A radical overhaul of mental health inpatient care is needed to achieve the Government’s goal of shifting treatment from hospitals to communities, according to a new report from the Centre for Mental Health.

Care beyond beds finds that inpatient care is too often characterised by unsafe levels of bed occupancy, chronic staffing shortages, and dilapidated facilities which risk re-traumatising patients.

Black people, neurodivergent people, and children are among the most poorly served.

The report says that the NHS’s 10-year plan must boost investment across the mental health system to drive a ‘safe and sustained shift’ towards community care and to provide inpatient care which is high quality, close to home, and adequately staffed.

It finds that limited community support means that people struggling with their mental health are ‘funnelled’ towards the more-acute end of the system. This causes more distress and upheaval and incurs higher costs.

This is especially the case for out-of-area placements, with patients being sent miles from their homes and support networks to get a hospital bed.

The report points out that inpatient services are an important part of the mental health care system, but that comprehensive investment in alternatives to inpatient care, such as crisis cafes and houses, would enable more people to get effective care closer to home.

But it also calls for a ‘fair share’ of NHS capital funding to be dedicated to mental health services so that outdated facilities can be updated or replaced.

Service users quizzed as part of the report described mental health services in general as fragmented, difficult to navigate, and under resourced.

Strikingly, many wards are not fit for purpose and are ill-equipped to deliver good quality care.

Some participants talked about their experiences of wards with mouse infestations and faeces on floors and walls and there was much criticism of the inadequacy of current inpatient services, primarily in relation to people not feeling safe.

But responses also reflected a pervasive sense of monotony, marked by uninspiring settings and a scant selection of activities which can contribute to a detrimental environment.

Andy Bell, chief executive at the Centre for Mental Health, said: “The NHS spends as much on inpatient services as it does on community mental health care, even though the vast majority of people access their support through community settings.

“As the Darzi report says, too many inpatient services are in outdated buildings that make safe and therapeutic care harder to provide.

“Small-scale and incremental change will be insufficient to deliver the system-wide change that’s needed.

“We need to redesign our mental health system with a wider range of options, including from community and voluntary sector organisations, and a much bigger say for people using services in the kind of treatment and support they can get.

“The new Mental Health Bill promises to modernise mental health care. It must go hand-in-hand with investment in services, staff, and better facilities so that people can receive compassionate and effective support in a mental health crisis close to home wherever they live.”