Out-of-Area Placements in Mental Health Services

What Are Out-of-Area Placements?

Out-of-area placements happen when a person is placed in a service or setting far from their home area because the right support isn’t available locally.

In the UK, this can involve:

• Adults with mental health needs being admitted to inpatient units outside their local NHS area, often due to bed shortages rather than specialist need.
• Children and young people being placed in residential homes, foster care, or mental health facilities far from their families and communities.

While some placements are made for specialist care that isn’t available locally, many are driven by gaps in provision. This can lead to emotional strain, disruption to care, and poorer outcomes for the person and their family.

In March 2024, there were 900 active adult out-of-area placements (OAPs) in England. Of these, 805 (89%) were recorded as inappropriate, indicating that they occurred due to a lack of local bed availability rather than clinical need.

For children and young people, between December 2023 and November 2024, there were 319 new inappropriate OAPs, and 79 children and young people remained in inappropriate OAPs at the end of November 2024 due to no suitable local bed being available. During the same period, there were 35,845 inappropriate OAP bed-days recorded for this group.

While out-of-area placements can provide a temporary solution, they may also disrupt continuity of care, making it difficult for family carers, friends, and local care coordinators to maintain regular contact. For many people, distance from their local support network can hinder recovery, leading to feelings of isolation or disconnection from familiar sources of emotional and social support. Addressing the overuse of out-of-area placements has become a national priority, focusing on ensuring that people can receive the care they need close to home within their local community mental health service.

How To Decide If an Admission is OAP?

An admission is classed as an Out-of-Area Placement (OAP) when a person is admitted to an inpatient mental health bed outside the area commissioned by their local NHS Integrated Care Board (ICB). This applies specifically to adult acute mental health services, not to specialist services such as eating disorders, perinatal care, or secure/forensic units, which are often regionally commissioned by design.

If a person is placed out of area because no suitable local bed is available, the admission is recorded as an inappropriate OAP. If the placement is made to access a specialist service that is not available locally, it is recorded as an appropriate OAP.

Providers must record each OAP in monthly submissions to NHS Digital, including the reason for placement, start and end dates, distance from home, and commissioner details. This standardised reporting ensures that OAPs are identified consistently across the country.

When Out-of-Area Placement May be Appropriate

An Out-of-Area Placement (OAP) isn’t always automatically inappropriate. While many OAPs happen due to the lack of local bed availability, there are circumstances in which placing someone outside their usual area may be justified and therefore recorded as appropriate.

Some of the main reasons an OAP may be considered appropriate include:

• The person becomes acutely unwell while temporarily away from home, such as during travel or a visit to another area.
• Safeguarding concerns, for example where there are serious safety risks in the local area (such as involvement in local criminal networks, domestic abuse, or threats to personal safety).
• Legal or offending restrictions that prevent the person from receiving treatment locally.
• The person chooses to receive treatment in another area, for example to be closer to supportive family or social networks.
• A specialist service is required that is not available within the local system, and the placement is needed to meet that specific clinical need.

An OAP is not considered appropriate if the placement happens solely because a local acute bed is unavailable. In such cases, it is classified as an inappropriate OAP.

The Impact of OAPs on People

Being placed far from home can be overwhelming for both adults and children. Anxiety and depression often set in as familiar faces, routines, and support networks disappear. Families find it harder to stay involved, care becomes fragmented, and recovery is disrupted. Across the UK, out-of-area placements continue to create emotional strain and poorer outcomes, affecting people and services alike.

Out-of-area placements can have a profound and often harmful impact on people and their families. The effects go beyond distance alone, influencing emotional wellbeing, recovery, and safety in multiple ways:

• Increased risk of serious safety incidents
  Investigations have linked some out-of-area placements to critical incidents, including deaths by suicide, often linked to systemic failures and lack of oversight.

• Prolonged Hospital Stay
  People placed out of area often spend more time in hospital compared to those supported locally.

• Increased anxiety and emotional distress
  Being in an unfamiliar environment, away from trusted people and familiar surroundings, can heighten stress, fear, and trauma.

• Breakdown in continuity of care
  Regular care teams and community professionals find it harder to maintain consistent involvement when the person is far from their local area.

• Isolation from family and social networks
  Distance makes visits difficult, leading to reduced contact with relatives, friends, and carers — factors that are crucial for recovery.

• Delays in discharge
  Returning home can be delayed because suitable local placements or community support are not available, extending the hospital stay unnecessarily.

