Neglect of community mental health services and lack of suitable hospital beds is fueling A&E waits of up to 80 hours for some mental health patients and leading to a growing crisis with profound effects on patients and the wider NHS.
That’s according to health leaders who are warning that the continued lack of resourcing for mental health has left services overwhelmed and at breaking point just as the NHS attempts to gear up for a very difficult winter.
Health leaders fear that the combined dearth of resource in community mental health services and available inpatient mental health hospital beds is having serious knock-on consequences for patients across the NHS, with other services, including A&E, being sucked into the crisis.
The situation has become so bad that healthcare leaders across the system are urgently calling for a more targeted approach to what is a society wide crisis.
They are alarmed that mental health patients are having to frequently turn up at A&E in crisis because of a lack of alternative and more appropriate options. Once there, thousands of patients are left stranded, often for long periods of time, waiting to be redirected to more suitable care facilities, or to be found supported housing and social care packages. NHS leaders fear that thousands more patients are often being admitted into inappropriate acute hospital beds meant for physically ill patients. This then has further consequences by delaying treatment for patients who need treatment for physical conditions.
One acute trust chief executive in the Southeast of England told the NHS Confederation: “The mental health crisis is having a huge impact on our emergency departments. The impact, most importantly on these patients themselves, but also on flow, waiting times and our staff is overwhelming at times and having a massive impact on our ability to keep all patients and staff safe.
“A lack of investment in care for patients who need mental health support outside of hospital and in the community is now having a direct impact on acute services, and often means we have no other choice but to admit. We urgently need this issue recognising as we move into winter.”
Another acute trust chief operating officer (COO) in the North of England said “We have weekly, often daily, instances where we have mental health patients in our ED awaiting mental health beds. These patients often wait three or more days in our ED.”
Another health leader added: “We had an instance a few weeks ago where we had seven mental health patients in ED. We had to admit patients to our core beds for purely mental health reasons which caused our medical consultants real concern that they, as general acute clinicians were clinically responsible for patients when they were not clinically appropriate."
Matthew Taylor, chief executive of NHS Confederation said: “The current focus on the elective recovery, industrial action and GP access has meant that mental health has slipped down the government’s set of priorities and patients and services are being forgotten. This is a national emergency which is now having serious consequences across the board, not least for those patients in crisis.
"We know that there is increasing demand for mental health support, but with limited supply in the community, this demand is washing up on the shores of wider NHS services and having a knock-on effect on the care of other patients, waiting times and recovery efforts.
“People are coming to A&E and having to wait very long periods of time to either be admitted or found the right package of care for those needs in the community. NHS leaders say that this is now leading to thousands of patients being admitted to acute care beds when this may not be the right clinical setting for them and risks their mental health deteriorating further as a result.
“There is real concern that due to a lack of investment in things like community mental health facilities and supported housing places, there is simply nowhere else for people to be referred on to quickly enough at which point the only viable option is an admission to an acute bed.”
“Health leaders are now calling on the government to make urgent and increased targeted investment in community mental health teams, temporary step-up beds and specialist staff ahead of the very pressured winter months. The reality is that many of the solutions to this problem lie outside of the NHS, not least with the need for more supported housing and social care support.”
Recent data shows that mental health patients are more than twice as likely to wait over 12 hours or more in A&E compared to all other patients, with nearly 1 in 5 waiting for over half a day in June 2023.
This is combined with the impact of waiting times for access to outpatient mental health services, with data showing that delays from initial referral to second mental health appointment for patients has a knock on impact on emergency departments.
However, NHS leaders say that the NHS is increasingly being left out on a limb trying to solve the crisis, with health services now frequently becoming the providers of last resort for those with mental health issues who would be better cared for in supported housing or other settings.
Another COO in the Midlands said: “We routinely experience long waits in ED for assessment, very long waits in ED for beds once assessed (50 hours on a trolley), stressed ED staff managing these complex patients and stressed mental health colleagues trying to place patients and offer good care.”
One acute leader working on the South Coast told us that even though mental health patients often come to A&E this is frequently not the right environment them to be in:
“We often reach a point where the whole system agrees that the acute hospital is not the right place for the patient, but finding a better place is hugely challenging. The impact this has on the patient themselves, the staff caring for them and the other patients in the ward cannot be underestimated. The patient is being physically cared for, but their mental health condition is often not improving, and may be deteriorating in the noisy environment of an acute hospital ward.”
Sean Duggan, chief executive of NHS Confederation’s Mental Health Network said: “It’s clear that the lack of focus and attention to mental health services is resulting in a far-ranging set of problems for the NHS, and while the major conditions strategy promises some positive actions in the longer term it will take years to have any impact and does nothing to address the current crisis.
“Leaders need to see mental health re-prioritised, with investment and action in the short, medium and longer term. A good place to start would be with the implementation of the clinically led review of standards for mental health, which includes A&E related urgent and emergency care mental health targets as well.”
