A shortage of staff means that people at risk of suicide who call crisis lines are not receiving the help they need
“You’re expected to learn on the job, which is disappointing when you're dealing with people’s lives.” Sophie, former call-handler on a mental health crisis line
One in five calls to NHS mental health crisis helplines are going unanswered, freedom of information (FOI) requests from the BBC have found.
The responses to FOI requests, from 29 of the 47 mental health trusts that have crisis lines, show that at least 418,000 calls went unanswered in 2021-22.
NHS crisis lines receive more than 200,000 calls each month in England. The aim of the lines is to signpost patients to services, and to provide access to urgent mental health support by phone for adults at high risk of suicide. The lines were seen as key to making mental health support more accessible during the pandemic.
In 10 trusts, some people waited more than an hour for their call to be answered.
Some of the lines are staffed by people who are not mental health professionals – of those trusts who answered the BBC’s FOI request, fewer than one in six said that all their crisis line staff were qualified mental health professionals.
Former staff members at three different NHS trusts told the BBC that they were not trained in assessing or supporting patients. One former employee, given the alias Sophie, said: “You’re expected to learn on the job, which is disappointing when you’re dealing with people’s lives.”
Sophie was a call-handler whose role was to assess patient risk and, if the caller was in need of urgent support, pass them on to a responder, usually a qualified mental health nurse. Because of staffing pressures, however, the responders were often busy and suicidal patients were asked to wait for help. “We would then try to call them back within 15 minutes. But it wasn’t always possible,” she said.
She added that call-handlers were told to limit the time spent speaking to callers to meet demand, she said, but this detracted from their ability to provide compassionate care.
In 2022, coroners investigating deaths published two Prevention of Future Deaths reports that highlighted concerns about crisis lines. In one case, the coroner found an individual had called his local NHS crisis line and described himself “as ‘suicidal’, wanting to die… [and] scared that that he might try and take his own life”.
The caller was not recognised by the service to have been in a mental health crisis, the inquest found, and no referral for crisis or urgent support was made. He was found dead the following day. In his report, the coroner found there had been “difficulties in recruitment” of staff, and that call handlers did not always have enough time to effectively assess patient risk.
NHS England said that crisis lines had seen “record demand” and that it had made £7m available to local areas to improve their crisis line service, to “ensure that everyone receives the support they need”.
Earlier this week, the government announced it would spend £150m on improving the NHS’s response to mental health patients in crisis, including providing specialist ambulances and crisis cafes and safe houses.
The finding that as many as one in five calls to mental health crisis helplines are going unanswered is deeply troubling. A helpline that doesn’t have enough staff, or has staff who lack the appropriate training or qualifications, is arguably of less value than no helpline at all. The situation reflects a wider problem of under-staffing in the NHS at a time when the number of people reporting mental health problems is continuing to grow. Evidence suggests that digital mental health apps can help with mild-to-moderate mental illness, and free up resource for dealing with more severe cases, but apps have to be offered in tandem with person-to-person support, rather than as a replacement for it. The government’s announcement this week of £150m to improve crisis services is welcome, but is unlikely to stem the flow of demand to crisis lines.