Out of area placements

We explore whether out of area placements in mental health services in England have changed over time.

Indicator

Last updated: 28/11/2019

Capacity and staffing
Mental health

Background

An 'out of area placement' (OAP) occurs when a person with acute mental health needs who requires inpatient care is admitted to a unit which 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 surrounding.

The government has set a national ambition to eliminate inappropriate OAPs in mental health services for adults in acute inpatient care by 2020-2021. 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.


How has the number of inappropriate out of area placements started each month changed over time? 28/11/2019

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At the end of August 2019, there were 755 active out of area placements (OAPs) in England, of which 710 (94%) were deemed 'inappropriate'. 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 August 2019, the number of inappropriate OAPs started each month increased overall from 586 to 695. In August 2019, there were 23,680 inappropriate OAP days.

To put these figures into context, in Q1 2019/20 there were 16,375 occupied mental health beds on average per day. We can estimate, therefore, that inappropriate OAPs make up around 5% of occupied mental health beds (there were 770 inappropriate OAPs active at the end of Q1 2019/20 divided by 16,375 occupied mental health beds).


How far are out of area patients travelling to receive acute mental health inpatient care? 28/11/2019

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Between February 2018 and August 2019, the number of inappropriate OAPs that required patients to travel a distance of 300km or greater increased from 35 to 60. The number of inappropriate OAPs that required patients to travel more than 200km but less than 300km increased from 115 to 155. 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 1,049 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 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, which means that the figures are susceptible to random variation (chance). For more information, please see NHS Digital's Out of Area Placements (OAPs) - Data Quality Statement.

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