Stop Revolving Door in MH Wards: Firm Admission Criteria, Reduced Readmissions
The Issue
Actual title on petition: Stop Revolving Door in MH Wards: Firm Admission Criteria, Reduced Readmissions
Alternative title:
Stop Revolving Door in MH Wards: Least Restrictive Care and Better Community Support 1
The Issue
Throughout my whole mental health service user journey I have felt let down by the lack of appropriate community crisis intervention and poor GP management of medication and withdrawals. I believe that, once my Section 2 ended on 12 September 2024, I no longer required ongoing inpatient mental health care.
In my view, the hospital should have discharged me back into the community at that point and, unless there was clear evidence of significant clinical deterioration requiring hospital admission, made every effort to support me in the community during the first 30 days following discharge. Where readmission was being considered during that period, I believe it should have been subject to enhanced senior clinical review, recognising the use of 30-day readmission as an established healthcare quality indicator while not preventing clinically necessary readmission where appropriate.
This should have included active consideration of community crisis services such as the Home Based Treatment Team (HBTT), Crisis Team and other least restrictive alternativesavailable to Mental Health Liaison Teams (MHLT).
Between 21 August 2024 and 16 July 2026, I spent a cumulative total of 692 days under Greater Manchester Mental Health NHS Foundation Trust (GMMH) inpatient services. This comprised 51 days during my first acute admission (21 August–10 October 2024), 114 days during my second acute admission (15 October 2024–5 February 2025), and 527 days in a mental health rehabilitation placement (5 February 2025–16 July 2026).
Of those 692 days, only 23 days were spent detained under Section 2 of the Mental Health Act (21 August–12 September 2024). The remaining 669 days were spent as an informal (voluntary) patient.
I believe this prolonged period of informal inpatient care contributed significantly to institutionalisation, loss of independence, disruption to my employment and relationships, and the culture shock I experienced on returning to community living.
Prolonged inpatient admissions can reduce independent living skills, increase dependency and contribute to institutionalisation for some patients, particularly where community alternatives may have been appropriate. They can also accumulate trauma and increase reliance on hospitals and PRN medication.
There is concern that many people are admitted to inpatient mental health care when risk may have been overstated and community-based crisis support may have been possible, more appropriate, and capable of producing better outcomes. This can subject patients to unnecessary trauma by placing them alongside other acutely unwell patients while they are themselves in a vulnerable state, often resulting in prolonged admissions in overcrowded, noisy, chaotic, volatile, and sleep-disruptive ward environments, where some patients may also have co-occurring substance misuse issues which is unfair on patients who do not have this issue.
These factors can contribute to loss of independence, poorer recovery, and avoidable readmissions.
This petition distinguishes between documented events, my views about what should have happened in my own care, and the wider reforms I believe should be considered for future patients. While this petition is based on my experience within Greater Manchester Mental Health NHS Foundation Trust (GMMH), the issues described reflect a wider systemic failure across UK inpatient mental health services, including both NHS and independent providers.
These failures are linked to chronic underfunding in both community and inpatient settings, inconsistent escalation to community-based alternatives where clinically appropriate by A&E staff and mental health liaison teams, high service pressure, and variable inpatient outcomes. Many acute wards are not conducive to long-term recovery for patients who require calm, stable environments.
This highlights the need for stricter admission criteria across both NHS trusts and independent providers such as Cygnet and Priory hospitals.
This petition therefore calls for reduced inappropriate cycling in and out of inpatient mental health care by tightening admission thresholds, strengthening safeguards around early readmission, and making better use of community crisis services where clinically appropriate.
In addition, NHS mental health services should move towards smaller, lower-density inpatient wards with fewer beds per ward—for example, reducing typical adult acute wards from around 20–24 beds to approximately 10–12 beds—alongside increased investment in community crisis services. This would help create calmer, safer and more therapeutic environments, strengthen therapeutic relationships, improve patient dignity and individualised care, and support better recovery outcomes while maintaining sufficient overall inpatient capacity for those who genuinely require hospital admission.
For the attention of:
* Greater Manchester Mental Health NHS Foundation Trust
* NHS Greater Manchester Integrated Care Board (ICB)
* Mayor of Greater Manchester
* Parliamentary and Health Service Ombudsman (PHSO)
* Care Quality Commission (CQC)
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The use of staff names have been abbreviated.
The Community Care Gap Before My Admission (January–August 2024)
Since 5 December 2023 due to medication changes which I was not educated enough by my pharmacist and doctor to manage on my own/gradually enough (I came off escitalopram from January 2024 to February 2024 and needed to be advised to do it across at least 6 months with a liquid formulation but was told 1 month is fine and with tablets, i’m now on mirtazapine which i’m unsure is for me) i also needed to be advised to increase the medication instead and contact gmmh helpline for a crisis team before my mental health deteriorated further and perceived risk increased so that admission looked likely, I've dealt with lack of community crisis team support and bad recovery environments from 21 August 2024, I have experienced severe and worsening mental health difficulties, initially including depression, anxiety and insomnia, which later progressed into more complex and enduring difficulties including more severe and longer lasting depression and anxiety (without any good days at all where I am happy or relief) EUPD and chronic insomnia following prolonged inpatient mental health treatment and separation from my support network, work life, and stable daily routines. Despite repeated contact with services and escalation from professionals involved in my care, I was not accepted for crisis or secondary mental health support at key points in 2024.
I spoke to a GP about withdrawing from my antidepressant escitalopram on 9 January 2024 i should have been encouraged to increase this instead and/or at the very least been given a hyperbolic tapering plan lasting at least 6 months with liquid formations of the medication. I was assessed on multiple occasions by DB (SPOA MHP) on 4 July, 16 July and 19 August 2024 and deemed not to meet criteria for secondary or tertiary mental health care, despite repeated escalation from my GP and psychologists VS “l am writing to refer your patient to your crisis team for immediate support and intervention” on the 10 June 2024 and the 3 July 2024 “I believe the client needs a psychiatric assessment of his current mental state.
I hope the NHS can assist him further.”–The crisis team referral from my GP never happened/ I was declined for CMHT, HBTT and a psychiatric assessment by BAS and SPOA despite clear need—and Dr SM on the 23 July 2024 “I believe the risk is sufficient to warrant further input from yourselves at this point”. On 9 August 2024, LG (Bolton A&E) advised that my referral was inappropriate rather than directing me towards Crisis Team or Home Treatment Team support.
