No beds and no clear answers: Concerns over mental health crisis capacity in Nottinghamshire

There are concerns for mental health patients in Nottinghamshire after an official failed to answer where they were being placed when beds are full.

According to a new report, there has been “sustained and significant mental health demand pressure across Nottingham and Nottinghamshire”.

The Nottingham and Nottinghamshire ICB, the NHS organisation responsible for planning, commissioning, and managing local health services, says this has been driven “primarily by a lack of available mental health bed capacity”.

The situation has worsened to the point that it is reported that there are no available beds and no clear plans to resolve the problem, the report says.

Some of the added pressure is coming from an increase in the number of people being taken to a place of safety by the police under Section 136, which allows officers to do so without a warrant.

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The problem was discussed at Nottingham City Council’s health scrutiny committee meeting on Thursday (March 19).

Chair of the committee, Cllr Georgia Power (Lab), said she was concerned because there have been cases in other areas of the country where patients have been sectioned under the Mental Health Act but remained at home due to a lack of beds.

She also raised concerns over people being detained in police custody due to a lack of bed spaces.

Both of these places, she said, are not appropriate for someone experiencing a mental health crisis.

Gemma Whysall, the ICB’s director of commissioning, said patients were typically placed in a Section 136 suite, of which there are two, and they are used specifically for detentions under the Mental Health Act, as well as a bed space managed by Nottinghamshire Healthcare NHS Foundation Trust, or in an emergency department.

However, when asked by Cllr Power if patients were being kept in custody due to a lack of bed spaces, Ms Whysall said: “To be honest, I don’t know.”

She added: “This winter Notts Healthcare Trust opened 10 additional beds on Dove Ward, so they have contributed to having more beds than we’ve ever had before this winter.

“In a similar way to how I describe the acute sector, they have higher acuity, a long length of stay, or people are waiting to leave mental health beds that need step-down care in the community.

“From my perspective, I look after patients that are in emergency departments, so if they have been conveyed by [ambulance] into an emergency department, we will have a system escalation, which will then look at the presentation and whether they have been assessed by an ambulance. Do they need a mental health bed, or is it a crisis at home?

“They are then part of a twice-daily escalation with Notts Healthcare around how we help to manage flow. Is it a discharge, a step-down, what capacity have they got coming up? The clinicians will get together based on the presenting need to make sure we have got a plan for that patient.”

The concerns come after Nottinghamshire Healthcare Trust capped the number of additional private mental health beds at 25.

In November last year, Cllr Power raised concerns that this had been done due to financial reasons, with the NHS under immense financial pressure, but the trust argued this was not the case.

There are currently two Section 136 suites in Nottinghamshire, one at Highbury Hospital in the city and one at Sherwood Oaks in Mansfield.

Cllr Power said the 10 additional beds were for people over the age of 65 only, and questioned how many spaces there were for younger patients.

“They said in their presentation every single one of those beds has been full every single day, so where are those patients who have been detained going?” she added.

“Many, many years ago, when we looked at this before there was a Section 136 suite in Nottingham, we know patients were being detained in custody. That is not a place someone who is having a mental health crisis should be.

“It concerned me they couldn’t tell us where those patients are being detained, other than A&E. But if those patients are in A&E, that is also not an appropriate place for them.

“I think that is really concerning. They are really vulnerable, but also they have no choice about being wherever they are.

“They don’t get to say I don’t want to be here. The fact that the ICB doesn’t seem to know where they are is really worrying.”