AAs a psychiatrist, I reserve admission to a psychiatric hospital bed only for the sickest patients, whose mental health has collapsed. But despite my best efforts to keep as many patients out of the hospital as possible, bed pressure invades every aspect of my daily work. The decision whether or not to admit a patient with a psychotic relapse who does not eat or drink, for example, must first be approved by the trust’s bed management team. The deplorable and growing scarcity of NHS mental health beds forces psychiatrists to make very difficult judgments about a patient’s care needs and the risk they pose.
Acting in the best interest of the patient often seems secondary to the need to manage the limited bed capacity of our hospital. If, after long and thorough discussions with bed management, I get the go-ahead to admit someone, I immediately become anxious that my patient will be sent to an “overflow” bed in the private sector, where I I can be fairly sure that he will receive much poorer care. care they would receive in the NHS.
I am not suggesting that being hospitalized in one of the underfunded NHS mental health hospitals in England is a pleasant experience. Most of our rooms are run down. Between six and eight patients share a single bathroom. Decades of underinvestment in mental health trusts are there for all to see. If the government is serious about mental health, it must start rebuilding our wards to provide a proper therapeutic environment and greater dignity in the care of our patients. And yet the quality of care we provide in the NHS to our sickest patients is far better than what they would receive in the private sector.
Over the past 20 years the NHS has come to rely increasingly on the private sector as our own stock of mental health beds has dwindled. This is despite the ever-increasing need and demand for inpatient mental health care. It’s a hugely short-sighted policy that has left NHS mental health services at the mercy of profit-making corporations.
Many NHS psychiatrists are very concerned about this growing reliance on the private sector, mainly because the quality of care there is highly variable and also because some private mental health operators have very questionable practices.
The idea that private provision of mental health care is ‘better’ than NHS care is a myth. Countless Care Quality Commission inspection reports have shown that private mental health hospitals suffer from serious staffing problems. The private mental health sector relies heavily on temporary staff, has few full-time psychiatrists and relies heavily on NHS psychiatrists working there one or two days a week.
The quality of inpatient therapeutic care is often poor and post-discharge follow-up care can be non-existent and poorly coordinated with NHS community teams. Once private companies have collected the NHS charges for someone’s stay in hospital, they often seem to forget about the patient, while we in the NHS continue to support them for as long as they need it.
Private beds are sometimes far from the patient’s home, family and friends, which is painful for everyone. I have lost count of the number of families who complain that their loved ones are in a private hospital far away and therefore cannot visit them. Out-of-area care reduces the support provided to the patient while hospitalized, may require them to stay longer, compromises effective and timely discharge planning and, most importantly, reduces their chances of recovery.
Private mental health hospitals often seem to hold NHS patients longer than necessary. They have no incentive to discharge patients and are paid to keep their beds full, with guaranteed income from the taxpayer. Hospital stays longer than necessary are bad for patients. When a hospital stay lasts several months, the person can become institutionalized and unskilled in daily tasks.
Some private hospitals also tell patients what they want to hear. They can accept the patient’s self-diagnosis too easily. A personality disorder diagnosis in the NHS often becomes bipolar disorder in the private sector. Again, it seems to be about filling their beds and increasing their profits.
The private care of NHS mental health patients is bad for patients, bad for the NHS and bad for taxpayers. The government needs to address this by building up NHS inpatient mental health bed capacity.
The author is a psychiatrist working at a mental health trust in London