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Mental health patients put at risk by placement in inappropriate settings

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Patients in community settings are at risk Patients in community settings are at risk

Pressures on the acute mental health sector are leading high-risk patients to be inappropriately placed in community settings, new research from the University of Manchester has found.

The National Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), looked at suicides in the UK between 2004 and 2014, and found that on average, more than 200 people in community mental health settings killed themselves. This is three times as many as in-patient settings. One third of patients under home treatment who died by suicide had been using the service for less than a week, and a third had been discharged from hospital in the previous two weeks. The report stated that community settings are often not suitable for high risk cases, leading to the possibility that they put at risk the lives of patients.

‘The report raises questions whether crisis resolution/home treatment was the most suitable setting for their care and raises concerns that crisis teams are increasingly used due to pressure on other acute services, particularly inpatient beds,’ said Professor Louis Appleby, Director of the NCISH.

Mental health services have been increasingly over the past year, with reductions in funding and rising demand leading to huge strains. A BBC investigation in February found that 29 of 53 Trusts in England reported a drop in income, in addition to a 1.4% fall in the number of nurses working in the psychiatric sector between 2010-11 and 2014-15.

However, there has been a 10% increase in the number of people sectioned under the Mental Health Act over the past year, leading to a surge in demand in the acute sector.

‘It is a flawed and unacceptable system whereby patients at risk of death by suicide are denied the hospital care that would be given to anyone with life-threatening physical illness and placed in the hands of overworked, understaffed community teams,’ said Marjorie Wallace, chief executive of the mental health charity Sane.

The number of suicides by mental health patients in the UK has risen in recent years, mainly as a result of increases in England, says the report. This reflects the large rise in the number of people under mental healthcare in England. During 2004-14, 28% of suicides in the UK general population were by people under mental health care, a total of 18,172 deaths.

Professor Nav Kapur, Head of Suicide Research at NCISH said the study had helped them identify what services can do to reduce suicide risk such as care planning and early follow-up on discharge from hospital, personalised risk management without routine checklists, and implementing guidance on depression and self-harm.

The report also looked at factors involved in patients who take their own lives. It found that over half had a history of alcohol or drug misuse. However, few had received specialist substance misuse treatment. Additionally, more patients who died by suicide were reported as having been unemployed or homeless, and 13% had experienced serious financial difficulties in the previous three months.

‘There are some very difficult, nuanced decisions are being made [by mental health professionals] around risk management and the use of resources to support people. In majority of people, this works successfully, but there are some for whom that support is not sufficient,’ said Ian Hulatt, professional lead for mental health at the RCN.

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