In my view, the period between 10 June 2024 and my admission on 21 August 2024 represented the greatest missed opportunity to prevent my subsequent admission through timely specialist community intervention. When Dr Baigresponded to the crisis team referral email with a routine GP appointment she offered mirtazapine but i was apprehensive due to reliance on a tablet to aid sleep and other bothersome side effects like excess sedation and weight gain.
A reintroduction of my prior antidepressant escitalopram at a therapeutic/max dose should have been trailed instead given my history with responding well on max dose citalopram and breaking down in front of my boss when i was on only 5mg escitalopram , a possible assessment of sleep medication daridexorant should have been suggested too. After the mirtazapine was declined No Mental Health referrals like CMHT or signposting to AnE MHLT for HBTT was made as a result of this consultation when the therapist specifically requested for crisis teams intervention.
I vaguely recall possibly being briefly informed by a receptionist/admin professional that crisis teams are self refer but nothing was discussed on the call with the GP about this and where and how i would get this support they not direct me to a referral portal or encourage me to ring 111 option 2 or the gmmh helpline to encourage about crisis support or advise me to attend AnE to get HBTT. At the very least I should have been advised to ring 111 option 2 to enquire about HBTT/ crisis team.
(At the time this was formerly The Greater Manchester Mental Health (GMMH) 24/7 Crisis Helpline (0800 953 0285))
From approximately 2017 to February 2024, I received antidepressant treatment for several years, including sertraline 50-100mg for around 6 months, citalopram 10mg - 40mg for approximately 3 years, venlafaxine 75 mg for around 7 months, and escitalopram 5-10mg (mostly 5mg as stepped up and back down due to appetite https://youtube.com/shorts/t51Qrou20Z4?is=Rkwl2Cs6MNwsv-uC for approximately 1 year,, with gaps between some courses of treatment. Despite this history, I was advised to discontinue escitalopram over approximately one month using tablets.
Looking back, I believe I should have been assessed as being at increased risk of antidepressant withdrawal and offered an individualised taper. NICE (2023) recommends reducing antidepressants in stages, with the speed and duration agreed between the patient and clinician, and that further dose reductions should occur only once withdrawal symptoms have settled or are tolerable.
The Royal College of Psychiatrists advises that tapering should be proportionate to the duration of treatment, noting that people who have taken antidepressants for several years may require tapering over some months.
Dr.Mark Horowitz similarly advocates an individualised, hyperbolic taper, explaining that long-term users may require tapering over several months or, in some cases, longer than a year, with progressively smaller dose reductions and consideration of liquid formulations where needed. In light of this guidance and my medication history, I believe a slower, individualised taper with regular review of withdrawal symptoms and consideration of a liquid formulation would have been more appropriate than assuming a one-month tablet taper would be suitable for me.
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Because more appropriate options for me that would have allowed me to stay with my support network of friends and family and colleagues and job like Home Treatment and other community crisis options were not provided at the time by CF, SD, RR, KG and Beth, from 21 August 2024 to 5 February 2025 I became subject to the poorly CQC-rated acute psychiatric inpatient system and was later placed in a mental health rehabilitation facility. I believe this has unintentionally further institutionalised me, reduced my independence, and separated me from my community, former life, and relationships, including my partner, friends and family.
I remain in rehabilitation as of June 2026, with planned discharge back to the community in July 2026, having experienced significant loss of former adult skills, relationships and occupational functioning.
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I believe that current inpatient mental health pathways can, in some cases, contribute to prolonged admissions and repeated readmissions that do not always support recovery.
This petition therefore calls for clearer safeguards around admission decisions, reduced unnecessary readmissions, and stronger community-based mental health support.
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My Experience and Why I Believe Different Decisions Should Have Been Made
I believe I should never have been subjected to these circumstances, particularly during my second admission from 15 October 2024 at Royal Bolton Hospital (Beech Ward, Rivington Unit), overseen by consultant psychiatrist —Dr AJ (Jay)— and my named nurse DC (Dr SS and nurse RH also involved on first admission)
Following my discharge on 10 October 2024, rather than being supported at my flat with my flatmate and with the Home Based Treatment Team (HBTT), I felt pressured by family, ambulance staff, police and hospital staff into readmission.
What was intended to be just a 28-day detention under the Mental Health Act (later reduced to 23 days - 21 August 2024 to 12 September 2024, inclusive) became a prolonged admission across both acute and mental health rehabilitation services (not substance misuse rehabilitation services, as I do not take drugs). The rehabilitation placement would not have been considered had the readmission not occurred.
In total, I have spent almost two years in services, which I believe was not clinically necessary and was detrimental to my recovery. In my view, I should have been discharged after those 23 days and supported in the community, with appropriate Crisis Team and Home Based Treatment Team (HBTT) input where necessary, rather than remaining within inpatient services.
Following the expiry of my detention, I was not detained under a further section of the Mental Health Act. I believe this indicates that I was no longer considered to meet the statutory criteria for compulsory detention on grounds of my safety or clinical need.
In my view, community-based alternatives should therefore have been pursued more actively to support my recovery and prevent prolonged institutionalisation. It took me out of the comfortable, productive community environments I was accessing prior to admission, including Manchester city centre, my own flat, the gym, the dance studio, the football field, my work office, community support groups such as TRE and breath work, and other social environments, and prevented me from living a meaningful and fulfilling life surrounded by people who love me and have my best interests at heart, like my partner and my friends, as I should have been doing in my 20s.
Instead, I was left surrounded by significant distress and acute mental illness with staff who are stretched too thinly and do not have the same emotional attachment to me as friends and family, so my progress, whether good or bad, doesn’t affect them enough to help me to the same degree family and friends can, in a chaotic environment with severely ill, constantly changing strangers rather than continuing to enjoy and work on personal relationships with people I wanted to spend my life with, like my friends and partner. On 14 October 2024, as documented, I stated to Rebecca Rudd from the mental health liaison team, “I do not want to go back into a mental health hospital because of the fear of violence and aggression from others, I would not feel safe.” Following assessment in A&E at Salford Royal Hospital by nurse Karin Goodier , it was also documented that I denied current intent to self-harm and presented no risk to others and it’s KG recorded “ I asked him if he feels suicidal, he denied this” and I told him I had a plan for HBTT, as an admission may have a further negative impact on his mental health“
Despite this, I was readmitted without full exhaustion of other least restrictive community options.
