None of us would question the urgent need for capital investment in mental health hospitals. We'd also recognise that the long-standing shortfall in investment in inpatient provision is now even more acute, because of the pandemic and the increase in service demands. The recent investment in mental health services is welcomed but if we don't level up capital investment, we're potentially putting a sticking plaster over an on-going issue that's still to be resolved.
The recent investment in mental health services is welcomed but if we don't level up capital investment, we're potentially putting a sticking plaster over an on-going issue that's still to be resolved.
Chair of Bradford District Care NHS Foundation Trust
Money alone will not fix the increasing demand for mental health services. It's important that we continue to rethink how and where we provide services but we need mental health hospitals that support recovery, and inpatient care that, as the NHS mental health implementation plan states, is 'world class'. Not doing this simply puts more financial pressure on the current system. It adds to existing costs with longer bed stays, poorer physical and mental health outcomes, higher staff costs – both in and out of hospital – and significant maintenance costs, just to keep the status quo.
Best practice inpatient mental health facilities are no longer the functional, security-focused and restrictive buildings that some areas still have. Clinical practice has moved on, but despite the best efforts of staff, these outdated facilities feel like places of containment. Depending on their size and scale, remedial work cannot address all the structural limitations to meet current national standards and to support good care. 'World class' inpatient environments dramatically improve the experience and outcomes for people, promoting recovery and impacting positively on their wider health determinants. Best-practice mental health hospitals are inclusive community buildings that balance design and function with patient safety, and destigmatise mental health.
They feature therapeutic spaces with access to safe outdoor areas to support wellbeing, and a choice of spaces for patients to interact with families and friends, or to be on their own. Small wards with natural light create calmer environments. A good mental health hospital enables 'meaningful admissions' that focus on recovery and discharge from the outset, giving an easier transition back to community provision. They actively connect with their locality, either co-hosting or providing drop-down spaces for other community services.
The ageing facilities in our current inpatient provision – in our case dating back to the 1960s – are hindering patients' recovery.
Chair of Bradford District Care NHS Foundation Trust
The ageing facilities in our current inpatient provision – in our case dating back to the 1960s – are hindering patients' recovery. In the words of one of our former patients, "it was individuals (staff) rather than the place itself that helped me to get on the road to recovery." Large wards – for us 20-plus beds – create cramped and noisy environments and impact on staff's ability to manage patients' safely. We need to reflect on the inferred value that is placed on those with a mental illness in our communities, if they are admitted to inpatient environments that are counterproductive to their recovery.
Our trust has ambitions to transform the central block for our biggest mental health hospital, to create a bright, welcoming, and therapeutic space, but we need national capital investment to deliver this. The plans have been co-designed with our staff, service users and partners, including our communities across Bradford, which is the fifth most income-deprived local authority in England.
The investment will benefit both service users and the wider community. The proposed development meets current best practice, including minimising carbon emissions, the ability to flex capacity and reducing the risk of out-of-area placements, with access to therapeutic internal and external space to improve wellbeing. Smaller wards will give staff clear lines of sight, to reduce the risk of incidents.
The cost of maintaining our current facility and the inevitable backlog of maintenance for a 1960s building, is two-thirds of the re-build cost. The new one will give a sustainable building that actively contributes to patients' recovery and wellbeing. In the words of our former patient, the proposed development is "less about security, detention and containment, and more about person-centered treatment options and recovery".
Do we want more sticking plasters over a perennial challenge?
Chair of Bradford District Care NHS Foundation Trust
So back to my original premise. Do we want more sticking plasters over a perennial challenge? Or do we genuinely want parity of esteem in capital investment for mental health hospitals, that matches the welcomed service investments, to help people return to a community setting as soon as they are able with support? It's disappointing that we're still having these discussions. We need mental health hospital environments that empower, not hinder people's ability to regain their mental wellbeing.
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