Improving patient flow in mental health

Efficiently guiding individuals through stages of treatment and support is a concept often associated with acute healthcare. However, in a collaboration, IMPOWER joined forces with Surrey and Borders NHS Foundation Trust (SABP), Surrey County Council, and Surrey Heartlands Integrated Care Board (ICB) to explore what flow improvement could look like in the mental health sector. This first-of-its-kind project ran for six months, during which IMPOWER made strides in understanding the unique challenges and potential strategies to improve mental health flow. Here’s what we learned, and why it matters.

The beginning of a new journey

In November 2023, we embarked on our first Mental Health Flow Improvement project: at the same time their new Associate Director for Flow and Bed Optimisation joined. This timing turned out to be a catalyst for meaningful collaboration.

Unlike in acute care, where patient flow often deals with high-volume, fast-turnaround cases, mental health involves fewer patients with much more individualised, often prolonged care. Here, the focus is on ensuring each patient receives targeted, personalised support in a system that depends on a network of external partners, from community settings to adult social care. This dependency on external partnerships was one of the first major considerations to guide the project.

Building connections across the system

Improving flow in mental health required engagement across different layers of the healthcare system. The project involved everyone from commissioning teams to acute wards, adult social care, and community services. We quickly identified points of pressure and barriers by leaning into established relationships and fostering new ones. Working closely with these partners helped shift perspectives and build a shared sense of responsibility around patient care and discharge planning.

During the project, two ‘Multi-Agency Discharge Events’ (MADEs) were organised, specifically focusing on patients who had been in the hospital for extended periods. These events offered partners a clearer view of the impact of delays and encouraged quicker, collaborative action. The project also experienced a critical incident that, although challenging, provided an opportunity to reset some ways of working across the network. SABP continued to be involved in multiple forums that enable it to better collaborate with external partners – relationships that could be vital for ongoing and future improvements.

Reducing length of stay and shifting mindsets

By the end of the six-month collaboration, there were measurable improvements. The average length of stay in SABP’s acute mental health wards had decreased, indicating an effective start in enhancing patient flow. This outcome didn’t arise from new beds or major structural overhauls, but from streamlined processes and a subtle cultural shift. There was a new shared understanding: discharge planning is not the responsibility of one person or department alone but a collaborative effort in which everyone plays a role.

Yet, while tangible progress was achieved, systemic issues in mental health care remained. One of the biggest challenges is the burden of risk, often perceived as an individual responsibility rather than a shared, systemic one.

Moving away from individual risk and embracing ‘system risk’

In many healthcare contexts, including acute care, individual clinicians are not held solely accountable for the outcomes of their patients after discharge. For example, a heart disease patient discharged from the hospital might later experience complications or even death due to their condition, but this doesn’t automatically lead to scrutiny of the treating clinician’s decisions. However, in mental health, the perception of risk is different. A psychiatrist or mental health consultant who discharges a patient might face significant scrutiny, potentially including Coroner’s Court, if that patient later experiences a crisis or a tragic outcome.

This intense focus on individual responsibility promotes a culture of risk aversion, often impacting decision making in ways that can delay or complicate discharge. For meaningful change, there needs to be a shift in the way risk is distributed, moving towards a ‘system risk’ model where collective responsibility and support empower professionals to make patient-centred decisions without fear of repercussions.

Continuing the journey to transform mental health flow

Through this partnership, IMPOWER and SABP made significant strides, but there is much more to do. Enhancing flow in mental health is possible, but it requires us to challenge ingrained practices and support a shift from individual accountability to shared, systemic responsibility. Improving mental health flow will not only reduce unnecessary hospital stays but also allow people to access the care they need, when they need it most.

This project was a powerful reminder that with the right collaboration and willingness to change, even small adjustments in mental health care processes can lead to better, faster and more supportive care for individuals on their journey to recovery.

If you would like to find out more about our work in mental health, please get in touch.