FINALISED OATS DEFINITION

OATs definition:

An inappropriate out of area treatment for mental health acute inpatients happens when:

A person with assessed acute mental health needs who requires* adult mental health acute inpatient care** is admitted to a unit that does not form part of the usual local network of services. By this we mean an inpatient unit that does not usually admit people living in the catchment of the person’s local community mental health service and where the person cannot be visited regularly by their care co-ordinator to ensure continuity of care and effective discharge planning.

Patients should be treated in a location which helps them to retain the contact they want to maintain with family, carers and friends, and to feel as familiar as possible with the local environment.

Placing providers are to determine if a placement is classed as an OAT. The definition necessarily allows providers to apply knowledge of local catchment arrangements and the patient’s circumstances in taking a decision if a placement is an OAT.

OATs can occur within one NHS provider, in other NHS providers, or independent sector providers (ISPs).

*NHS commissioned and funded non-specialist

**the scope of this definition covers adult and older adult (functional) acute and psychiatric intensive care unit (PICU)

OATs decision tree: for the placing provider to use to determine whether an admission is out of area (RAG rated)

Classification of an out of area treatment will be in two parts:

  1. The main measure of OATs: a yes / no element that captures whether or not the person has been admitted inappropriately to a bed outside their local area i.e. to an inpatient unit that does not usually receive admissions of people living in the catchment of the person’s local community mental health service and where the person cannot be visited regularly by their care co-ordinator to ensure continuity of care and effective discharge planning.
  2. A supplementary measure that captures the distance travelled from home.

Patient experience:

For people using services, an improved service without inappropriate out of area treatments means that:

  • People should be admitted to a unit within the catchment area of their local community mental health service where they are known and their care coordinator can visit them regularly. This should help ensure people can be supported to recover, helped to get home as soon as possible and given the right support once they are home to continue recovering.
  • Treatment should be in a location which helps people to retain the contact they want to maintain with family, carers and friends, and to feel as familiar as possible with the local environment. In most cases we expect this location to be within the catchment area of a person’s local community mental health service. However, a person may request admission outside of the catchment area of their local community mental health service – e.g. If another area is closer to family, carers and friends.
  • If a person is out of area, there should be regular* reviews and assessments focussed on enabling the person’s return to their local service (see comment above about personal circumstances) as soon as possible, ensuring minimum disruption to care.

*The frequency of reviews will depend on the circumstances and type of placement but will be a minimum of weekly with many places reviewing much more frequently.

An out of area treatment may be appropriate when:

  • The person becomes acutely unwell when they are away from home ( In such circumstances, the admitting provider should work with the person’s home team to facilitate repatriation to local services as soon as this is safe and clinically appropriate)
  • There are safeguarding reasons such as gang related issues, violence and domestic abuse.
  • The person is a member of the service’s staff or has contact with the service in the course of their employment.
  • There are offending restrictions.
  • The decision to treat out of area is the Individual’s choice e.g. where a patient is not from the local area and wants to be near their family and networks

This list is non-exclusive. There are other reasons why treatment in an out-of-area unit may be appropriate. In these cases discharge and/or return to an appropriate local unit should be facilitated at the earliest point. An out-of-area placement which is solely or primarily necessitated because of the unavailability of a local acute bed will not meet the criteria for being appropriate.

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