My records show that clinicians internally explored:
* Home Based Treatment Team (HBTT) support only in the context of me staying with my parents;
* referral to one crisis bed provider, which declined to accept me;
* and HBTT gatekeeping before admission. In my view, several other community options were not discussed with me at all.
In particular, I do not recall any discussion about:
* HBTT support within my own Manchester tenancy, where I lived with a trusted flatmate;
* temporary HBTT support while staying with my partner;
* temporary HBTT support while staying with trusted friends, where clinically appropriate, rather than focusing almost entirely on my parents’ homes, both of whom were unable to support me because of their own circumstances. Furthermore, although services such as:
* Community Mental Health Team (CMHT) involvement;
* the Recovery Lounge;
* Number 93;
* and respite services
appear within Trust documentation as recognised community resources, I do not recall these being discussed with me as realistic alternatives to readmission, nor have I seen evidence that they were actively explored in relation to my individual circumstances.
In my view, community alternatives were therefore not fully exhausted in a manner that reflected my own circumstances, including:
* my own Manchester tenancy;
* my previous independent living;
* and my documented wish to avoid further inpatient care where safely possible. My concern is therefore not that community alternatives did not exist, but that the exploration of those alternatives was too narrow.
Once my parents’ homes and a single crisis bed were no longer considered suitable, I believe there should have been broader consideration of whether my own tenancy, existing support network and other community services could have provided a safe, less restrictive alternative to prolonged informal readmission. I experienced a brief episode of acute distress at my father’s home involving a bath and a bread knife.
Although I had thoughts of self-harm, I did not act and was successfully de-escalated with family support. On a separate occasion, intrusive thoughts led me to contact my mother requesting euthanasia.
Following a misunderstanding during attempts to calm me, emergency services attended and I was taken to A&E, where I experienced a stress-related tachycardic episode. Although medically cleared following ECG and blood tests, I believe this escalation worsened both my psychological distress and physical symptoms.
Despite being medically stable, I was considered for readmission. Given that the documented treatment goals included distress tolerance, medication support, psychological work and crisis support, I believe there should have been enhanced consultant-level scrutiny as to whether those aims could have been delivered through intensive community treatment before a prolonged informal admission was agreed.
In my view, readmission to a busy 22-bed acute ward, full of unwell strangers and with staff stretched too thinly to provide truly individualised care, became the only realistic option that was presented to me. I do not believe sufficient consideration was given to Home Based Treatment Team (HBTT) support within my own Manchester tenancy, with my flatmate, or temporarily with my partner or trusted friends, despite these representing potentially less restrictive alternatives to prolonged inpatient admission.
Rather than supporting me through Crisis Team or Home Based Treatment Team (HBTT) input within my own home environment, surrounded by my partner, flatmate, friends and family, I was readmitted to an acute ward. In my view, community-based treatment would have provided a calmer, more personalised and recovery-focused environment, with support tailored to my individual needs rather than a generic inpatient ward setting.
I believe the prolonged admission and repeated exposure to a highly stressful ward environment contributed to trauma-related symptoms, emotional dysregulation and factors associated with my subsequent diagnosis of EUPD. I felt my level of risk was overstated, I was not given sufficient time in the 2-bed mental health assessment area to consider alternatives, and I was not clearly informed that I could decline informal admission.
I felt decisions were made under pressure rather than through genuine shared decision-making. I was then returned to a 22-bed acute ward which I experienced as chaotic, with frequent alarms, restraints and rapid tranquillisation.
I also witnessed a patient being restrained following an incident involving a hammer taken from a workman, reinforcing my perception that this was an unsafe and highly distressing environment for lower-risk patients. More broadly, I was assessed by DB (SPOA MHP) on 4 July, 16 July and 19 August 2024 and deemed not to meet criteria for secondary or tertiary mental health care despite repeated escalation from my GP and psychologists VS and SM, both of whom requested crisis and psychiatric review.
On 9 August 2024, LG (Bolton A&E) advised that my referral was inappropriate rather than directing me towards Crisis Team or Home Treatment Team support. During this period I repeatedly sought help through GP appointments (including six out-of-hours consultations), crisis lines and the Listening Lounge, yet no structured crisis plan or clear escalation pathway was provided.
On my second admission discharge planning was abysmal and there was no clear path for my recovery instead i was left on the ward suffering with copious amounts of leave overnight with no discharge date set.
"MHLT have exhausted all options (not throughly enough because the crisis bed rejected me and they didnt wait to place me at another one) and HBTT has been explored on several occasions. This has been revisited as there is a piece of work that can be done with HBTT particularly around distress tolerance however family not accepting this.
Dad not agreeing to HBTT and has refused to have him home – feels that risks are too high. Doesn’t feel that risks can be managed safely in the community at present.
"
I had a tenancy in manchester at two different flats during the course of all this
Rather than considering my own flat for a place to do the HBTT work they only restricted it to my mums or dads when considering this option when I had a tenancy in Manchester with a flatmate that could have been utilised to do this work
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Wider issue
Many patients appear to experience similar cycles due to unclear clinical rationale for informal admissions. NICEguidance discourages inpatient admission for individuals with EUPD except in exceptional circumstances, yet this continues in practice.
The Care Quality Commission (CQC) has repeatedly raised concerns about inpatient ward environments and their impact on recovery, safety and independence. I also believe acute wards are chaotic environments caring for people with widely differing clinical needs, working backgrounds, support needs and levels of risk.
More specialised services and better separation of patient groups could provide calmer, more therapeutic environments, strengthen therapeutic relationships and improve recovery for everyone. While acute admission may occasionally be necessary to stabilise someone in crisis, I believe unnecessarily prolonged admissions often become counterproductive, increasing dependency, institutionalisation and barriers to recovery.
Based on the allostatic load model and cumulative lifespan adversity, I believe adult trauma follows the same disease-producing pathway described by the childhood ACEs framework. Prolonged psychological stress, social isolation and repeated crises can contribute to poorer physical health, reduced independence and increased long-term mortality.
I also believe greater awareness of hyperbolic antidepressant tapering and withdrawal, alongside earlier review of evidence-based medication options, may prevent deterioration and reduce the need for inpatient admission in some patients. Multiple clinicians documented severe insomnia and sensitivity to environmental noise as major contributors to my deterioration.
