Mental health cases at A&E reach crisis level as waits get longer and specialised beds dwindle

“We’ve got two,” explains Emer Szczygiel, emergency department head of nursing at King George Hospital, as she walks inside a pastel coloured room. 

“If I had my time back again, we would probably have four, five, or six because these have helped us so much in the department with the really difficult patients.”

On one wall, there’s floral wallpaper. It is scored through with a graffiti scrawl. The words must have been scratched out with fingernails.

There are no other implements in here.

Patients being held in this secure room would have been searched to make sure they are not carrying anything they can use to harm themselves – or others.

There is a plastic bed secured to the wall. No bedding though, as this room is “ligature light”, meaning nothing in here could be used for self harm.

On the ceiling, there is CCTV that feeds into a control room on another part of the Ilford hospital’s sprawling grounds.

“So this is one of two rooms that when we were undergoing our works, we recognised, about three years ago, mental health was causing us more of an issue, so we’ve had two rooms purpose built,” Emer says.

“They’re as compliant as we can get them with a mental health room – they’re ligature light, as opposed to ligature free. They’re under 24-hour CCTV surveillance.”

There are two doors, both heavily reinforced. One can be used by staff to make an emergency escape if they are under any threat.

What is unusual about these rooms is that they are built right inside a busy accident and emergency department.

The doors are just feet away from a nurse’s station, where medical staff are trying to deal with acute ED (emergency department) attendances.

The number of mental health patients in a crisis attending A&E has reached crisis levels.

Some will be experiencing psychotic episodes and are potentially violent, presenting a threat to themselves, other patients, clinical staff and security teams deployed to de-escalate the situation.

Like physically-ill patients, they require the most urgent care but are now facing some of the longest waits on record.

On a fairly quiet Wednesday morning, the ED team is already managing five mental health patients.

One, a diminutive South Asian woman, is screaming hysterically.

She is clearly very agitated and becoming more distressed by the minute. Despite her size, she is surrounded by at least five security guards.

She has been here for 12 hours and wants to leave, but can’t as she’s being held under the Mental Capacity Act.

Her frustration boils over as she pushes against the chests of the security guards who encircle her.

“We see about 150 to 200 patients a day through this emergency department, but we’re getting on average about 15 to 20 mental health presentations to the department,” Emer explains.

“Some of these patients can be really difficult to manage and really complex.”

“If a patient’s in crisis and wants to harm themselves, there’s lots of things in this area that you can harm yourself with,” the nurse adds.

“It’s trying to balance that risk and make sure every emergency department in the country is deemed a place of safety. But there is a lot of risk that comes with emergency departments, because they’re not purposeful for mental health patients.”

In a small side room, Ajay Kumar and his wife are waiting patiently by their son’s bedside.

He’s experienced psychotic episodes since starting university in 2018 and his father says he can become unpredictable and violent.

Ajay says his son “is under a section three order – that means six months in hospital”.

“They sectioned him,” he tells us.

“He should be secure now, he shouldn’t go out in public. Last night he ran away [from hospital] and walked all the way home. It took him four and a half hours to come home.

“I mean, he got three and a half hours away. Even though he’s totally mental, he still finds his way home and he was so tired and the police were looking for him.”

Now they are all back in hospital and could be waiting “for days”, Ajay says.

“I don’t know how many. They’re not telling us anything.”

Matthew Trainer, chief executive of Barking, Havering and Redbridge University Hospitals NHS Trust, is at pains to stress nobody is blaming the patients.

“We’ve seen, particularly over the last few years, a real increase in the number of people in mental health crisis coming into A&E for support,” he says.

“And I don’t know if this is because of the pandemic or wider economic pressures, but what we’re seeing every day is more and more people coming here as their first port of call.”

The hospital boss adds: “If you get someone who’s really distressed, someone who is perhaps experiencing psychosis etc, I’m seeing increasing numbers of complaints from other patients and their families about the environment they’ve had to wait in.

“And they’re not blaming the mental health patients for being here.

“But what they’re saying is being in a really busy accident & emergency with ambulances, with somebody highly distressed, and you’re sat there with an elderly relative or a sick child or whatever – it’s hard for everyone.

“There’s no blame in this. It’s something we’ve got to work together to try to fix.”

New Freedom of Information data gathered by the Royal College of Nursing shows that over the last five years, more than 1.3 million people in a mental health crisis presented to A&E departments.

That’s expected to be a significant underestimate however, as only around a quarter of English trusts handed over data.

For these patients, waits of 12 hours or more for a mental health bed have increased by more than 380%.

Over the last decade, the number of overnight beds in mental health units declined by almost 3,700. That’s around 17%.

The Department for Health and Social Care told Sky News: “We know people with mental health issues are not always getting the support or care they deserve and incidents like this are unacceptable.

“We are transforming mental health services – including investing £26m to support people in mental health crisis, hiring more staff, delivering more talking therapies, and getting waiting lists down through our Plan for Change.”

Claire Murdoch, NHS England’s national mental health director, also told Sky News: “While we know there is much more to do to deal with record demand including on waits, if a patient is deemed to need support in A&E, almost all emergency departments now have a psychiatric liaison team available 24/7 so people can get specialist mental health support alongside physical treatment.

“The NHS is working with local authorities to ensure that mental health patients are given support to leave hospital as soon as they are ready, so that space can be freed up across hospitals including A&Es.”

Patients in a mental health crisis and attending hospital are stuck between two failing systems.

A shortage of specialist beds means they are left untreated in a hospital not designed to help them.

And they are failed by a social care network overwhelmed by demand and unable to provide the early intervention care needed.