An 'out of area placement' (OAP) occurs when a person with acute mental health needs who requires inpatient care is admitted to a unit that does not form part of the usual local network of services. This means that the person cannot be visited regularly by their care coordinator to ensure continuity of care and effective discharge planning. Patients should be treated in a location that helps them to maintain contact with family, carers and friends, and to feel as familiar as possible with their local surroundings.
The government has set a national ambition to eliminate inappropriate OAPs in mental health services for adults in acute inpatient care by 2020-21. Inappropriate OAPs are where patients are sent out of area because no bed is available for them locally, which can delay their recovery.
OAPs are an indicator of a whole mental health system under pressure, not simply the result of too few acute mental health beds. A lack of focus on prevention, high levels of delayed discharges, increasing pressures in community care, lack of crisis response, and a rise in Mental Health Act use can all increase the pressure on bed capacity, which can in turn lead to reliance on OAPs.
At the end of September 2021, there were 715 active out of area placements (OAPs) in England, of which 645 (90%) were deemed ‘inappropriate’ (data not shown). An OAP is inappropriate if the reason is non-availability of a local bed. There are a number of reasons why an OAP may be appropriate; for example, if a person becomes acutely unwell when they are away from home, or if there are safeguarding issues.
Between September 2017 and February 2020, the number of inappropriate OAPs started each month increased overall from 586 to 665. In March 2020, the number of inappropriate OAPs started to fall sharply, reaching a low of 210 in April. This may reflect a decrease in admissions to mental health inpatient care. It may also be due to discharges being increased to reduce bed occupancy during the coronavirus (Covid-19) pandemic, meaning that more patients were able to be admitted to inpatient care within their local network of services.
Between April and October 2020, the number of inappropriate OAPs started each month increased again to 630. Since then, inappropriate OAPs have gradually fallen, and in September 2021, 430 inappropriate OAPs were started. It is worth noting that NHS Digital reports that due to the Covid-19 outbreak, the quality and coverage of the data is being affected (see ‘About this data’ for more information).
To put these figures into context, in Q2 2021/22 (July to September 2021) there were 16,148 occupied mental health beds on average per day. We can estimate, therefore, that inappropriate OAPs make up around 4% of occupied mental health beds (there were 645 inappropriate OAPs active at the end of Q2 2021/22 divided by 16,148 occupied mental health beds).
Between February 2018 and February 2020, the number of inappropriate OAPs that required patients to travel a distance of 300km or greater increased from 35 to 50. Those that required patients to travel more than 200km but less than 300km increased slightly from 115 to 120.
In April 2020, there was a 45% fall in the total number of inappropriate OAPs active during the period compared with February 2020. The number of inappropriate OAPs that required patients to travel a distance of 300km or greater fell to 25 and OAPs that required patients to travel more than 200km but less than 300km fell to 65.
Between April 2020 and March 2021, the total number of inappropriate OAPs active during the period increased again by 79%. The number of inappropriate OAPs that required patients to travel a distance of 300km or more increased to 70, and patients who travelled more than 200km but less than 300km increased to 185.
Since then, the total number of active inappropriate OAPs fell by 20% to 975 in September 2021. Inappropriate OAPs that required patients to travel a distance of 300km or more decreased to 50, but those who travelled more than 200km but less than 300km increased slightly to 190.
These are significant distances to travel for acute mental health inpatient care. This may leave patients isolated from family and other visitors, and may mean that care coordinators are unable to visit regularly.
About this data
The Out of Area Placements (OAPs) in Mental Health Services data collection began in October 2016 and is for providers in England only. The collection only includes OAPs that have started since the beginning of the collection process, meaning that the current maximum duration for an OAP is 1,780 nights. The number of OAPs that are longer than this is believed to be minimal. OAPs from both NHS and independent providers are included.
Definition: An OAP for acute mental health inpatient care is defined as happening when a person who has assessed acute mental health needs and requires adult mental health acute inpatient care is admitted to a unit that does not form part of their usual local network of services. By this we mean an inpatient unit that does not usually admit people living in the catchment area of the person's local community mental health service, and where the person cannot be visited regularly by their care coordinator to ensure continuity of care and effective discharge planning.
The number of recorded OAPs nationally is very low. This means that the figures are susceptible to random variation (chance), and the monthly data should be interpreted with caution.
During the Covid-19 outbreak, NHS Digital has reported that the quality and coverage of some data is being affected, including an increase in non-submissions for some datasets. There are also different patterns being observed in the data, such as fewer patients being referred to hospital and more appointments being carried out via phone or email. Data covering the Covid-19 outbreak should therefore be interpreted with care. For more information, please see NHS Digital's Out of Area Placements (OAPs) – Data Quality Statement.