• Higher risk of self-harm and incidents
  Research shows that people placed out of area may experience more incidents of self-harm after admission compared to those admitted locally.

• Loss of trust and confidence in services
  Families and carers often feel excluded from decisions, which can erode confidence in mental health support systems.

Additionally, out-of-area placements disrupt the continuity of care that is critical in mental health treatment. The distance limits the involvement of the person’s local community mental health team and care coordinator, who know their specific needs and history best. With limited access to these trusted caregivers, people may experience delays in essential aspects of care, including assessment updates, care planning, and discharge preparation. The lack of regular interaction with their care team may also reduce the effectiveness of discharge planning, increasing the risk of readmission. These disruptions emphasise the importance of reducing inappropriate out-of-area placements and ensuring people remain connected with local community services for better health outcomes.

Challenges Faced by Care Providers in Managing OAPs

Care providers face several challenges in managing out-of-area placements, starting with coordinating services across different regions. When admitted to facilities outside their usual local network, care providers must work with multiple teams, sometimes across NHS trusts or with independent providers, to ensure that the person receives appropriate and continuous care.

This often requires navigating variations in care protocols, policies, and available resources, which can complicate service delivery and lead to delays or gaps in care. Providers must also maintain frequent communication with the person’s local community mental health team to keep them involved in treatment updates and to plan for a smooth discharge, adding to the logistical complexities.

Another significant challenge is ensuring continuity of care and effective discharge planning, both essential for successful recovery. In an out-of-area placement, it can be difficult for care coordinators to visit regularly, as travel time and distance become barriers. Without regular in-person visits, providers may struggle to monitor the person’s progress accurately, adjust care plans as needed, and prepare for a seamless transition back to local services.

Additionally, limited visits make it harder for providers to engage with family and carers, whose involvement is often crucial for the person’s long-term recovery. As a result, managing out-of-area placements demands significant resources and coordination efforts to mitigate these challenges, all while prioritising the person’s well-being and recovery outcomes.

Continuity of Care Concerns

Continuity of care is a critical concern in out-of-area placements, as being placed outside a person’s local network disrupts the consistent support they typically receive from their regular care team. The involvement of familiar care coordinators, who understand the person’s history and unique needs, is often reduced, making it challenging to provide seamless, personalised care.

This disruption can lead to gaps in treatment, as it may be difficult to maintain the same level of monitoring and engagement that would be possible within the local community. Regular assessments and timely updates to care plans are essential for adapting to changes in the person’s well-being. Still, these are harder to implement when the distance prevents frequent in-person visits.

Furthermore, continuity of care directly influences the discharge planning process, which is essential for a person’s successful transition into their community. Without regular contact, care providers face challenges in preparing a discharge plan that aligns with the person’s ongoing support needs, increasing the risk of readmission.

What Can Be Done

To reduce the negative impact of out-of-area placements, healthcare providers and community services can implement strategies to strengthen local resources and improve communication between facilities. Effective discharge planning, coordinated support, and expanding local service capacities are essential.

By investing in resources such as acute mental health beds within local networks and expanding community mental health services, people with mental health needs are less likely to require placement outside their local area. Regular reviews of situations where out-of-area placement is unavoidable can ensure that each person is transitioned back to their community as soon as it is clinically safe.

Enhanced collaboration between out-of-area providers and local community mental health teams can also improve continuity of care. Implementing structured communication channels and frequent case reviews helps ensure that each person’s progress is tracked effectively and that discharge plans align with their needs. When providers work closely with community services, they can facilitate a smoother transition, allowing people to reconnect with their support networks quickly and resume recovery within familiar surroundings.

How Nurseline Community Services Can Help

provides urgent crisis response for young people and adults with mental health needs.

Every crisis can be managed when timely, specialist support is in place. Nurseline Community Services responds rapidly to support young people and adults through mental health crises, bringing together clinical expertise, proactive strategies, and compassionate care.

Our approach includes:

• Proactive support through Positive Behaviour Support (PBS), PROACT-SCIPr-UK® practice, and the use of multimedia tools to understand behaviour and respond with insight.
• A trauma-informed approach that builds trust, prioritises emotional safety, and creates the conditions for recovery.
• Specialist mental health support from experienced mental health nurses and community psychiatric nurses, ensuring clinical oversight at every step.
• Close collaboration with families and professionals to stabilise situations early, prevent unnecessary admissions, and keep people connected to their communities.

Reach out today to learn more about how we can support you or your loved ones in preventing hospital admission and out-of-area placements.