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The waiting game

Limit out-of-area rehabilitation for people with complex psychosis, NICE says

Out-of-area rehabilitation placements for people with complex psychosis and related severe mental health conditions should only be used in exceptional circumstances, draft NICE guidance has urged.

Keeping people in placements closer to home can help them maintain contacts with friends, family and local services and reduce length of stay, the recommendations advise.

Since 2012, many NHS inpatient rehabilitation units have closed across England and only half of trusts have a community rehabilitation team, the guidelines state.

The draft recommendations, which are out for consultation until February, say exceptions may be made for patients who need highly specialised services, for example those with psychosis and brain injury or psychosis and autism spectrum disorder.

In circumstances where people are moved to rehabilitation services outside their local area, they should be given a reason, told what steps will be taken to return them nearer to home and what help they will get to keep in contact with family or carers, the guidelines state.

Over 80% of people who are referred for mental health rehabilitation have a primary diagnosis of schizophrenia, schizoaffective disorder or other psychosis, and around 8% have bipolar affective disorder, NICE said.

The recommendations also highlight the importance of reviewing physical health needs of those with psychosis and related severe mental health conditions, which are likely to be higher than that of the general population.

GPs should keep practice registers of this group of patients, the guidelines state, with those in rehabilitation services receiving an annual physical health check as a minimum.

Paul Chrisp, director of NICE’s centre for guidelines, said reducing out-of-area placements for rehabilitation of people with complex psychosis and related mental health conditions would improve their quality of life as well as reduce costs to the NHS.

He said: ‘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 moved back home or live with family or friends.’

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