Transition between inpatient mental health settings and community or care home settings

Search and selection strategy

We conducted an initial search for relevant Cochrane reviews and national policy and legislation in this area. The results of these searches, alongside information suggested by topic experts, was deemed sufficient to proceed with the surveillance review. Furthermore, the focus of the NICE guideline is around service delivery, with a social care element, both of which are more driven by policy and legislation. As such no additional evidence searches were undertaken.

See appendix A for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.

We sent questionnaires to 27 topic experts and received 5 responses. The experts who responded included a social worker, a consultant geriatrician, 2 general practitioners, and a representative of a homelessness charity.

Two topic experts thought the NICE guideline should be updated, 2 did not and 1 did not respond. The experts raised issues around homelessness (see equalities), funding and the interface between mental and physical health.

One expert commented that the level of suicide 1 week after discharge was concerning, a stakeholder also commented on this issue and highlighted updated evidence (see reasons for the decision). This was considered during the 2017 exceptional review and the evidence was found to be consistent with recommendations 1.6.7 and 1.6.8 in the NICE guideline.

Another expert commented that there have been changes to legislation which were identified during this surveillance review and another that the surveillance review should focus on the issue of out of area inpatient placements among children. Recommendations 1.3.10 to 1.3.12 in the NICE guideline cover minimising out of area admissions and highlight the increased risk associated with these admissions.

The experts raised issues around homelessness. The NICE guideline currently provides recommendations on discussing housing arrangements before discharge (recommendation 1.5.7) and providing additional support to homeless people (recommendation 1.5.8). However, the recommendations do not highlight the Homelessness Reduction Act 2017 and as such a cross reference will be added to section 1.5 to highlight the Act. No additional changes to the NICE guideline were deemed necessary as NICE is currently developing a guideline on integrated health and social care for people experiencing homelessness.

Implementation of the guideline

Topic experts highlighted that mental health services were struggling to meet basic demands and implementing the recommendations can be difficult. We plan to share these comments and the reports we have identified with NICE's Impact and Adoption team.

Other sources of information

We considered all other correspondence received since the NICE guideline was published. This included a letter from MIND highlighting new evidence about follow-up times that had been considered as part of the 2017 exceptional review. We also considered a request to add a cross reference to NICE's guideline on excess winter deaths and illness and the health risks associated with cold homes. However, the recommendations in that NICE guideline were assessed as not being relevant to NICE's guideline on transition between inpatient mental health settings and community or care home settings. Therefore such a cross reference is not proposed.

Views of stakeholders

Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was not to update the guideline, we consulted with stakeholders.

Overall, 6 stakeholders commented, 2 agreed with the decision to not update. Stakeholders comprised representatives from NHS England, 2 charities, and 3 royal colleges. They highlighted issues with specific groups (see equalities) and the impact of COVID-19 on mental health services. They specifically identified that it has resulted in rapid discharge practices during periods of high COVID-19 incidence and that it poses a risk to the physical and mental health of healthcare staff. Stakeholders also commented that there is uncertainty about the risks and benefits of using telemedicine with people with mental health conditions.

A stakeholder also commented that everyone discharged from mental health services should be followed up within 48 hours and highlighted new evidence from the National Confidential Inquiry into suicide and safety in mental health (NCISH). Recommendations 1.6.7 and 1.6.8 in the NICE guideline recommend follow-up within 7 days unless a risk of suicide has been identified in which case follow-up should be within 48 hours. A 2017 exceptional surveillance review which considered findings from the NCISH report covering the period 2004 to 2014 concluded the results were 'largely consistent' with the current recommendations. Findings from a more recent NCISH report covering 2007 to 2017 highlighted by the stakeholder, are consistent with findings considered during this exceptional review and we therefore assessed the recommendations as remaining valid.

See appendix B for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.