Off-rolling has recently become a buzzword in the world of education. It refers to the removal, by various means, of students from schools’ records who are deemed too complicated or who don’t make the statistics look good. However, it’s not just education. Off-rolling is common in mental health services and disproportionally affects those most vulnerable and marginalised.

Off-rolling takes three main forms. The first is prematurely discharging patients from secondary mental health services such as community mental health teams. Traditionally, one could expect better care if one had moderate to severe mental health difficulties, as opposed to mild problems, as funding was based on clinical need. However the relentless obsession with targets and outcome privileges services that give good optics.

Patients can find their behaviour framed as attention-seeking or manipulative, based more on discrimination than fact

So services for people with mild to moderate problems will always perform better by these kind of metrics of success, as the milder the mental health problems, the quicker and cheaper the treatment, allowing vast numbers to be seen. In this context, secondary services are under huge pressure to produce similar improvements despite devastating cuts in funding. To manage these expectations, secondary care has re-oriented to a new value – that of recovery, which, as the pioneering mental health survivor-led campaigning group Recovery in the Bin demonstrate, has become decoupled from its founding principles to discriminate against people who remain disturbed or unwell.

Originally, recovery was an idea arising from the psychiatric survivor movement to trouble the notion that experiences such as hearing voices were essentially pathological, and would necessarily lead to squashed lives consisting only of hospitalisations and despair. However, while there are excellent examples of recovery-oriented services in the NHS, recovery principles are used increasingly to justify discharging patients who clinicians, themselves under huge pressure, know are not functioning well in the community or would never be able to.

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Discharge is now common if patients are ambivalent about the care options available or struggle to attend appointments, though this is often as a result of the very mental health problems these services are designed to treat. “Failing” to show an improvement after treatment is also seen as a legitimate reason for discharge even when evidence-based alternatives have not been offered; keeping someone relatively stable through ongoing support has been downgraded, foreclosing the reality of long-term need and the catastrophic decline that can occur when this is removed.

Patients with serious mental health problems are discharged in a way that was unthinkable five, let alone 15 years ago, sometimes without warning. Carers, activists, police and GPs are often left desperately trying to link the person back into mental health services. Sometimes this will succeed, though often via a traumatic experience such as being sectioned. For others, it is too late.

The second form of off-rolling is labelling people as having a personality disorder, most often borderline personality disorder. This diagnosis tends to be given to patients who are seen as challenging in some way, for example by repeatedly seeking help at Accident & Emergency or becoming angry when feeling let down by staff members. These kind of reactions are nearly always very sensible responses to a lack of decent care and containment either from the NHS and/or from early caregivers and society at large. Yet the reaction this label elicits is often not compassion or reflection but exclusion on the grounds that crisis care, inpatient care and so on are not good for the patient in some way. Instead, patients can suddenly find their behaviour framed as attention-seeking or manipulative, an idea based more on discrimination than fact.

The third most common form of off-rolling is sending patients with complex needs to out-of-area beds often provided by for-profit providers. There are huge problems with this: the least of which is the excessive cost to the public purse. For not only is the distance from home, often for months or years, a risk factor for death by suicide but these out-of-sight-out-of-mind patients are sometimes subject to draconian levels of seclusion, physical restraint and ward restriction.

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At present, there are no national figures available on discharge from community mental health services – when it happens and why; whether adequate support in the community is on offer; whether discharge from mainstream services to the waiting lists of specialist services is based on a real prospect of care in the near future, or leaves vulnerable patients with nothing, and so on. There is, however, clear evidence that poor discharge practices come up again and again in coroner’s reports.

The concept of off-rolling may help draw attention to a growing crisis. Yet statistics are not the only answer. So, too, is a change to the ideological frameworks that enable off-rolling. So, too, is decent funding for services for people with complex mental health needs, people whom we have often already overwhelmingly let down and who now face the madness of a society that frames itself as ever more mental-health friendly while neglecting those most in need.

• Dr Jay Watts is a clinical psychologist, psychotherapist and senior lecturer

• In the UK, Samaritans can be contacted on 116 123 or email jo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.