don’t offer the necessary treatment."

Psychiatrists say that community can be a better option than a prolonged hospital stay, particularly when the loss of specialist units means there isn't the right treatment in hospital.

“At times inpatient care can’t really provide all the support a person requires,” Dr Sridevi Kalidindi, national rehabilitation psychiatry lead for the NHS’ Getting It Right First Time initiative.

“But we need to look at what an individual needs and then develop a care package around them, an alternative in the community wherever possible."

Dr Kalidindi said the recent NHS Forward View for Mental Health and 10-year plan have begun to address the postcode lottery across England by setting core mental health services for each region.

But a decade of cuts to council budgets mean many contracts have had to be offered to the lowest bidder, rather than be lost altogether.

“It’s about giving the service user a voice to make sure they get what they need in the community,” Dr Kalidindi said. “But it’s not an easy time, in theory we’re out of austerity, but the public services are pretty difficult.”