Recommendation one
We note the Department of Health and Social Care’s (DHSC) national statutory guidance on discharge from mental health settings. As it is implemented, DHSC and NHS England must engage with people and services to assess the impact the guidance has on them. In particular, they must make sure that Integrated Care Systems account for the different professionals that should be involved in the discharge multi-disciplinary team (MDT).
To make sure transitions of care consider a patient’s full condition and situation, an MDT must be involved in discharge planning and delivery. This team should include representatives of the different points in a patient care pathway. This will create a ‘safety net’ of care around a person when they leave an inpatient setting. The MDT members should be seen and referred to as equal partners in someone’s care.
Each transition of care should include or state the reasons for excluding:
- the current inpatient mental health team
- other medical specialities involved in an individual’s physical health care
- occupational therapists
- dieticians (for example, for individuals with a diagnosed eating disorder)
- the community mental health team or a representative from primary care
- the crisis response team
- voluntary and community sector partners involved in support services
- a mental health social worker, where relevant
- a local authority representative responsible for housing, where relevant.
Integrated care boards are in a good position to help bring together these different partners to make sure planning for transitions in care is safe and patient-centred.
A patient’s care plan on discharge must clearly reflect the involvement of each of these teams.
Recommendation two
NHS England should extend the requirement for a follow-up check within 72 hours of discharge for people from inpatient mental health settings to include people discharged from emergency departments.
When someone is discharged from inpatient mental health services, they should have a follow-up appointment within 72 hours of leaving hospital. This is usually led by the community mental health team or crisis mental health team and is informed by evidence from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). If a person in a mental health crisis goes to a hospital emergency department and is assessed, they may be treated, transferred to a mental health ward or sent home. Depending on clinical assessments, a support plan may be put in place with a community mental health team, but it may take time for this to happen.
When a lead emergency department clinician or psychiatric liaison team is discharging someone from an emergency department to their home, they should confirm or rule out a follow-up call or appointment with a crisis mental health team, care coordinator or primary care provider within 72 hours. This applies the principles of safe transitions of care and discharge to emergency admissions and assessments.
Recommendation three
NHS England and Integrated Care Boards should make sure that people who are being discharged from mental health settings can choose a nominated person to be involved in discussions and decision-making around transitions of care.
In the absence of reform to the Mental Health Act, guidance should state that people are asked to name a nominated person who they would like to be included throughout the planning and transition of their care. As set out in the draft Mental Health Bill, this nominated person would replace the ‘nearest relative’ role and could be a close relative, carer or another trusted person. The nominated person should be able to support the individual in advocating for their wishes and concerns in the transition of care. Healthcare professionals should listen to the nominated person’s views and record them alongside the views of the person who is having their care transferred.
Other people including family members and carers should still be informed and updated on discharge plans.
Recommendation four
NHS England should make sure that patients and their support network are active and valued partners in planning transitions of care and are empowered to give feedback, including through complaints.
We welcome the ambition set out in NHS England’s forthcoming ‘Culture of Care Standard for Mental Health Inpatient Services’, including the core commitments around ‘choice’ (the right for patients and their support network to be engaged in all parts of care) and ‘transparency’ (open and honest conversations with all people involved in someone’s care). We know that inpatient mental health settings are at greater risk of developing ‘closed cultures’, so national leadership is needed to build and maintain an open culture.
As the standards are rolled out over 2024, mental health services and integrated care boards must be held to account for making sure that:
- the views and experiences of individual patients, their families, carers and nominated person are held in balance with any clinical perspective in making decisions about transitions of care
- staff support and encourage people to use this right and, in the case of someone being detained under certain sections of the Mental Health Act, listen to the views of an individual, their family and carers before making a clinical decision
- people are empowered to give feedback about their or their loved-one’s care and staff proactively seek out their feedback
- when things go wrong in care, people affected are supported to make a complaint and know that this will be responded to in an honest and compassionate way. Where necessary, services must effectively signpost and support people to take their complaint to the appropriate organisation, such as the Parliamentary and Health Service Ombudsman, Local Government and Social Care Ombudsman, Care Quality Commission or Mental Health Tribunal.
Recommendation five
The Government must show its commitment to transforming and improving mental health care by introducing the Mental Health Bill to Parliament as a priority.
People using mental health services need their safety and rights to be protected. Patients, families, carers, staff and commissioners of care need a twenty-first century Mental Health Act so they can receive and deliver modern mental health care. Modernised and strengthened legislation must prioritise patient safety and experience and put the voice of people, their families and carers at its heart. We welcome the terms of the draft Mental Health Bill as a whole.
In future draft versions of the Mental Health Bill, we need to see legislation that:
- removes barriers to accessing justice for mental health patients by including mandatory signposting to the Parliamentary and Health Service Ombudsman, Local Government and Social Care Ombudsman, Care Quality Commission or the Mental Health Tribunal as appropriate for the type of complaint
- allows people to complain to us in the most suitable way for them. This should not be in writing only as this discriminates against people who may find it difficult to communicate their experiences of care in this way, including:
- people living with severe mental health conditions
- people with specific accessibility needs
- people who do not have English as their first language.