The number of patients waiting more than 12 hours is more than twice as high as before the pandemic
“The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place." Katherine Henderson, president, Royal College of Emergency Medicine
Some mental health patients who arrive at A&E in crisis are having to wait days for an inpatient bed, according to new research from HSJ.
The research suggests that A&E waits of more than 12 hours have increased dramatically in 2022, and are now two-and-a-half times as high as pre-Covid levels.
HSJ sent freedom of information requests to a selection of acute hospitals in England, in a range of regions and trust sizes, and received full responses from 13.
These trusts between them recorded approximately 600 cases of mental health patients waiting over 12 hours in A&E during the first few months of 2022. If they continue on the same trajectory, that will reach nearly 1,800 cases by the end of the year. All but two of the trusts recorded significant increases.
The same organisations recorded fewer than 700 such waits in total in the whole of 2019. The numbers dropped during 2020, when demand sunk across nearly all services as a result of the pandemic, before increasing to roughly 900 in 2021.
Projected nationally, the findings suggest there may be about 20,000 long delays in England through the year.
The trusts also reported repeated examples of mental health patients waiting up to three days in A&E for a mental health inpatient bed to become available, something the charity Rethink described as “outrageous.”
Delays typically occur when the patient needs detention under the Mental Health Act or is waiting for a bed to become available outside the acute hospital.
The Royal College of Emergency Medicine president, Katherine Henderson, said that the experience of mental health patients in A&E was “not what it should be from a caring health care system.” She added: “We have massive concern for this patient group. We feel they are getting a really poor deal at the moment.
“The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place.
“Mental health crisis first responder teams work – a mental health practitioner working with the ambulance service can prevent the need for an ED visit.”
Dr Henderson described A&E as the “wrong environment” for mental health patients and said it was not equivalent to physical health patients waiting for days in an A&E cubicle for the right help.
Annabelle Price, chair of the liaison psychiatry faculty at the Royal College of Psychiatrists, said that the long waits were “unacceptable”, adding: “Increased waiting times and the number of people reaching crisis levels reflects how services are struggling to meet demand. Inpatient beds must also be available for those who need to be admitted, which is a particular challenge for children and young people.
“Early intervention can be crucial in preventing mental health difficulties getting to crisis point, so it’s vital that people can access the help they need when they need it.”
This research from HSJ is deeply worrying. People experiencing a mental health crisis should not have to spend 12 hours waiting for a bed. Mental health problems are on the increase, and hospitals do not have enough beds and staff to cope with the demand. Although the NHS long-term plan is committed to improving community health provision, demand is outstripping supply. As Katherine Henderson of RCEM says, investment in community mental health services is urgently needed to support people before they reach crisis stage.