Ministers urged to alter approach to mentally-ill people living outside NHS area

A mental welfare body has called on the Scottish Government to take a “human rights and health economics-based approach” towards mentally-ill people living outside of their NHS area.

The Mental Welfare Commission report estimates 162 people in Scotland who are mentally ill or have learning disabilities are in this category, with the majority receiving care in private-sector facilities.

The study focuses on 59 of the 162 individuals, speaking to them and their relatives directly where possible in order to hear about their experience of referral, their care and treatment, and any plans they may have to return to their home area.

The commission also sought to assess the impact and costs of the placements.

The majority of individuals and their relatives were happy with the quality of care and treatment in the out-of-area placements.

They also said the quality of care was better than before the move but that they felt being away from home had an impact on their relationships with relatives and families.

The average stay at the point of the report’s research was more than eight years, with one individual living in an out-of-area establishment for 28 years.

Discharge planning was cited as a concern both for current service providers and for health boards who made the referrals.

Current providers identified that getting engagement from the funding health board could be challenging and slow.

For the funding service, it was around their concerns relating to a lack of an appropriate local service and the risk of relapse for the individual.

The commission sought to estimate costs but says it found a lack of accurate information.

It gave an estimation of more than £13 million a year being spent by NHS Scotland services on out-of-area care and treatment of the 59 people included in the report.

However, the commission predicted the real figure will in fact be higher.

Claire Lamza, executive director for nursing at the Mental Welfare Commission, said: “When people with mental ill health or learning disability are placed outwith their NHS health board area for care and treatment, they are likely to have highly complex, specialist needs that have been assessed as not being able to be met by their local health services.

“This report examined in detail the care in place for 59 of the estimated 162 people who are living in out of NHS board areas, almost all of whom are in private-sector facilities.

“We were reassured to hear positive feedback from individuals and relatives on the quality of care, but we also heard they were unsure of the plans that were being put in place for a return closer to home and about the impact on relatives of travelling to see their family member, and the toll that this took on their relationship.

“When we sought to clarify with health boards the costs and oversight of these placements we found gaps in information; we believe our funding estimates are likely to be considerably lower than the true costs.”

Ms Lamza recommended including “setting new standards, developing accurate data collection and creating a national oversight and scrutiny role”.

She added: “We also ask Scottish Government to take a human rights and health economics-based approach, and consider whether a regional resource should be developed for those individuals who are considered at greatest risk of being out of area.”

The Scottish Government has been contacted for comment.