Relocating from out-of-area treatments: service users' perspective



    Corresponding author
    1. Clinical Nursing Research Fellow and Out of Area Reviewing Officer, Camden and Islington NHS Foundation Trust (CINHSFT), Accommodation Team, Islington Rehabilitation and Recovery Services, London, UK
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D. D. Rambarran, Accommodation Team, Islington Rehabilitation and Recovery Services, 11 Southwood Smith Street, London N1 0YL, UK, E-mail:


Accessible summary

  • In the UK, there are growing concerns about the impact of ‘out-of-area treatments’ (OATs) on mental health service users, both clinically and financially. In addition to being costly to the National Health Service (NHS) and local social care authorities, service users placed out of area have been socially dislocated and in some cases over supported.

  • Prompted by these concerns, a project was set up in one inner London Borough, to review and where appropriate repatriate mental health service users they had placed outside the local area. This study explored the experiences and impact of these relocations from service users' perspectives.

  • Increased autonomy was the most commonly reported positive outcome, which was welcomed by all; however, many service users also reported feeling lonely in their new local placements. Five out of seven were pleased with their increased contact with family and most concluded that generally, relocation enhanced their quality of life.

  • A number of NHS Trusts are considering the implementation of similar approaches to review their ‘OATs’ clients; hence the favourable outcomes reported here and elsewhere are likely to encourage this. However, it is essential that these be considered alongside the support required for service users to reconnect positively with their families, in addition to adjusting to more independent living.


Asylum closures over recent decades resulted in mental health services being increasingly sited in the community. However, under provision of highly supported accommodation led to service users being placed away from their local area in ‘out-of-area treatments’ (OATs). OATs have raised major concerns in relation to enabling service users' recovery, owing to limitations in promoting autonomy, social dislocation and costs. In 2004, an OATs project was set up in a London Borough to address these concerns. In the first 4 years, the project succeeded in relocating 22 service users to less restrictive environments locally. This study aims to explore the outcome of relocation from service users' perspective. A qualitative methodology was utilized. Semi-structured interviews were carried out with seven service users who relocated. All seven service users shared a strong aspiration for independent living but there was associated loneliness. Five welcomed increased contact with family and friends, but lacked social confidence, inhibiting social inclusion. Service users with long-term and consistent care managers were more able to address fears. Five out of seven service users concluded that relocation increased their autonomy thus enhanced their quality of life.