In my view, these factors should receive greater consideration when deciding whether an acute ward environment is therapeutically appropriate for a particular patient. Prolonged exposure to highly stressful inpatient environments may leave some patients with persistent hyper-vigilance, impaired emotional regulation and difficulties returning to normal daily life.
These effects can continue long after discharge and may undermine recovery. I also believe being removed from work and placed in a chaotic hospital environment, instead of the supportive setting of my workplace and close colleagues and professional relationships that had taken years to build, was severely damaging and not reflective of person-centred care.
I believe prolonged inpatient exposure can significantly reduce quality of life, independence and long-term outcomes. It can affect employment, financial stability and basic wellbeing.
Hospital food is also often inexpensive and heavily processed, contributing to lethargy and providing poor nutritional support for recovery and engagement. As a result, I am currently unable to return to my previous role in the same capacity or sustain full-time employment without significant adjustments.
I had built a successful career in digital marketing and was working towards progression into management. My role depended not only on technical ability but also on strong professional relationships with colleagues, clients and industry contacts that had taken years to develop.
Prolonged removal from the workplace interrupted those relationships, reduced my professional credibility and deprived me of the daily experience, confidence and routine that comes from working in a corporate environment. The loss of daily collaboration with colleagues, clients and wider industry professionals also disrupted relationships and networks that had taken years to establish and maintain, making reintegration into my profession significantly more difficult.
Instead of reinforcing healthy workplace behaviours and professional development, I spent many months adapting to institutional routines that I believe were the opposite of the independent, collaborative and fast-paced environment in which I had previously thrived. I now face long-term unemployment, reduced independence and a significantly damaged professional and personal support network.
I have also lost key aspects of my life outside work. Social activities I once enjoyed—including TRE, breathwork, football, HIIT classes, singing and dancing—have ceased entirely, and skills I previously had feel diminished.
Since these experiences I have become severely socially withdrawn and agoraphobic. I rarely leave my rehabilitation placement and have lost confidence carrying out everyday activities, rebuilding friendships and participating in community life.
I believe prolonged institutionalisation has significantly reduced my independence and quality of life. When I do leave the unit, I continue to experience severe suicidal thoughts, so I have concluded that staying indoors is currently the safer option.
I also believe greater scrutiny is needed over the routine use of PRN medication on acute wards. While appropriate in some circumstances, excessive reliance on sedating medication such as promethazine may reduce patients’ ability to engage with psychological therapies and recovery-focused activities, while increasing the risk of long-term reliance on these medicines after discharge.
I recognise that inpatient psychiatric admission is sometimes essential, particularly where there is an immediate and serious risk to life or where safe assessment and stabilisation cannot be achieved in the community. However, I believe it should remain the least restrictive option and be limited to the shortest clinically necessary period.
In my view, many patients who require admission can be safely assessed, stabilised and have treatment initiated within around 28 days, after which recovery should continue through community-based services, including community wellbeing hubs and peer support groups, wherever clinically appropriate. This would allow people to rebuild their independence while remaining connected to everyday life, employment, family and society.
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What I am asking for
I am calling for:
* Separate service for drug induced mental health conditions its not fair on non substance abusers to share a service and environment with other patients who struggle with addiction -i’m not saying these people don’t deserve help because they do, everyone does but it should be in a separate environment to non users- as this can make the environment unsafe for non-drug users as they are in a vulnerable state and with drug use happening often on the wards vulnerable people (not myself) could have easily got involved which could have worsened their mental state
* There should be more segregation on the wards in regards to risk level/severity of illness
* Reducing typical adult acute wards from around 20–24 bedsto approximately 10–12 beds while maintaining staffing levels—alongside increased investment in community crisis services
* Time-limited informal admissions with regular review.
* Stronger admission criteria for inpatient psychiatric care.
* Enhanced senior clinical review of any psychiatric readmission within the first 30 days following discharge, unless there is clear evidence that immediate inpatient admission is clinically necessary.
* Increased investment in Community Mental Health Teams (CMHT) and Home Treatment Teams.
* Improved discharge planning and community reintegration support.
* Greater recognition of antidepressant withdrawal, hyperbolic tapering principles and evidence-based medication review before considering inpatient admission where clinically appropriate.
* Greater oversight of PRN prescribing on acute wards, particularly promethazine, ensuring sedating medication is used only where clinically necessary and alongside recovery-focused interventions.
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Final call to action
Please sign this petition to support reform of acute psychiatric care so that it prioritises recovery, independence and effective community-based treatment.
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Similar petitions
https://c.org/BCtkxbCtFk
https://www.change.org/Hyperbolictaperingantidepressants
Personal Reflection
If time travel were ever possible, there are five points in my care I would choose to revisit:
* 9 January 2024 – following my breakdown at work, to review my medication before withdrawing from escitalopram.
* 17–21 May 2024 – when my mental health deteriorated again before my therapist’s Crisis Team referral.
* 10 June 2024 – when my therapist requested immediate Crisis Team intervention and psychiatric assessment.
* 12 September 2024 – when my Section 2 ended and, in my view, discharge with Home Based Treatment Team support should have been actively pursued.
* 12–14 October 2024 – when I believe community alternatives should have been explored more fully before prolonged informal readmission.
📋 Sourcing and References
1. The Least Restrictive Principle Mandate: Gov.uk Mental Health Act Code of Practice — Chapter 1 legally binds trusts to use the least restrictive option available and actively support existing family and community housing networks.
2. GMMH Segment 4 Performance Status: CQC Provider Inspection Summary for GMMH — Official documentation confirming GMMH's placement into Segment 4 of the NHS Oversight Framework,
3.Acute Ward Safety & Chaos Evidence: BBC News Assessment of GMMH Acute Wards — Independent CQCfindings confirming acute wards were rated "Inadequate" due to systemic chaos, failures in basic safety protocols, and severe fire safety risks across units.
