'Harrowing' A&E experiences for mental health patients

Thousands of people with acute mental health needs are being let down in accident and emergency departments because of prolonged waits, lack of privacy and delayed statutory assessments, according to a new report by the Health Services Safety Investigations Body (HSSIB)
The report, titled ‘Mental health crisis care: care of patients in Emergency Departments’ revealed that patients experiencing mental health crises are twice as likely to wait over 12 hours in emergency departments (EDs) compared to other patients.

Children and young people could experience prolonged waits in EDs or paediatric settings while assessments continued, when responsibility for care was unresolved, or while suitable onward provision was sought.

Dedicated mental health spaces varied in availability, design and suitability, and there were no nationally defined service standards or built environment standards. Some mental health assessment rooms did not meet Royal College of Psychiatrists’ Psychiatric Liaison Accreditation Network standards.

In response to the report, Dr Ian Higginson, President of the Royal College of Emergency Medicine, said: “People experiencing a mental health crisis deserve appropriate, therapeutic and timely care.

“This report is yet further evidence that this is, frequently, not the case – and it is putting lives at risk. For many patients experiencing an acute mental health episode, Emergency Departments (EDs) are not a positive environment which facilitates recovery.

“They are often loud, overcrowded, overstimulating places with little privacy for patients. Further, as HSSIB points out, EDs are not always equipped – or staffed – to prevent people in mental health crisis from absconding and potentially harming themselves further. That is just not right.

“Unfortunately, the harrowing stories in the report do not come as a surprise. All too often, mental health patients are put at risk of harm during or after a stay in an ED.

“That weighs heavily on us; as clinicians, we want to see our patients receiving the best possible care for their condition.

“What we need, and what patients need, is a better choice of setting in which to treat people in crisis. While, for some, the ED is the right place to come at least at first – it cannot be the default for everyone, for all the reasons laid out in this report.

“Patients experiencing mental health crisis should not be languishing in an ED for days on end waiting for a bed. It is unfair and dangerous. For those who do experience long waits, we need joint ownership between specialties to ensure the right care is being delivered by the right people.

“We look forward to working with partners, including other royal colleges, to improve care for these vulnerable patients who are being let down can be improved.”