A shared responsibility: aligning public and independent mental health crisis care

We are at a decisive moment in the reform of mental health crisis care. The reformed Mental Health Act is on the horizon, promising a further shift toward reducing admissions and further strengthening community-based care. But to deliver real value and genuine improvements we need clear accountability, driven by good data.  

New research from The King’s Fund highlights an area where this is lagging: the NHS is already heavily reliant on the independent sector for inpatient mental health beds. This reliance is no longer a short-term safety valve; it is seemingly a permanent feature of the system and continues to grow. While not in itself a problem, it does place a clear responsibility on us to ensure that patients experience the same standard of care, with equal levels of oversight, data and transparency, whether they are in an NHS or an independent setting. 

Between January and March 2025, NHS trusts reported 17,999 mental health beds, with an occupancy rate of 89.5%. At the same time, independent sector providers offered an additional 7,195 beds available for NHS-funded patients, which accounts for around 28.6% of total capacity. When you consider that NHS bed numbers are based on occupancy and independent are based on those available to the NHS, that means that a fifth of capacity now sits outside of the NHS — delivered by private providers, charities and social enterprises. It’s also worth asking the question of why it has taken so long to get the granular data needed to fully contextualise the issue. Why did it take a think tank to get a full grasp of the situation? 

A fine balance

This trend raises multiple issues. The shift toward community care is both important and necessary, but the reality is that those who are acutely unwell will continue to need inpatient support. The difficulty lies in how this balance has been managed. To move care into the community requires significant upfront investment, yet inpatient beds have been reduced in advance of that capacity being built. This has left services constrained at both ends. In many areas, patients receive insufficient support on wards, the independent sector is called upon to fill gaps, and community services lack the resources to prevent repeated cycles of crisis. The reality is that each of these elements remains a postcode lottery. Some trusts and regions are making real progress, but the picture is far from consistent, leaving too many people without the care they need at the time they need it. The answer cannot ever be to simply increase bed numbers. Instead, we should be ensuring that inpatient provision is of consistently high quality, with robust oversight and transparent data, while at the same time guaranteeing that community investment is delivered in a way that is evidence based and measurable. 

Second, we must shine a light on the visibility of these capacity pinch points. The King’s Fund analysis underscores a critical data gap: independent providers are not mandated to report the same performance, outcome and experience metrics as NHS Trusts. And, as outlined in the research, when data is mandated, such as for people detained under the Mental Health Act: “data quality and completeness are notably poorer among independent sector providers”. This opacity undermines accountability, makes planning precarious and threatens patient safety when decisions hinge on incomplete information. 

Third, there is a growing concern that patients may experience unnecessary delays, transfers or spend significant time an inappropriate distance from home because of fragmented resource visibility. When NHS trusts rely on spot purchases from independent providers, placements can be far from familiar support networks, especially for the most vulnerable. This is not just inconvenient; it can compromise continuity and quality of care. 

Fourth, fragmentation in crisis care continues to deepen. Too many stakeholders, including NHS Mental Health Trusts, Local Authorities, Integrated Care Systems, independent providers and regulators, remain siloed. Crucially, a patient’s care journey spans these silos, yet digital tools that could unify information across providers remain under used. Without real-time access to bed availability, patient history, risk assessments and care plans, AMHPs and clinicians cannot coordinate effectively at critical junctures. 

Brining resources together

Effective community care can only evidence it is working well if admissions are prevented where appropriate. When hospitalisation is needed, it must be timely, high quality and well coordinated. It must also last as long as needed, but not shorter than required to ensure patients do not end up needing readmission. Reducing admissions can be seen as a positive move if it doesn’t increase the risk of people coming to harm, but if legislative efforts fail to address visibility, resource mapping and digital integration, we may simply shift unmet demand around the system rather than resolve it. 

That begs the question of what must be done. Here are some thoughts. 

Prioritise accountable investment in mental health infrastructure

The NHS estate is ageing, but expansion alone is not the answer. Policy makers should continue to explore greater investment, including independent investment, which can often deliver new facilities quicker. In some areas, ICBs are already working with private providers to build hospitals integrated with local services and focused on recovery. The priority should be ensuring these arrangements are transparent, provide value for money and are held to the same standards of data and oversight. Spot purchasing offers poor value. However, longer term accountable partnerships, such as housing and social care packages that support effective discharge or community care provision, can strengthen the system if providers commit to integration and quality.

Digitally connect across sectors

At Thalamos, we believe that real time, interoperable digital tools can bring coherence. Whether a patient is admitted to an NHS ward or an independent site, their information should travel with them, allowing local teams to keep sight of their patients and plan for supported discharge as early as possible rather than risk them getting lost in the system. This visibility also helps to ease some of the pressures that can arise when patients are placed in the independent sector, where different commissioning and payment structures can make discharge planning more complex. Provider collaboratives are already working to address these challenges by bringing partners together to focus on recovery and to reduce unnecessary reliance on inpatient care overall.

