Avoiding Out-of-Area Placements Should be the Rule, Not the Exception
David Brindle, the Guardian’s public services editor and NDTi’s ambassador and former chair, reflects on his 2010 story about ‘out of area treatments’ in light of the Close to Home review.
Journalists rarely return to follow up with people we write about. The story is usually a one-off and we move on to something else. But I often wonder what became of George.
It wasn’t his real name – I think he may have chosen the pseudonym – but he was a 37-year-old former electrician who had been diagnosed with schizophrenia and sent “out of area” to a care placement where he had remained for six years. He was coming back to his home borough under an initiative in Islington, north London, to repatriate people like him if they wished to return.
That was 10 years ago. The extent, the cost and above all the inhumanity of inappropriate out-of-area placements in mental health was no secret, if not widely discussed, yet little was being done about it. I was able to get space to profile George in the Guardian simply because the Islington scheme was so unusual.
Fast forward a decade and things seem little better. As the excellent new NDTi guide to avoiding out-of-area placements points out, numbers have if anything been rising and many people are being sent more than 100km from home. While there may in some cases be valid clinical or other reasons for resorting to such placements, in general we should be making every effort to avoid them.
Just as I highlighted Islington in 2010, the guide commends practice in Lambeth, Bradford and Sheffield where effective measures are today avoiding out-of-area placements. But these should be the rule, not the exception.
In many ways, as the guide observes, the perpetuation of inappropriate out-of-area placements exemplifies fundamental problems with the whole mental health care pathway. Not until that pathway is strengthened, and resources are made available to improve access to quality home-based services, will the practice go away. But we must take every opportunity in the meantime to challenge commissioning decisions that meekly – and sometimes lazily – accept its inevitability.
George was relatively lucky: he had been placed not far from home in what we would now call a shared lives scheme, though for six years there he saw few people other than his carers, fellow lodgers and, periodically, his social worker and psychiatrist. When the opportunity to return to his borough arose, he jumped at the chance.
When I met him, he had his own flat in the community where he had grown up, was working on his fitness and had a couple of part-time voluntary jobs to get back into the swing of working. All the signs were good, and I like to think that things continued positively. Perhaps I should be content with that.
David Brindle is the public services editor for the Guardian newspaper. He has been with the paper since 1988, first as social services correspondent and then as editor of the Society section. He was formerly NDTI’s chair and remains an ambassador for the organisation.