Mental health beds are full, leaving patients without treatment and clinicians with difficult choices

There has been growing concern throughout the last year in the NHS mental health sector about services becoming overstretched during the pandemic. The Royal College of Psychiatrists asked psychiatrists about the pressures on the ground and they confirmed what we had anticipated—mental health beds are full. 

Of the 320 members of the Royal College of Psychiatrists who participated in our December survey, 85% said there was more pressure on beds compared to the same time last year. In fact, the vast majority (92%) of those we spoke to estimated there were less than 5% of beds available in their trust. In order to manage admissions and discharges effectively, the College recommends that 15% of beds should be vacant at any one time. 

High levels of bed occupancy in mental health trusts are an indicator of pressure in other parts of the system. The shortage of beds and the lack of mental health services available in the community, alongside the insufficient number of crisis mental health services are the main drivers behind these pressures.

There are high levels of unmet mental health need in the community, which has grown during the pandemic. There are also significant pressures on beds in general hospitals, and delays in discharging patients from mental health inpatient settings due to a lack of social care support. 

Major challenges with infection prevention and control in mental health and intellectual disability inpatient environments has also meant some beds, such as dormitory accommodation, needed to be closed, resulting in fewer beds available overall than before covid-19 hit.

These problems result in difficult decisions for overstretched staff and challenging experiences for patients. 

We see increases in patients sent out of their local area for treatment, which we know can lead to poorer experience of care and worse outcomes. The latest data on inappropriate out of area placements for November shows the highest month-end number since September 2019. There are also pressures in A&E, with patients with a mental health need often waiting longer than 12 hours for a bed.   

Although much of this sounds—and is—bleak, there are solutions.

The NHS Long Term Plan, if fully implemented, will help tackle the problem of service pressures, but we still need urgent action to improve the current situation we find ourselves in. Patients who are ready to be discharged should be supported to do so. We are calling for an extra £150m funding in 2021/22 to support people leaving mental health inpatient stays. The funding is intended to “bridge the gap” between inpatient and community care by supporting people as they recover from their illness at home.

We need Government to invest in additional beds in high priority areas, and to commit to build a further six mental health hospitals by 2024/25 as part of the Health Infrastructure Plan. The quality of the mental health inpatient environment also needs to be drastically improved by addressing maintenance backlog issues. 

This should run alongside funding to bolster community mental health services.

But the biggest challenge we need to address are the social determinants of poor mental health that drive demand for mental health services and put pressure on beds. There are no easy answers but through working together across sectors to tackle health inequalities we can make progress.

I hope that our vaccination programme is successful so that the pressure on mental health beds will ease over the next few months. As we wait, we must seize this opportunity to make sure mental health services can provide the care patients need, during the pandemic and beyond.

Adrian James, President, Royal College of Psychiatrists.

Competing interests: none declared.