Annex II
MENTAL HEALTH INDEPENDENT SECTOR SERVICE
PROVISION
The independent mental health sector can broadly
be divided into two: acute mental health and substance misuse
treatment and non-acute mental health care. This division is based
on type of patient, length of stay and funding source. Acute mental
health covers patients with acute mental health illness, the length
of stay is shorter than for non-acute mental health care and funding
is either from private medical insurance (though many PMI policies
exclude mental health cover) or increasingly from health authorities,
either by agreement or spot purchased. Substance misuse services
are also mostly spot-purchased by health and/or local authorities.
Medium secure care is categorised here as acute
care and is usually spot purchased on "Service Level Agreements".
Acute care is also delivered in mental nursing homes although
the term is misleading and these facilities are in reality mental
health hospitals—some with up to 100 in-patient places or
more.
Non-acute mental health care is usually not
covered by PMI policies though other types of liability insurance
may cover it. It includes brain injury rehabilitation, rehabilitation
of the mentally ill, people with learning disabilities who have
challenging behaviour and long term care of people with mental
health disabilities. Funding comes largely from the NHS spot purchasing,
income support or local authorities. In-patient stays are usually
months or years as opposed to weeks or days in acute care.
Some services do not fit neatly into these categories
of acute and non-acute care. Medium secure care is categorised
as acute care in this submission, however, length of stay is often
months. Substance misuse, adolescent psychiatry and treatment
for eating disorders typically require initial acute mental health
treatment followed by non-acute care. Long-term care including
care for the elderly mentally ill (EMI) and care for people with
learning disabilities is provided in nursing and residential care
homes.
There are some 75 independent hospitals or units
in the United Kingdom providing acute mental health care and/or
substance misuse in-patient treatment and a total of 2,500 acute
mental health or substance misuse beds—excluding medium
secure. Due to the significant numbers of substance misuse places
registered by local authorities as care homes, this figure underestimates
the total number of residential substance misuse services.
There are 909 additional independent medium
secure beds representing over 30 per cent of the UK's total medium
secure provision. Partnerships in Care is the single largest provider
of independent medium secure beds and provides 18.5 per cent of
the total number of beds (including the NHS). St. Andrew's Hospital
in Northampton provides 7 per cent of the total number of medium
secure beds available.
In the past few years the sector has diversified
into specialist areas of provision such as eating disorders and
adolescent psychiatry. For example, Laing (1998) reports that
there are 31 independent sector specialist units treating eating
disorders. Other significant niches of provision include low/medium
secure care, 24-hour nursed care and brain injury rehabilitation.
Registered mental nursing homes provide 80.6 per cent (205 beds)
of brain injury beds, the NHS providing the rest. St Andrews,
Partnerships in Care and Westminster Health Care between them
provide the vast majority of services.
The three largest acute mental health providers
(includes Priory Hospitals and Cygnet) operate 41 per cent of
the acute mental health sector's bed capacity (this figure excludes
medium secure care). The fourth largest provider is St Andrew's
Group that has 7 per cent of the market total.
The largest providers of non-acute mental health
care including medium secure care are Partnerships in Care (the
single largest provider), Priory Hospitals and St Andrew's Group.
Excluding mental health beds for the EMI and acute psychiatry,
Laing (1998) estimates that 67 per cent of beds for non-acute
mental health care are provided by independent registered nursing
homes and residential care homes. Care Principles are treating
mental health patients with learning disabilities, particularly
in the child and adolescence categories.
| 