4.The Harm of Institutional Deskilling: Centre for Mental Health Research Briefings — Documents detailing how over-extended hospital stays actively strip voluntary patients of independent living skills, creating a severe and damaging shock when they are discharged. [1]
5.Home Treatment Team Mandates: NHS England Community Mental Health Guidance — Guidance on the role of community crisis and Home Treatment Teams and the principle of providing care in the least restrictive settingwhere clinically appropriate
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The Issue
Actual title on petition: Stop Revolving Door in MH Wards: Firm Admission Criteria, Reduced Readmissions
Alternative title:
Stop Revolving Door in MH Wards: Least Restrictive Care and Better Community Support 1
The Issue
Throughout my whole mental health service user journey I have felt let down by the lack of appropriate community crisis intervention and poor GP management of medication and withdrawals. I believe that, once my Section 2 ended on 12 September 2024, I no longer required ongoing inpatient mental health care.
In my view, the hospital should have discharged me back into the community at that point and, unless there was clear evidence of significant clinical deterioration requiring hospital admission, made every effort to support me in the community during the first 30 days following discharge. Where readmission was being considered during that period, I believe it should have been subject to enhanced senior clinical review, recognising the use of 30-day readmission as an established healthcare quality indicator while not preventing clinically necessary readmission where appropriate.
This should have included active consideration of community crisis services such as the Home Based Treatment Team (HBTT), Crisis Team and other least restrictive alternativesavailable to Mental Health Liaison Teams (MHLT).
Between 21 August 2024 and 16 July 2026, I spent a cumulative total of 692 days under Greater Manchester Mental Health NHS Foundation Trust (GMMH) inpatient services. This comprised 51 days during my first acute admission (21 August–10 October 2024), 114 days during my second acute admission (15 October 2024–5 February 2025), and 527 days in a mental health rehabilitation placement (5 February 2025–16 July 2026).
Of those 692 days, only 23 days were spent detained under Section 2 of the Mental Health Act (21 August–12 September 2024). The remaining 669 days were spent as an informal (voluntary) patient.
I believe this prolonged period of informal inpatient care contributed significantly to institutionalisation, loss of independence, disruption to my employment and relationships, and the culture shock I experienced on returning to community living.
Prolonged inpatient admissions can reduce independent living skills, increase dependency and contribute to institutionalisation for some patients, particularly where community alternatives may have been appropriate. They can also accumulate trauma and increase reliance on hospitals and PRN medication.
There is concern that many people are admitted to inpatient mental health care when risk may have been overstated and community-based crisis support may have been possible, more appropriate, and capable of producing better outcomes. This can subject patients to unnecessary trauma by placing them alongside other acutely unwell patients while they are themselves in a vulnerable state, often resulting in prolonged admissions in overcrowded, noisy, chaotic, volatile, and sleep-disruptive ward environments, where some patients may also have co-occurring substance misuse issues which is unfair on patients who do not have this issue.
These factors can contribute to loss of independence, poorer recovery, and avoidable readmissions.
This petition distinguishes between documented events, my views about what should have happened in my own care, and the wider reforms I believe should be considered for future patients. While this petition is based on my experience within Greater Manchester Mental Health NHS Foundation Trust (GMMH), the issues described reflect a wider systemic failure across UK inpatient mental health services, including both NHS and independent providers.
These failures are linked to chronic underfunding in both community and inpatient settings, inconsistent escalation to community-based alternatives where clinically appropriate by A&E staff and mental health liaison teams, high service pressure, and variable inpatient outcomes. Many acute wards are not conducive to long-term recovery for patients who require calm, stable environments.
This highlights the need for stricter admission criteria across both NHS trusts and independent providers such as Cygnet and Priory hospitals.
This petition therefore calls for reduced inappropriate cycling in and out of inpatient mental health care by tightening admission thresholds, strengthening safeguards around early readmission, and making better use of community crisis services where clinically appropriate.
In addition, NHS mental health services should move towards smaller, lower-density inpatient wards with fewer beds per ward—for example, reducing typical adult acute wards from around 20–24 beds to approximately 10–12 beds—alongside increased investment in community crisis services. This would help create calmer, safer and more therapeutic environments, strengthen therapeutic relationships, improve patient dignity and individualised care, and support better recovery outcomes while maintaining sufficient overall inpatient capacity for those who genuinely require hospital admission.
For the attention of:
* Greater Manchester Mental Health NHS Foundation Trust
* NHS Greater Manchester Integrated Care Board (ICB)
* Mayor of Greater Manchester
* Parliamentary and Health Service Ombudsman (PHSO)
* Care Quality Commission (CQC)
⸻
The use of staff names have been abbreviated.
The Community Care Gap Before My Admission (January–August 2024)
Since 5 December 2023 due to medication changes which I was not educated enough by my pharmacist and doctor to manage on my own/gradually enough (I came off escitalopram from January 2024 to February 2024 and needed to be advised to do it across at least 6 months with a liquid formulation but was told 1 month is fine and with tablets, i’m now on mirtazapine which i’m unsure is for me) i also needed to be advised to increase the medication instead and contact gmmh helpline for a crisis team before my mental health deteriorated further and perceived risk increased so that admission looked likely, I've dealt with lack of community crisis team support and bad recovery environments from 21 August 2024, I have experienced severe and worsening mental health difficulties, initially including depression, anxiety and insomnia, which later progressed into more complex and enduring difficulties including more severe and longer lasting depression and anxiety (without any good days at all where I am happy or relief) EUPD and chronic insomnia following prolonged inpatient mental health treatment and separation from my support network, work life, and stable daily routines. Despite repeated contact with services and escalation from professionals involved in my care, I was not accepted for crisis or secondary mental health support at key points in 2024.
I spoke to a GP about withdrawing from my antidepressant escitalopram on 9 January 2024 i should have been encouraged to increase this instead and/or at the very least been given a hyperbolic tapering plan lasting at least 6 months with liquid formations of the medication. I was assessed on multiple occasions by DB (SPOA MHP) on 4 July, 16 July and 19 August 2024 and deemed not to meet criteria for secondary or tertiary mental health care, despite repeated escalation from my GP and psychologists VS “l am writing to refer your patient to your crisis team for immediate support and intervention” on the 10 June 2024 and the 3 July 2024 “I believe the client needs a psychiatric assessment of his current mental state.
I hope the NHS can assist him further.”–The crisis team referral from my GP never happened/ I was declined for CMHT, HBTT and a psychiatric assessment by BAS and SPOA despite clear need—and Dr SM on the 23 July 2024 “I believe the risk is sufficient to warrant further input from yourselves at this point”. On 9 August 2024, LG (Bolton A&E) advised that my referral was inappropriate rather than directing me towards Crisis Team or Home Treatment Team support.
