Children forced to travel hundreds of miles for NHS mental health treatment

Exclusive: NHS England figures reveal some under-18s sent as far as 285 miles for inpatient services

Children and young people with serious mental health problems are receiving treatment as far as 285 miles away from their homes, despite a pledge to end such practice, because bed shortages in some areas are so severe.

Experts say sending highly troubled under-18s to units far from their family and friends can be frightening for them, reduces their chances of recovery and increases their risk of self-harm.

In all, 1,039 children and adolescents in England were admitted to a non-local bed in 2017-18, in many cases more than 100 miles from home, figures collated by NHS England show. Many had complex mental health problems that often involve a risk of self-harm or suicide, such as severe depression, eating disorders, psychosis and personality disorders.

Patients from Canterbury, in Kent, were sent 285 miles for inpatient mental health care, those from Cornwall and the Isles of Scilly 258 miles and those from Bristol 243 miles.

Bed shortages meant that in 119 of the NHS’s 195 clinical commissioning groups (CCGs) at least one patient under-18 was sent out of the area for care last year, the statistics show.

NHS England has acknowledged that the separation from relatives and isolation that very vulnerable patients experience during out-of-area placements can be damaging.

Its own policy states that in order to maximise the chances of recovery, “patients should be treated in a location which helps them to retain the contact they want to maintain with family, carers and friends and to feel as familiar as possible with the local environment”.

mental health travel distances

NHS England has pledged to end the use of the practice and is creating between 150 and 180 more beds to that end, but while the number of under-18s involved has fallen, their continued widespread placing in units far from home raises questions about how soon the goal will be achieved.

Dr Louise Theodosiou, a spokeswoman for the Royal College of Psychiatrists, welcomed the 24% fall in the number of children and young people sent out of area, from 1,365 in 2016-17, but said the figure was still unacceptably high.

“Severe mental illness in young people can stem from or be exacerbated by difficult social or educational factors that need the support of local services if the young person is to get better and stay better,” she said.

“When a young person is sent far from home it is much harder for them to engage with all local services and benefit from family support – they may not be able to fully participate in family therapeutic work, for example – and so the difficulties they faced before getting ill may remain upon their return home.”

Barbara Keeley, the shadow cabinet member for mental health, said the figures – which she obtained under the Freedom of Information Act – revealed a national scandal.

The figures also show:

  • Sixty-six CCGs – one in three – sent under-18s on an out-of-area placement at least 100 miles away last year, and 33 sent patients more than 150 miles from home.
  • A patient from Hertfordshire’s placement in 2015-16 was 316 miles from home, the longest distance recorded in the past three years.
  • Young people from 25 CCGs – one in eight, have had to receive inpatient care at least 200 miles from home in the past three years.

Emma Thomas, the chief executive of the charity Young Minds, said: “For children, being far from home is often distressing and going to a hospital hundreds of miles way can make a frightening situation worse for the whole family. Too many children are still having to travel extremely long distances.”

Families also faced paying for travel and accommodation that they may not be able to afford. She said the NHS’s pledge to end such placements “cannot come quickly enough”.

Keeley said: “All the evidence shows that out-of-area placements jeopardise the recovery of people with mental health conditions. It is heartbreaking that parents, worried for their children, will be miles away because of the government’s failure.”

An NHS source, speaking anonymously, said bed shortages were inevitable. “By its very nature, specialist provision for these acutely unwell children and young people is to serve large populations, so may not be near where they live, which is clearly undesirable and yet also unavoidable.”

Bristol, North Somerset and South Gloucestershire CCG said it hoped to have increased its stock of child and adolescent mental health services (CAMHS) beds from 10 last year to 32 by the end of this year. Cornwall is building its first CAMHS inpatient unit, comprising 14 beds, which is due to open next year.

Under-18s from the Canterbury and Coastal CCG area are treated in London, 60 miles away, by the South London and the Maudsley mental health trust. The CCG said it had also sent 35 children and young people to receive specialist mental health treatment as outpatients at three different hospital trusts in London during 2017-18.

The Department of Health and Social Care said: “It is completely unacceptable for patients to be sent away from their family and friends for treatment. That’s why the NHS is opening more specialist beds to tackle this and we have committed to ending inappropriate placements altogether by 2020.

“We are transforming mental health services with record investment and an ambitious plan to increase the workforce, and will announce further improvements to mental health provision later this year as part of our long-term plan for the NHS.”


Denis Campbell Health policy editor

The GuardianTramp

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