The death of a man from Cornwall has sparked warnings that mental health patients are having to travel hundreds of miles for care.
The British Medical Association says more than 100 from the Duchy were sent away from home for treatment last year.
It is after David Knight from St Austell took his own life just days after being released from hospital in Somerset.
An inquest into David’s death the following year recorded a verdict of suicide and the evidence it heard prompted an intervention from Cornwall senior coroner Emma Carlyon that reached all the way to the Department of Health.
David, aged 29, had walked on to the train tracks and stood in front of an oncoming train, the inquest heard. Despite using emergency brakes, the driver was unable to stop.
Cygnet Hospital Kewstoke in Somerset, where he had been a patient for eight weeks, is one of many private hospitals used by the NHS when it runs out of local mental health beds, an increasingly common occurrence. It is 150 miles from David’s home, a not untypical distance for these so-called OOA or ‘out-of-area’ beds.
That the bed was outside of Cornwall, senior psychiatrists told the inquest, was ‘very likely’ to have had a bearing on his death. Cygnet Kewstoke had not informed Cornwall’s community health team that David was on leave. There’d been ‘no communication’ at all; no plan or support in place to reduce the risk of David harming himself.
While ‘misjudgement about leave’ can happen anywhere, the psychiatrists said in evidence, the use of an OOA bed had ‘increased the risk of poor communication’. Cygnet Health Care, which runs the hospital, says it has ‘worked with local NHS partners to learn from this extremely sad case’.
Around the time of David’s death, Cornwall had up to 40 patients in such beds. That year, across England, almost 4,800 patients were admitted to them in 2015-16, figures released to the BMA under the Freedom of Information Act shows.
David’s case was raised with health secretary Jeremy Hunt and NHS England late last year by Dr Carlyon in a ‘report to prevent future deaths’ to flag the chance of tragedies occurring under similar circumstances.
She urged a review of bed numbers in Cornwall to end the ‘routine’ use of OOA admissions. ‘I understand though that this is a national issue,’ her report tells Mr Hunt.
Despite the known risks of OOA beds, the numbers are going in the wrong direction, rising 40 per cent from 4,213 in 2014-15 to 5,876 last year, BMA research shows.
In some trusts, use has rocketed: seven-, three- and two-fold respectively in Leicestershire Partnership NHS Trust; Oxleas NHS Foundation Trust, south London; and Mersey Care NHS Foundation Trust in the north-west.
More than half of the 44 trusts areas we examined, including Cornwall, admitted more than 100 patients to OOA beds last year.
BMA consultants committee psychiatric specialty lead Andrew Molodynski says it is ‘simply shocking’ that large parts of the NHS have no PICU beds. Doctors, nurses and social workers often spend hours hunting for OOA beds, Dr Molodynski says. ‘This hunt takes us away from other severely ill patients.’
OOA admissions have opened up a ‘safety gap’ in patient care, he adds. ‘Unfamiliar hospitals and staff lack the detailed knowledge of patients, held by their doctors back home; they’re less familiar with the risks patients pose to themselves and the treatments that have worked well in the past.’
As well as the risks posed to patients, families are commonly forced to travel long distances for visits, a BMA analysis of more than 1,100 patient journeys has found. On average, visits involve a four-hour drive in a day; a six-hour trip by public transport.
For David’s parents, a single visit involved a seven-hour roundtrip, on his father Gerald Knight’s one day off work a week, often giving them just an hour to see their son.
‘He felt safe with me or he felt safe in hospital, but when he was there, it was just a load of strangers,’ Ms Nancarrow says.
‘Coming from his home, where he stayed with his mum and dad and his family popping in, he had none of that. David asked us to stay a bit longer. He desperately wanted us to and we did. But it was such a long journey back. He was so far away, he just felt he was on his own.’
The Cornwall coroner wrote that David’s parents and his dog, Loki, a three-year old Alaskan Malamute, were ‘significant protective factors in preventing him from self-harm and recovery’, in her report, sent to Mr Hunt.
Lengthy journey times ‘made it difficult to physically and practically’ arrange leave and visits and impossible for Loki to be included in his treatment.
Ms Nancarrow says David loved his dog. ‘When he was making a fuss of Loki it was getting all the horrible things out of his head that was taking control,’ she adds. ‘He used to walk his dog 12 miles a day when he was feeling better. It used to give him a break from all the things that were going through his head.’
She traces the deterioration in her son’s mental health to the day he was hit in the face with a brick by an older boy when he was 15.
‘He was such a lovely baby, cheerful. As he got older, he was so happy,’ she says. ‘It was a good time until he was 15,’ Ms Nancarrow adds. ‘Then he became scared, wouldn’t go out on his own. He went downhill, downhill, downhill until he done what he did.’
David was diagnosed with paranoid schizophrenia, which the coroner said was ‘exacerbated by non-compliance with prescription medication and cannabis use’, following the jury’s findings at the inquest. Ms Nancarrow doesn’t believe cannabis use contributed to his suicide.
NHS Kernow CCG, which covers Cornwall, says it has developed an ‘action plan’ since David’s death ‘to ensure all services work together, including the police, council, acute trust, out of hours and our providers’.
‘We have also worked with Cornwall Partnership NHS Foundation Trust to agree an operational process should an out-of-county placement be required,’ he added.
NHS Kernow said: “There is a national shortage of beds for adult inpatient mental health placements, and patients from Cornwall and the Isles of Scilly (CIOS) do sometimes have to be placed out of county when it is clinically appropriate to do so and when there is no local bed available. To access the right care when it’s needed, sometimes people may need treatment outside Cornwall and this will be a clinical decision as part of that patient’s treatment plan. The decision to admit someone as an inpatient away from their local area is not taken lightly, but is similar to physical ill-health when sometimes the right treatment for that patient is further from home. We are committed to working with our partners to help mental health service users to get the right care when they need it.
“We are working with our mental health service providers to come up with a solution that will improve services in Cornwall and the Isles of Scilly, aiming to stop or reduce the number of times patients are placed with inpatient mental health services out of county. This will mean patients are treated nearer their families. We are hoping this will be in place by March 2018. In addition to this, in 2015 we established a local Crisis Care Concordat steering group, a multi-agency group that ensures all services work together, including the police, council, acute trust, out of hours and our providers.”
Originally posted and written at PirateFM.co.uk