In my view, the period between 10 June 2024 and my admission on 21 August 2024 represented the greatest missed opportunity to prevent my subsequent admission through timely specialist community intervention. When Dr Baigresponded to the crisis team referral email with a routine GP appointment she offered mirtazapine but i was apprehensive due to reliance on a tablet to aid sleep and other bothersome side effects like excess sedation and weight gain.
A reintroduction of my prior antidepressant escitalopram at a therapeutic/max dose should have been trailed instead given my history with responding well on max dose citalopram and breaking down in front of my boss when i was on only 5mg escitalopram , a possible assessment of sleep medication daridexorant should have been suggested too. After the mirtazapine was declined No Mental Health referrals like CMHT or signposting to AnE MHLT for HBTT was made as a result of this consultation when the therapist specifically requested for crisis teams intervention.
I vaguely recall possibly being briefly informed by a receptionist/admin professional that crisis teams are self refer but nothing was discussed on the call with the GP about this and where and how i would get this support they not direct me to a referral portal or encourage me to ring 111 option 2 or the gmmh helpline to encourage about crisis support or advise me to attend AnE to get HBTT. At the very least I should have been advised to ring 111 option 2 to enquire about HBTT/ crisis team.
(At the time this was formerly The Greater Manchester Mental Health (GMMH) 24/7 Crisis Helpline (0800 953 0285))
From approximately 2017 to February 2024, I received antidepressant treatment for several years, including sertraline 50-100mg for around 6 months, citalopram 10mg - 40mg for approximately 3 years, venlafaxine 75 mg for around 7 months, and escitalopram 5-10mg (mostly 5mg as stepped up and back down due to appetite https://youtube.com/shorts/t51Qrou20Z4?is=Rkwl2Cs6MNwsv-uC for approximately 1 year,, with gaps between some courses of treatment. Despite this history, I was advised to discontinue escitalopram over approximately one month using tablets.
Looking back, I believe I should have been assessed as being at increased risk of antidepressant withdrawal and offered an individualised taper. NICE (2023) recommends reducing antidepressants in stages, with the speed and duration agreed between the patient and clinician, and that further dose reductions should occur only once withdrawal symptoms have settled or are tolerable.
The Royal College of Psychiatrists advises that tapering should be proportionate to the duration of treatment, noting that people who have taken antidepressants for several years may require tapering over some months.
Dr.Mark Horowitz similarly advocates an individualised, hyperbolic taper, explaining that long-term users may require tapering over several months or, in some cases, longer than a year, with progressively smaller dose reductions and consideration of liquid formulations where needed. In light of this guidance and my medication history, I believe a slower, individualised taper with regular review of withdrawal symptoms and consideration of a liquid formulation would have been more appropriate than assuming a one-month tablet taper would be suitable for me.
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Because more appropriate options for me that would have allowed me to stay with my support network of friends and family and colleagues and job like Home Treatment and other community crisis options were not provided at the time by CF, SD, RR, KG and Beth, from 21 August 2024 to 5 February 2025 I became subject to the poorly CQC-rated acute psychiatric inpatient system and was later placed in a mental health rehabilitation facility. I believe this has unintentionally further institutionalised me, reduced my independence, and separated me from my community, former life, and relationships, including my partner, friends and family.
I remain in rehabilitation as of June 2026, with planned discharge back to the community in July 2026, having experienced significant loss of former adult skills, relationships and occupational functioning.
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I believe that current inpatient mental health pathways can, in some cases, contribute to prolonged admissions and repeated readmissions that do not always support recovery.
This petition therefore calls for clearer safeguards around admission decisions, reduced unnecessary readmissions, and stronger community-based mental health support.
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My Experience and Why I Believe Different Decisions Should Have Been Made
I believe I should never have been subjected to these circumstances, particularly during my second admission from 15 October 2024 at Royal Bolton Hospital (Beech Ward, Rivington Unit), overseen by consultant psychiatrist —Dr AJ (Jay)— and my named nurse DC (Dr SS and nurse RH also involved on first admission)
Following my discharge on 10 October 2024, rather than being supported at my flat with my flatmate and with the Home Based Treatment Team (HBTT), I felt pressured by family, ambulance staff, police and hospital staff into readmission.
What was intended to be just a 28-day detention under the Mental Health Act (later reduced to 23 days - 21 August 2024 to 12 September 2024, inclusive) became a prolonged admission across both acute and mental health rehabilitation services (not substance misuse rehabilitation services, as I do not take drugs). The rehabilitation placement would not have been considered had the readmission not occurred.
In total, I have spent almost two years in services, which I believe was not clinically necessary and was detrimental to my recovery. In my view, I should have been discharged after those 23 days and supported in the community, with appropriate Crisis Team and Home Based Treatment Team (HBTT) input where necessary, rather than remaining within inpatient services.
Following the expiry of my detention, I was not detained under a further section of the Mental Health Act. I believe this indicates that I was no longer considered to meet the statutory criteria for compulsory detention on grounds of my safety or clinical need.
In my view, community-based alternatives should therefore have been pursued more actively to support my recovery and prevent prolonged institutionalisation. It took me out of the comfortable, productive community environments I was accessing prior to admission, including Manchester city centre, my own flat, the gym, the dance studio, the football field, my work office, community support groups such as TRE and breath work, and other social environments, and prevented me from living a meaningful and fulfilling life surrounded by people who love me and have my best interests at heart, like my partner and my friends, as I should have been doing in my 20s.
Instead, I was left surrounded by significant distress and acute mental illness with staff who are stretched too thinly and do not have the same emotional attachment to me as friends and family, so my progress, whether good or bad, doesn’t affect them enough to help me to the same degree family and friends can, in a chaotic environment with severely ill, constantly changing strangers rather than continuing to enjoy and work on personal relationships with people I wanted to spend my life with, like my friends and partner. On 14 October 2024, as documented, I stated to Rebecca Rudd from the mental health liaison team, “I do not want to go back into a mental health hospital because of the fear of violence and aggression from others, I would not feel safe.” Following assessment in A&E at Salford Royal Hospital by nurse Karin Goodier , it was also documented that I denied current intent to self-harm and presented no risk to others and it’s KG recorded “ I asked him if he feels suicidal, he denied this” and I told him I had a plan for HBTT, as an admission may have a further negative impact on his mental health“
Despite this, I was readmitted without full exhaustion of other least restrictive community options.
