The reconfiguration of clinical services report provides new insights into the drivers of reconfiguration and the underpinning evidence. It builds on a major analysis, commissioned by the National Institute for Health Research (NIHR), of reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT).
This page summarises the report's findings on the reconfiguration of mental health services.
Proposals reviewed by NCAT
- Closing inpatient wards or beds
- Centralising existing services at fewer sites, with more appropriate facilities such as provision of single rooms
Key drivers of mental health service reconfiguration
Cost, workforce and implementing national policy were the primary drivers of this type of reconfiguration.
Context and relevant policy
- Shift from institutional care and long-term acute facilities to care delivered by community mental health teams and a smaller number of inpatient units.
- The Department of Health National Service Framework for Mental Health – a programme to strengthen and develop community service infrastructure.
- Ensuring parity of access to mental and physical health services, as described in the Department of Health’s Healthy lives, healthy people and No health without mental health strategies.
- Increase in demand for specialist mental health services and decrease in number of mental health beds.
The current evidence base
The evidence indicates that substituting inpatient mental health service provision with a community-based service delivers better outcomes for people with moderate mental health needs at comparable cost. Although one-off savings may be generated by rationalising inpatient provision, community services are unlikely to produce ongoing savings and may be more expensive for patients with complex needs.
The evidence also suggests that some types of community services are more cost-effective than others.
There may be arguments for centralisation if this releases capital to invest in improved and safer accommodation. In rural areas, telehealth can facilitate access to specialist advice and support.
Relevant college and other guidance
NICE guidance recommends use of assertive outreach or case management for people with severe mental health conditions such as psychosis and schizophrenia, who are likely to disengage from treatment or services.
The Royal College of Psychiatrists (RCPsych) advises that inpatient rehabilitation services should be provided as part of a wider clinical network, with short-term hospital or community-based rehabilitation units or access to supported accommodation ‘available in all but the smallest services’.
The RCPsych also advises that ‘mental health providers should review the physical environment within which they provide care, and consider whether it is fit for the purpose of providing a therapeutic environment’.
The RCPsych Accreditation scheme for Inpatient Mental Health Services (AIMS) sets out standards for inpatient care, including staffing and environment and facilities.