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

Reasons for the decision

The NICE guideline focuses on service delivery driven by policy and legislation. We therefore considered the impact of new policy and legislation as well as the views of topic experts. Searches of the published literature were limited to new and updated Cochrane reviews. Guideline recommendations are relevant to current practice and are not in conflict with new evidence.

We identified temporary changes to the Mental Health Act due to the coronavirus pandemic, in particular around using video technology for Mental Health Act assessments and leave and visiting. Several stakeholders also commented that COVID-19 had greatly impacted mental health services (see views of stakeholders).

We identified new legislation including an amendment to the Mental Health Act, new policy around ending inappropriate out of area admissions for mental health services, and a number of reports reviewing mental health services, highlighting that people's experience of mental health care still remains poor. However, experts generally agreed that the NICE guideline remains current but did note implementation issues with mental health services struggling to meet basic demands. Guideline recommendations were assessed as still relevant to current practice and are not in conflict with new legislation. However, cross references will be added to other relevant NICE guidelines on mental health services for specific mental health problems, the section on advance care planning in the NICE guideline on decision-making and mental capacity, and the Homelessness Reduction Act 2017. Stakeholders were consulted on these findings and the decision not to update.

A stakeholder highlighted new evidence from the National Confidential Inquiry into suicide and safety in mental health (NCISH) about suicide risk and follow-up times. The stakeholder questioned recommendations 1.6.7 and 1.6.8 in the NICE guideline, which recommend follow-up within 7 days unless a risk of suicide has been identified, in which case follow-up should be within 48 hours. The new evidence was assessed as consistent with the findings of the 2017 exceptional surveillance review which assessed NCISH evidence as being 'largely consistent' with recommendations 1.6.7 and 1.6.8.

For further details and a summary of all evidence identified in surveillance, see appendix A.