My records show that clinicians internally explored:
* Home Based Treatment Team (HBTT) support only in the context of me staying with my parents;
* referral to one crisis bed provider, which declined to accept me;
* and HBTT gatekeeping before admission. In my view, several other community options were not discussed with me at all.
In particular, I do not recall any discussion about:
* HBTT support within my own Manchester tenancy, where I lived with a trusted flatmate;
* temporary HBTT support while staying with my partner;
* temporary HBTT support while staying with trusted friends, where clinically appropriate, rather than focusing almost entirely on my parents’ homes, both of whom were unable to support me because of their own circumstances. Furthermore, although services such as:
* Community Mental Health Team (CMHT) involvement;
* the Recovery Lounge;
* Number 93;
* and respite services
appear within Trust documentation as recognised community resources, I do not recall these being discussed with me as realistic alternatives to readmission, nor have I seen evidence that they were actively explored in relation to my individual circumstances.
In my view, community alternatives were therefore not fully exhausted in a manner that reflected my own circumstances, including:
* my own Manchester tenancy;
* my previous independent living;
* and my documented wish to avoid further inpatient care where safely possible. My concern is therefore not that community alternatives did not exist, but that the exploration of those alternatives was too narrow.
Once my parents’ homes and a single crisis bed were no longer considered suitable, I believe there should have been broader consideration of whether my own tenancy, existing support network and other community services could have provided a safe, less restrictive alternative to prolonged informal readmission. I experienced a brief episode of acute distress at my father’s home involving a bath and a bread knife.
Although I had thoughts of self-harm, I did not act and was successfully de-escalated with family support. On a separate occasion, intrusive thoughts led me to contact my mother requesting euthanasia.
Following a misunderstanding during attempts to calm me, emergency services attended and I was taken to A&E, where I experienced a stress-related tachycardic episode. Although medically cleared following ECG and blood tests, I believe this escalation worsened both my psychological distress and physical symptoms.
Despite being medically stable, I was considered for readmission. Given that the documented treatment goals included distress tolerance, medication support, psychological work and crisis support, I believe there should have been enhanced consultant-level scrutiny as to whether those aims could have been delivered through intensive community treatment before a prolonged informal admission was agreed.
In my view, readmission to a busy 22-bed acute ward, full of unwell strangers and with staff stretched too thinly to provide truly individualised care, became the only realistic option that was presented to me. I do not believe sufficient consideration was given to Home Based Treatment Team (HBTT) support within my own Manchester tenancy, with my flatmate, or temporarily with my partner or trusted friends, despite these representing potentially less restrictive alternatives to prolonged inpatient admission.
Rather than supporting me through Crisis Team or Home Based Treatment Team (HBTT) input within my own home environment, surrounded by my partner, flatmate, friends and family, I was readmitted to an acute ward. In my view, community-based treatment would have provided a calmer, more personalised and recovery-focused environment, with support tailored to my individual needs rather than a generic inpatient ward setting.
I believe the prolonged admission and repeated exposure to a highly stressful ward environment contributed to trauma-related symptoms, emotional dysregulation and factors associated with my subsequent diagnosis of EUPD. I felt my level of risk was overstated, I was not given sufficient time in the 2-bed mental health assessment area to consider alternatives, and I was not clearly informed that I could decline informal admission.
I felt decisions were made under pressure rather than through genuine shared decision-making. I was then returned to a 22-bed acute ward which I experienced as chaotic, with frequent alarms, restraints and rapid tranquillisation.
I also witnessed a patient being restrained following an incident involving a hammer taken from a workman, reinforcing my perception that this was an unsafe and highly distressing environment for lower-risk patients. More broadly, I was assessed by DB (SPOA MHP) on 4 July, 16 July and 19 August 2024 and deemed not to meet criteria for secondary or tertiary mental health care despite repeated escalation from my GP and psychologists VS and SM, both of whom requested crisis and psychiatric review.
On 9 August 2024, LG (Bolton A&E) advised that my referral was inappropriate rather than directing me towards Crisis Team or Home Treatment Team support. During this period I repeatedly sought help through GP appointments (including six out-of-hours consultations), crisis lines and the Listening Lounge, yet no structured crisis plan or clear escalation pathway was provided.
On my second admission discharge planning was abysmal and there was no clear path for my recovery instead i was left on the ward suffering with copious amounts of leave overnight with no discharge date set.
"MHLT have exhausted all options (not throughly enough because the crisis bed rejected me and they didnt wait to place me at another one) and HBTT has been explored on several occasions. This has been revisited as there is a piece of work that can be done with HBTT particularly around distress tolerance however family not accepting this.
Dad not agreeing to HBTT and has refused to have him home – feels that risks are too high. Doesn’t feel that risks can be managed safely in the community at present.
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I had a tenancy in manchester at two different flats during the course of all this
Rather than considering my own flat for a place to do the HBTT work they only restricted it to my mums or dads when considering this option when I had a tenancy in Manchester with a flatmate that could have been utilised to do this work
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Wider issue
Many patients appear to experience similar cycles due to unclear clinical rationale for informal admissions. NICEguidance discourages inpatient admission for individuals with EUPD except in exceptional circumstances, yet this continues in practice.
The Care Quality Commission (CQC) has repeatedly raised concerns about inpatient ward environments and their impact on recovery, safety and independence. I also believe acute wards are chaotic environments caring for people with widely differing clinical needs, working backgrounds, support needs and levels of risk.
More specialised services and better separation of patient groups could provide calmer, more therapeutic environments, strengthen therapeutic relationships and improve recovery for everyone. While acute admission may occasionally be necessary to stabilise someone in crisis, I believe unnecessarily prolonged admissions often become counterproductive, increasing dependency, institutionalisation and barriers to recovery.
Based on the allostatic load model and cumulative lifespan adversity, I believe adult trauma follows the same disease-producing pathway described by the childhood ACEs framework. Prolonged psychological stress, social isolation and repeated crises can contribute to poorer physical health, reduced independence and increased long-term mortality.
I also believe greater awareness of hyperbolic antidepressant tapering and withdrawal, alongside earlier review of evidence-based medication options, may prevent deterioration and reduce the need for inpatient admission in some patients. Multiple clinicians documented severe insomnia and sensitivity to environmental noise as major contributors to my deterioration.
