This event was a follow-up to Cygnet’s summer discussion in the House of Lords, which looked at: ‘Integration, Investment, and Impact: The Call to Transform Mental Health and Social Care’.
At today’s event Cygnet’s Group Clinical Director Dr Jon Van Niekerk addressed Crisis Management, Demand, and System Pressures.
Jon said:
The picture for our mental health ecosystem is often a frustrating one.
We have strong national plans, but patients meet a system full of bottlenecks – hard to get into when they’re very unwell, and hard to leave even when they’re ready to go home.
1. The Implementation Gap
The problem isn’t a lack of strategies. We have the NHS Long-Term Plan, 10-Year Plan, manifesto commitments and the Mental Health Bill. What we don’t have is consistent delivery on the ground.
Recent NHS data shows the biggest reason people can’t leave mental health hospitals is because there’s nowhere appropriate for them to go. Nearly a fifth of all delayed bed days are due to waiting for supported housing.
A significant number of beds are blocked, not by clinical need, but by the absence of safe accommodation.
We see the same pattern across the wider NHS. Over winter, around one in seven acute hospital beds were occupied by people medically fit to leave. Mental health is part of that bigger flow problem and it’s amplified by the lack of suitable step-down options.
2. “Too Far, Too Fast”: Rebalancing inpatient and community care
The intention to move care closer to home was absolutely right. But in many places it’s happened too quickly, and without the community infrastructure to support it.
The rise in inappropriate out-of-area placements tells the story. The aim was to eliminate them by 2020. We’re now years on, and thousands of placement days still happen every quarter.
In short, we cut beds locally before we built enough alternatives. The pressure didn’t disappear, it was just pushed elsewhere.
The result is a constant cycle of crisis: ambulance crews and police searching for beds, patients sent far from their families, and community teams managing very high-need patients without the housing and social-care backup they require.
3. Housing and step-down care: The missing link
If I could emphasise one point above all others, it’s this: you cannot fix mental health flow without fixing housing.
The evidence is clear. When people have support with housing, finances and employment, they’re less likely to be admitted, they recover faster, and they stay well for longer.
Supported housing works. It prevents admission and shortens hospital stays. Yet it remains one of the scarcest parts of the system, and the top cause of delayed discharge.
These services are not “add-ons”. They are essential infrastructure. Without them, we’re asking hospitals to do the impossible.
4. Cross-sector commissioning and the role of ICBs
Most of the daily frustrations clinicians face aren’t about treatment, they’re about process.
The ward team is ready to discharge someone.
The local authority panel isn’t meeting for three weeks.
The housing provider is worried about risk because they’re not part of the clinical planning.
We need commissioning that crosses these boundaries and treats recovery as a shared journey, not a hand-off between organisations.
ICBs are in a good position to lead this, but they need the backing to;
- Pool budgets with local authorities,
- Jointly commission supported housing and step-down pathways, and
- Bring NHS, independent and voluntary providers into a single, coherent system.
A national framework for commissioning “recovery pathways”, covering clinical care, housing and social support together, would help turn local good practice into the norm.
5. The role of independent and voluntary providers
Independent and voluntary providers are already central to mental health care.
Organisations like Cygnet run key parts of the acute, secure and rehabilitation pathway under NHS commissioning. This isn’t about “NHS versus independent sector”. It’s about all providers working to the same standards, the same outcomes, and the same expectations around quality and safety.
If we treat independent and voluntary providers as true partners, they can help relieve pressure quickly, particularly through flexible step-down and specialist rehabilitation services. Through genuine partnership working, we better ensure individuals receive the right care, in the right place and at the right time.
6. Practical steps we can take now
While long-term reform matters, there are actions we can take immediately to ease the biggest pressure points:
Make supported housing for mental health a priority in national and local housing plans.
Create transitional “recovery units” using existing NHS or independent estate, linked directly with housing providers.
Introduce clear delayed-discharge dashboards at ICB level to drive local problem-solving.
Ensure continuity from inpatient to community teams wherever possible.
Build social-needs assessment into every care plan, including housing, employment, benefits advice. We know it reduces relapse and crisis presentations.
None of this needs new legislation. It needs clarity, joint working, and the ability to pool resources.
7. From “who owns the risk?” to “how do we share responsibility?”
Finally, there’s a cultural shift we need to make.
In a pressured system, conversations often become: “Who owns this risk?”
What patients need is a different mindset: “How do we share responsibility for this person’s recovery?”
That means shared accountability across the NHS, local government, housing and independent providers. It means listening to what service users say about being stuck in hospital or being discharged into unsafe housing. And it means aligning national policy, local commissioning and frontline practice around a single goal; recovery.
If we do that, we can move away from constant crisis management and towards a system that genuinely supports people to rebuild their lives.
Conclusion
Behind every delayed discharge statistic is a real person, someone who’s ready to go home, ready to rebuild their life, but stuck in a hospital bed because the system can’t catch them when they step out.
We wouldn’t accept that for our own families. We shouldn’t accept it for anyone else’s.
Mental health care shouldn’t be a game of “find the bed” or “wait your turn”. It should be a system that meets people where they are, supports their recovery, and gives them every chance to thrive.
We know what works. We know what needs to change.
What’s missing is the collective will to make it happen.
If we can choose collaboration over silos, action over aspiration, and shared responsibility over passing the risk around, then we can build a system that doesn’t just manage crises, it prevents them.
And for the people we serve, that shift isn’t abstract.
It’s the difference between being stuck, and finally moving forward.