People are leaving hospital too soon – but is it always acute care that they need?

December 12th, 2017 by Rachael Byrne, Executive Director of New Models of Care in Care and Support blog

Home View customers enjoing the facilities

Figures released by Mind this month show that many people with mental health problems feel that they are being discharged from hospital too soon.

Imagine the situation. Having been at crisis point, you are admitted for acute inpatient care, recovering gradually with daily support. You’re growing in confidence, trusting those around you, the medication is beginning to stabilise and then, all of a sudden, you’re being discharged and heading home to an empty house. There’s nobody to turn to for reassurance when the symptoms flare up.

Or perhaps you do have loved ones at home, but they, too, are nervous about doing the right thing and providing the right kind of support. They also feel scared and isolated.

Being in the early stages of recovery, you’re still vulnerable. The stress builds back up, the symptoms return, and you feel isolated in terms of your care. You’re close to crisis point – again.

The problem is, it’s not ideal for people to stay in hospital for longer than required. That can create its own set of problems. It can inhibit recovery because there is little opportunity to ease back into day-to-day life.

So perhaps it’s not as clear cut as people needing to be in hospital, or being well enough to embrace total independence. Perhaps we need a stepping stone – a way to continue a journey to recovery with levels of support decreasing gradually, at a suitable pace.

We know that there is also a hospital bed crisis, that some people are stuck in hospital for longer than they need to be. Some can’t secure a bed, and others are, as Mind’s research shows, leaving too soon.

Supported housing services – specifically step-down services, like Home View in Blackpool, a partnership between Home Group and Lancashire Care Trust – bridge the gap. But they, too, have had to face their own set of challenges. Not least the uncertainty that we in the housing sector faced for over 18 months relating to the proposed funding caps that would limit the sustainability of services.

But thankfully, October’s announcement that this cap would not apply to such services has recognised the vital role of supported housing. On top of this, we know that NHS England’s very own mental health lead, Claire Murdoch, is a great advocate for the role of supported housing in health and wellbeing too.

Denise Welch with Home View customers

Home Group’s mental health ambassador, Denise Welch, strikes a pose with customers and colleagues at Home View

But acknowledgement, on its own, isn’t enough. Both the housing sector and the NHS need to take action at all levels to bring these services to fruition. We’ve been given the approval, now we need to make it happen.

At Home Group, for example, we have invested in clinical governance expertise to make us a more fit-for-purpose partner for the NHS. We are investing in skills development and further recruitment, as well as designing buildings that promote wellbeing.

In health, leaders obviously see the potential. But we need conversations to happen at a local level too. After all, it’s not up to the patients, who may still be vulnerable, to seek out services and join the dots. We need longer-term holistic approaches. For mental health trusts to link in with housing providers and look at bespoke solutions to local needs. Are people stuck in hospital? Are people having to leave the area for a hospital bed? Are people stuck in the revolving door of crisis – hospital – home and back again, because they don’t have the right level of support?

We are moving into a new year with new budgets and recent policy changes that enable, rather than inhibit, the positive development of supported services. And we have a duty to make this happen. In my view, our New Year’s resolution should be to take action while we can. To get those services ready as quickly as possible, and to help people to finally sustain their health and wellbeing and progress onto the next stage of their journey to independence.