In my view, these factors should receive greater consideration when deciding whether an acute ward environment is therapeutically appropriate for a particular patient. Prolonged exposure to highly stressful inpatient environments may leave some patients with persistent hyper-vigilance, impaired emotional regulation and difficulties returning to normal daily life.
These effects can continue long after discharge and may undermine recovery. I also believe being removed from work and placed in a chaotic hospital environment, instead of the supportive setting of my workplace and close colleagues and professional relationships that had taken years to build, was severely damaging and not reflective of person-centred care.
I believe prolonged inpatient exposure can significantly reduce quality of life, independence and long-term outcomes. It can affect employment, financial stability and basic wellbeing.
Hospital food is also often inexpensive and heavily processed, contributing to lethargy and providing poor nutritional support for recovery and engagement. As a result, I am currently unable to return to my previous role in the same capacity or sustain full-time employment without significant adjustments.
I had built a successful career in digital marketing and was working towards progression into management. My role depended not only on technical ability but also on strong professional relationships with colleagues, clients and industry contacts that had taken years to develop.
Prolonged removal from the workplace interrupted those relationships, reduced my professional credibility and deprived me of the daily experience, confidence and routine that comes from working in a corporate environment. The loss of daily collaboration with colleagues, clients and wider industry professionals also disrupted relationships and networks that had taken years to establish and maintain, making reintegration into my profession significantly more difficult.
Instead of reinforcing healthy workplace behaviours and professional development, I spent many months adapting to institutional routines that I believe were the opposite of the independent, collaborative and fast-paced environment in which I had previously thrived. I now face long-term unemployment, reduced independence and a significantly damaged professional and personal support network.
I have also lost key aspects of my life outside work. Social activities I once enjoyed—including TRE, breathwork, football, HIIT classes, singing and dancing—have ceased entirely, and skills I previously had feel diminished.
Since these experiences I have become severely socially withdrawn and agoraphobic. I rarely leave my rehabilitation placement and have lost confidence carrying out everyday activities, rebuilding friendships and participating in community life.
I believe prolonged institutionalisation has significantly reduced my independence and quality of life. When I do leave the unit, I continue to experience severe suicidal thoughts, so I have concluded that staying indoors is currently the safer option.
I also believe greater scrutiny is needed over the routine use of PRN medication on acute wards. While appropriate in some circumstances, excessive reliance on sedating medication such as promethazine may reduce patients’ ability to engage with psychological therapies and recovery-focused activities, while increasing the risk of long-term reliance on these medicines after discharge.
I recognise that inpatient psychiatric admission is sometimes essential, particularly where there is an immediate and serious risk to life or where safe assessment and stabilisation cannot be achieved in the community. However, I believe it should remain the least restrictive option and be limited to the shortest clinically necessary period.
In my view, many patients who require admission can be safely assessed, stabilised and have treatment initiated within around 28 days, after which recovery should continue through community-based services, including community wellbeing hubs and peer support groups, wherever clinically appropriate. This would allow people to rebuild their independence while remaining connected to everyday life, employment, family and society.
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What I am asking for
I am calling for:
* Separate service for drug induced mental health conditions its not fair on non substance abusers to share a service and environment with other patients who struggle with addiction -i’m not saying these people don’t deserve help because they do, everyone does but it should be in a separate environment to non users- as this can make the environment unsafe for non-drug users as they are in a vulnerable state and with drug use happening often on the wards vulnerable people (not myself) could have easily got involved which could have worsened their mental state
* There should be more segregation on the wards in regards to risk level/severity of illness
* Reducing typical adult acute wards from around 20–24 bedsto approximately 10–12 beds while maintaining staffing levels—alongside increased investment in community crisis services
* Time-limited informal admissions with regular review.
* Stronger admission criteria for inpatient psychiatric care.
* Enhanced senior clinical review of any psychiatric readmission within the first 30 days following discharge, unless there is clear evidence that immediate inpatient admission is clinically necessary.
* Increased investment in Community Mental Health Teams (CMHT) and Home Treatment Teams.
* Improved discharge planning and community reintegration support.
* Greater recognition of antidepressant withdrawal, hyperbolic tapering principles and evidence-based medication review before considering inpatient admission where clinically appropriate.
* Greater oversight of PRN prescribing on acute wards, particularly promethazine, ensuring sedating medication is used only where clinically necessary and alongside recovery-focused interventions.
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Final call to action
Please sign this petition to support reform of acute psychiatric care so that it prioritises recovery, independence and effective community-based treatment.
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Similar petitions
https://c.org/BCtkxbCtFk
https://www.change.org/Hyperbolictaperingantidepressants
Personal Reflection
If time travel were ever possible, there are five points in my care I would choose to revisit:
* 9 January 2024 – following my breakdown at work, to review my medication before withdrawing from escitalopram.
* 17–21 May 2024 – when my mental health deteriorated again before my therapist’s Crisis Team referral.
* 10 June 2024 – when my therapist requested immediate Crisis Team intervention and psychiatric assessment.
* 12 September 2024 – when my Section 2 ended and, in my view, discharge with Home Based Treatment Team support should have been actively pursued.
* 12–14 October 2024 – when I believe community alternatives should have been explored more fully before prolonged informal readmission.
📋 Sourcing and References
1. The Least Restrictive Principle Mandate: Gov.uk Mental Health Act Code of Practice — Chapter 1 legally binds trusts to use the least restrictive option available and actively support existing family and community housing networks.
2. GMMH Segment 4 Performance Status: CQC Provider Inspection Summary for GMMH — Official documentation confirming GMMH's placement into Segment 4 of the NHS Oversight Framework,
3.Acute Ward Safety & Chaos Evidence: BBC News Assessment of GMMH Acute Wards — Independent CQCfindings confirming acute wards were rated "Inadequate" due to systemic chaos, failures in basic safety protocols, and severe fire safety risks across units.
4.The Harm of Institutional Deskilling: Centre for Mental Health Research Briefings — Documents detailing how over-extended hospital stays actively strip voluntary patients of independent living skills, creating a severe and damaging shock when they are discharged. [1]
5.Home Treatment Team Mandates: NHS England Community Mental Health Guidance — Guidance on the role of community crisis and Home Treatment Teams and the principle of providing care in the least restrictive settingwhere clinically appropriate
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Petition created on 25 June 2026