Relocating from out‐of‐area treatments: service users' perspective

Abstract

Asylum closures over recent decades resulted in mental health services being increasingly sited in the community. However, under provision of highly supported accommodation led to service users being placed away from their local area in 'out-of-area treatments' (OATs). OATs have raised major concerns in relation to enabling service users' recovery, owing to limitations in promoting autonomy, social dislocation and costs. In 2004, an OATs project was set up in a London Borough to address these concerns. In the first 4 years, the project succeeded in relocating 22 service users to less restrictive environments locally. This study aims to explore the outcome of relocation from service users' perspective. A qualitative methodology was utilized. Semi-structured interviews were carried out with seven service users who relocated. All seven service users shared a strong aspiration for independent living but there was associated loneliness. Five welcomed increased contact with family and friends, but lacked social confidence, inhibiting social inclusion. Service users with long-term and consistent care managers were more able to address fears. Five out of seven service users concluded that relocation increased their autonomy thus enhanced their quality of life.

Perspectives of service users and carers with lived experience of a diagnosis of personality disorder: A qualitative study

“…There was a distinct lack of therapy largely due to service unavailability. This, in turn, led to out-of-area placements, which can be detrimental to individual well-being (Rambarran, 2013). The lack of appropriate interventions stemmed across people's timeline of illness and care.…”

The journey of service users with complex mental health needs: a qualitative study

“…Individuals with CMH needs are often accommodated in out-of-area placements (OAPs) that are a long distance from their loved ones (Chinn et al, 2011 ), due to the inability of local services to meet their needs. In addition to being costly to the NHS and local social care authorities, individuals placed out-of-area can achieve poorer outcomes (Beadle-Brown et al, 2005 ), experience disruptions to their lives (Galante et al, 2019 ) and, in some cases, be over supported (Rambarran, 2013 ). As little regulation exists surrounding such placements, and because OAPs are viewed as a way to contain those that NHS services find troubling (Care Quality Commission, 2014 ), service user experience must be examined.…”

COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

“…Individuals presenting with complex needs are often accommodated in out-of-area placements that are a long distance from their loved ones and communities [ 4 ], due to the inability, or arguably the unwillingness [ 3 ], of local services to meet their needs. There are growing concerns about the impact of out–of-area placements on mental health service users, both clinically and financially [ 5 ]. In addition to being costly to the NHS and local social care authorities, individuals placed out-of-area can become socially dislocated, achieve poorer outcomes [ 6 ], experience disruptions to their lives [ 7 ] and in some cases, be over-supported [ 5 ].…”

“…There are growing concerns about the impact of out–of-area placements on mental health service users, both clinically and financially [ 5 ]. In addition to being costly to the NHS and local social care authorities, individuals placed out-of-area can become socially dislocated, achieve poorer outcomes [ 6 ], experience disruptions to their lives [ 7 ] and in some cases, be over-supported [ 5 ]. The issue of distance can also cause complications for the ‘home’ services who made the referral, which are services generally provided in the locality of a patient’s home, as it can be difficult to maintain contact regarding the suitability of the placement and the person’s care, which can also hinder their rehabilitation and eventual reintegration into their home community [ 4 , 8 ].…”