At least 11,000 people a year who have recently been in mental health inpatient care are not followed up within a week of coming home, despite guidelines requiring the NHS to contact them. People discharged after hospital treatment for a mental health crisis should receive a visit or phone call to assess their needs, the National Institute for Health and Care Excellence (Nice) says. But figures obtained under freedom of information laws by the charity Mind show that one in 10 such people are not contacted.
“Patients should only be discharged from specialist mental health services when there are ongoing care arrangements in place for them. Failure to do so can put the person at risk of harm, their condition can relapse and it can mean they are more likely to go going back into hospital,” said Dr Paul Lelliott, the Care Quality Commission’s deputy chief inspector of hospitals. Mind discovered that the Nice guidelines were often breached after receiving information from 54 of England’s NHS 56 mental health trust and one of Wales’s seven health boards.
Separate research by Mind, among 850 patients about their experience of after-hospital care, found that those who were not followed up were twice as likely to attempt to take their own lives and a third more likely to harm themselves. They are also more than twice as likely to end up back in A&E suffering another crisis, the survey found.
Natalie, 26, from Somerset, who ended up in hospital after trying to take her own life, said the crisis team did not visit her for a week afterwards.“When you’re that unwell, it’s hard getting through each day. Each hour is tough, so just 24 hours can feel like such a long time. I needed someone to talk to, to help me understand my thoughts and feelings. To see someone only after a week, it’s not enough,” she said.
The CQC’s Lelliott said pressure on mental health services, including to discharge patients to free up beds, should not compromise the aftercare they received.
“We know that hospitals are under increasing pressure to discharge patients as soon as possible but providers must not compromise their ongoing care responsibilities to their patients. It is vital that when they discharge patients into community, it is done in a safe way that ensures people get the continuity of care they deserve and have every right to expect,” he stressed.
Nice guidelines say all such patients should be contacted within a week, and those thought to be at risk of suicide within 48 hours. Last year’s National Confidential Inquiry into Suicide and Homicide found that most suicides occurred on the third day after release.“Patients leaving hospital can feel unsupported as they return to the problems that may have led to their admission. Those first few days are the time of greatest risk,” said Prof Louis Appleby, the director of the confidential inquiry.
Barbara Keeley, the shadow minister for mental health, said: “Mind’s research is yet more evidence of the gap between rhetoric and reality with this government. We are seeing people in some of the most vulnerable positions with their mental health being put at further risk.”
The Liberal Democrat MP Norman Lamb, who was the mental health minister in the coalition government, backed Mind’s call for all discharged patients to be contacted within 48 hours. “The moral case for this proposal is overwhelming. When we know that the risk of loss of life through suicide doubles if there is no timely follow up, the government and NHS England have an absolute duty to act. But this requires investment in community support which is so often lacking.”
Prof Mark Baker, director of the Nice Centre for Guidelines, said it was reviewing its recommendations to see if they needed to be updated in the light of Mind’s findings. NHS England said: “Improved access to mental health support for people in the community where they live is part of our plans for the biggest expansion of mental health services in Europe.”
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