Use of out-of-area rehabilitation placements for adults with complex psychosis should be curtailed says NICE

A new draft NICE guideline published today (20 December 2019) on the rehabilitation of adults with complex psychosis and related mental health conditions says they should have access to rehabilitation services in their local area and the use of out-of-area placements limited.

 

A new draft NICE guideline published today (20 December 2019) on the rehabilitation of adults with complex psychosis and related mental health conditions says they should have access to rehabilitation services in their local area and the use of out-of-area placements limited.

The draft guideline says those commissioning services should aim to place people locally and limit the use of out-of-area placements wherever possible, except for people with particularly complex needs.

And commissioners should only provide an out-of-area placement after a local placement funding panel has confirmed that the person’s care cannot be provided locally. 

The draft guideline recommends that when people are placed in out-of-area rehabilitation services, they (and their family or carers) should be told the reasons for this, what steps will be taken to return them to their local area, what support will be provided to help them keep in contact with their family or carers, and the advocacy support available to them.

Paul Chrisp, director of NICE’s centre for guidelines, said: “Our independent guideline committee believes that reducing out-of-area placements for rehabilitation of people with complex psychosis and related mental health conditions will result in more people receiving rehabilitation closer to home, which would improve their quality of life as well as reduce costs to the NHS.

“Evidence suggests that people placed in out-of-area inpatient rehabilitation units have a longer average stay than those placed in rehabilitation facilities closer to their homes. It also suggests that receiving rehabilitation locally makes it easier for people to maintain contact with their families, communities and local support networks or activities, such as peer support groups. This can lead to an earlier discharge when they are well enough to be move back home or live with family or friends.”

The draft guideline also recommends that inpatient rehabilitation units should operate with an expected maximum length of stay (which should be used as a guide rather than an absolute) to reduce the chance of people becoming ‘institutionalised’ and having lengthy hospital stays.

Other recommendations cover areas including:

  • Community rehabilitation
  • Maintaining and supporting social networks
  • Engagement in community activities, including leisure, education and work
  • Care and treatment for physical health conditions

A consultation on the draft recommendations is now open. Stakeholders can have their say at nice.org.uk until 5 February 2020.

Evidence suggests that people placed in out-of-area inpatient rehabilitation units have a longer average stay than those placed in rehabilitation facilities closer to their homes.

Paul Chrisp, director of NICE’s Centre for Guidelines