A report by the Health Services Safety Investigations Body (HSSIB) reveals that accident and emergency (A&E) departments have increasingly become the primary location for individuals experiencing a mental health crisis, primarily due to deficiencies within the urgent and emergency mental health care system.
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The report indicates that A&E facilities are not equipped to meet the specific needs of these patients, resulting in prolonged waits, overcrowded conditions, and insufficient privacy. These factors can significantly increase distress and risks for patients, their families, and healthcare staff.
Staff at A&E departments described mounting pressures, including burnout, compassion fatigue, and moral distress while managing the care of individuals needing specialized mental health support in unsuitable environments. Issues such as delayed admissions to mental health inpatient services, extended stays in A&E, and inadequate post-discharge support often go unrecognized as safety concerns, hindering efforts for systemic improvements.
Nichola Crust, a senior safety investigator at HSSIB, emphasized the vulnerability of individuals arriving at emergency departments in mental health crises, stating that they require timely, compassionate, and coordinated care that respects their dignity and ensures their safety. Crust noted that emergency departments frequently provide care in settings inappropriate for extended mental health treatment, which contributes to elevated levels of distress and complicates understanding and addressing a patient’s evolving risks and needs.
To enhance care for those in mental health crises, the report recommends specific actions, including:
1. The Department of Health and Social Care (DHSC) and NHS England should collaborate with national stakeholders to establish minimum operational service standards and design expectations for emergency departments, aiming to eliminate unwarranted variations in care and better address patients' therapeutic needs.
2. Strengthened support and guidance is necessary to clarify roles, responsibilities, and accountability concerning the Mental Health Act assessment pathways. This includes improving shared care, governance, and processes for identifying and addressing delays related to assessments, bed availability, and subsequent care.
Dorit Braun, chief executive of Making Families Count, expressed support for the recommendations, stating that creating clear standards of care would benefit clinicians, patients, families, and the public at large.