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 co-ordinator 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 discharge, 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 August 2020, there were 675 active out of area placements (OAPs) in England, of which 650 (96%) 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, and it reached 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. Since April, the number of inappropriate OAPs started each month has increased, and in August 2020, 575 inappropriate OAPs were started. It is worth noting that NHS Digital reports that due to the Covid-19 outbreak, the quality and coverage of some data is being affected (see ‘About this data’ for more information).
To put these figures into context, in Q1 2020/21 (April to June 2020) there were 13,906 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 575 inappropriate OAPs active at the end of Q1 2020/21 divided by 13,906 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. The number of inappropriate OAPs that required patients to travel more than 200km but less than 300km increased from 115 to 120.
In April 2020, the number of inappropriate OAPs that required patients to travel a distance of 300km or greater fell to 25 and there were 65 inappropriate OAPs that required patients to travel more than 200km but less than 300km. This came alongside a 38% fall in the number of active inappropriate OAPs compared to February 2020. Between April and August, the number of active inappropriate OAPs increased by 49%, and the number of inappropriate OAPs that required patients to travel a distance of 300km or more increased to 50. The number of inappropriate OAPs that required patients to travel more than 200km but less than 300km increased to 140.
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 co-ordinators 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 1,415 nights. The number of OAPs that are longer than this is believed to be minimal.
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 co-ordinator 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). 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 caution. For more information, please see NHS Digital's Out of Area Placements (OAPs) – Data Quality Statement.