Use community-based care to complement, not compensate for, inpatient shortcomings

Community support reduces admissions, but only if properly resourced. We must invest equally in upstream services such as crisis resolution, supported housing, therapy and peer support so that fewer people become so unwell they require inpatient care. Additionally, there are social policies that can reduce crisis like reducing the harms associated with gambling, social media use, low quality employment and housing instability. 

Alongside the challenges set out by The King’s Fund, it is worth noting that the independent sector is also bringing in approaches that can differ from what the NHS typically has capacity to deliver, and which contribute positively to the ecosystem overall.

(1) One area is the innovative use of data. Some providers have invested in real-time platforms that integrate staffing levels, patient acuity and therapeutic activity, allowing ward teams to spot issues early. This has led to tangible improvements in patient safety and a reduction in restrictive practices.

(2) There is also evidence of a strong emphasis on embedding services in the community. Independent crisis facilities, designed for direct referral from ambulance or police, provide swift alternatives to A&E. These models help people stabilise locally and reduce the need for long transfers.

(3) In terms of alternative care strategies, bespoke one-patient therapeutic units for individuals with complex needs offer a level of personalisation that is hard to replicate elsewhere. They have been shown to shorten hospital stays and support better transitions back into the community.

(4) Some independent organisations are trialling new forms of collaboration with the NHS, such as jointly-managed wards. These have, in certain areas, significantly reduced out-of-area placements, while still operating to NHS governance standards.

(5) Finally, there has been significant progress in bringing living experience into service design. Formal roles for experts by experience now shape ward routines, staff training and governance meetings, ensuring that services reflect the perspectives of the people they serve. 

Playing to strenghs

In a recent conversation with an independent sector psychiatric hospital director, they made some very interesting observations. In their experience, when independent hospitals and the NHS work in partnership, the quality of care for patients can be very high. But there are always tensions to manage. 

On purchasing, private hospitals favour block booking over spot purchasing. It makes staffing and budget planning more sustainable and can mean the NHS gets access to beds at a much lower cost than private fees. At the same time, Trusts feel pressure to keep patients in house and may only use independent beds as a last resort. 

The care pathway is often the most complex element. Private hospitals can provide single rooms, higher staff ratios and faster access to medication review or stabilisation. But the risk is that if patients are transferred back mid-treatment, they can deteriorate. Therapy teams are rightly cautious not to start something that may be disrupted by a sudden transfer. That’s why many providers prefer to support patients later in their admission, when care planning is clearer and the emphasis is on discharge. Out-of-area placements make recovery and this discharge planning harder, as family and community links are disrupted. 

Bed management is another persistent challenge. In both sectors, managers spend huge amounts of time on the phone trying to locate a bed. A shared, real-time occupancy dashboard across NHS and independent providers would transform this. It would save staff time and, more importantly, reduce delays for patients in crisis. Communication gaps between sectors can also make discharge planning more fragmented, but where dedicated case managers bridge the two systems, patients experience much smoother transitions. 

Done well independent provision can genuinely complement NHS services. But it requires clarity, transparency and strong integration to avoid creating further cracks in the system. 

Following the data

Recent findings of the Centre for Mental Health add another valuable perspective to this debate. Its recent study highlights a striking mismatch between evidence and practice in crisis care provision. Services with strong evidence of effectiveness, such as crisis resolution and home treatment teams or acute day units, are patchy and in some places in decline. Meanwhile, newer approaches like crisis cafés, which lack a strong evidence base, are proliferating — so we need to ensure we are building the evidence to validate these. 

This inconsistency underscores the need for targeted investment. If resources are to be stretched further, they must be channelled into models with proven impact, evaluated robustly, and delivered consistently across the country where appropriate. The study also points to the risks of short-term or piecemeal funding that leaves voluntary and community-led services vulnerable, despite their ability to reach groups who may not engage with statutory care. 

Taken alongside The King’s Fund data, the message is clear: investment decisions in crisis care must be guided by evidence, transparency and system-wide integration, rather than by expediency or trends. Without this focus, the cracks in provision will only deepen. 

What The King’s Fund study shows is that mental health crisis care in the UK is no longer a purely NHS endeavour. It is a hybrid, and increasingly, a fragmented one. But this need not be a failure in design. It can instead be a chance to reimagine how we integrate provision for better outcomes. 

The new Mental Health Act must not blind us to the system-wide cracks underneath. We must use this moment to strengthen ties between NHS, social care, police, regulators and the independent sector; inpatient and community settings; and scattered data and joined up insight. Only then can we reshape crisis care to be both compassionate and coherent.