Record numbers of patients kept in mental health units longer than necessary

The number of patients kept in psychiatric units in England, despite being ready for discharge, is at its highest level in eight years.

An analysis by the Guardian of NHS Digital data shows that, in March, the figures for delayed discharges of patients in NHS mental health trusts reached 49,677 days. This is higher than any month since January 2016, when NHS Digital began publishing figures on delayed discharge.

In April 2023, the number of delayed discharges was 39,098. Before the pandemic, they typically ranged from between 20,000 and 30,000 days a month. During the pandemic, in July 2020, they reached a low of under 17,000.

The term “delayed discharges” is used to refer to instances when a patient is clinically ready to leave hospital but is unable to be discharged for non-clinical reasons. This can reduce the availability of beds for incoming patients.

The figures show the number of days in which patients who were clinically ready to leave hospital were not discharged. For example, if eight patients had their discharge delayed by five days, that would be recorded as 40 days in the monthly figures.

One in five delays caused by wait for care home place

More than 20% of the delayed discharges in March were caused by patients having to wait for a care home place to become available, with a similar proportion caused by delays in finding supported housing. Other reasons for delayed discharge included delays in providing non-hospital-based NHS care or social care in patients’ own homes.

The highest number of delayed discharges were recorded at Barnet, Enfield and Haringey Mental Health NHS trust, in London, and East London NHS foundation trust.

Dr Lade Smith, president of the Royal College of Psychiatrists, told the Guardian: “Delays to discharge are very often caused by a lack of social care and local authority provision in the community. Many patients with severe mental illness have unmet housing needs or financial worries that pre-date their admission to hospital, meaning additional support is needed before they can return home.

“Mental health social care providers help reduce people’s length of stay in hospital. They provide vital advice, community support and crisis services which also prevent people from needing to be admitted in the first place. The withdrawal of funding from social care and local authorities following the pandemic resulted in a sharp increase in the number of delayed discharges.

“An additional £100m investment will be necessary to adequately address this issue.”

Lack of resource has a ‘domino effect’

Mark Winstanley, chief executive of the charity Rethink Mental Illness, said: “It’s deeply concerning that these figures show an increase in delayed discharge. Keeping people in hospital longer than necessary prevents them from rebuilding their lives and continuing their recovery.

“The data reveals how a lack of resource in other parts of the system have a domino effect, with access to NHS community care, social care and supported housing among the key factors causing delays.

“People severely affected by mental illness often need continued support when they leave hospital, and this data suggests this support is patchy and in short supply. At a time when there is high demand for inpatient care for people in crisis and a shortage of available beds, this issue is placing huge pressure on inpatient services. The next government must fix our mental health system and ensure that the wider support people need is resourced to meet demand.”

An NHS England spokesperson said: “While services are being expanded and transformed thanks to £2.3bn NHS Long Term Plan funding, there is no doubt mental health services are under significant pressure.

“We work closely with colleagues in social care and local government to tackle factors affecting delays, such as housing and care home placements.”