One in three people sent home from hospital too early – with no plan for further mental health care
Research released today by mental health charity Mind reveals serious problems with the planning around discharging people from mental health hospitals.
The survey of over 1,000 people who have been in hospital in mental health crisis, found:
- One in three people (38%) felt they were discharged from hospital sooner than they should have been
- One in five (21%) were given no notice at all that they were going home. This even happens when people have been in hospital for a long time - one in three people (33%) in hospital for more than a month were given less than 48 hours’ notice that they were being discharged or no notice at all
- Two out of five people (37%) said there was no plan for further care and support, contrary to guidelines
- Less than half of people (44%) said managing their mental health or self-care was considered in plans for leaving hospital
- Only half of people (51%) said their accommodation needs were considered in any plans, and less than a third (29%) said that money and benefits were considered
The days and weeks after leaving hospital after a mental health crisis are critical. People are at high risk of suicide in the first week after leaving hospital and if they are unsupported they risk becoming unwell again and ending up back in hospital.
It is important that care plans for ongoing support are made before people leave. NICE (National Institute for Health and Care Excellence) guidelines state that plans should be made for people’s ongoing care from admission or as early as possible from when they go into hospital. There should be a written plan that is put together in collaboration with the person receiving care. Yet nearly two in three people (66%) in the survey said they were not given a written care plan and one in four (23%) said they were unaware of any plan at all.
As well as ongoing mental health care, planning for additional support with housing and finances should be included when people leave hospital. But around half of respondents said that these things were not well considered or, in some cases, considered at all. This risks people being sent home to unsafe or uncertain housing or financial situations that will have a negative impact on their recovery from crisis.
Mind has produced a booklet to help people plan for their care when they leave hospital after a mental health crisis and a briefing to show what can be done to support people.
Phillipa is 34 years old and has been diagnosed with both emotionally unstable personality disorder and a long-standing eating disorder. She was in hospital in January 2016.
“I'd been in my local mental health unit for a week, when one morning I woke up to be told that there was a taxi waiting for me downstairs, and to get ready. Dazed and confused, still half asleep, I didn’t understand. Did I have an appointment? Was I visiting somewhere? Did they have the right person?
“Within minutes I found myself in the taxi, with all my belongings shoved into four bin liners. Handed not enough medication to get me through the weekend, I was now off suicide watch and, with a staff member, apparently headed for my local Community Mental Health Team (CMHT).
“I didn’t know the time, if I had my door key, if I had money on me or if I had my bus pass. No one could explain what had just happened. How would I get meds at the weekend? Did I have food in the house? Did I have money on the electricity meter, the gas meter? Did my phone have battery? What would I do? Was there anyone around this weekend? How will I get home from the CMHT?
“My brain froze. I went into a state of shock. Was I even awake? I cannot do this. I don’t think most people could have coped, and in my already fragile state of mind, I really had no chance.”
Paul Farmer, Chief Executive of Mind, said:
“It is shocking that so many people are being sent home from hospital before they feel like they are ready to leave, with no appropriate plan for the care of their mental health. This is not good enough. It is a tragedy that so many people so very recently leaving the care of hospital are being left to cope alone, and are at risk of losing their lives.
“Whether you’ve been in hospital for days or for months, when you come out you need the right care and support to help you stay well. Appropriate planning while you’re in hospital is essential. Help with things like housing or finances can make a huge difference, and you should at the very least have support to look after your mental health.
“Leaving hospital and coming home can be daunting. You need to feel prepared and confident you will get the support and services you need to help pick up the pieces and continue getting better. Providers must urgently make the improvements needed for everyone in their care.”
 Mind survey of 1,221 people (2017)
 National Institute for Health and Care Excellence (2017) Transitions between inpatient mental health settings and community or care home settings
 Mind, Planning for Recovery (2017)