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Thousands of people in a mental health crisis are enduring waits of up to three days in A&E before they get a bed, with conditions “close to torture” for those in such a distressed state.
At one hospital, some patients have become so upset at the delays in being admitted that they have left and tried to kill themselves nearby, leading nurses and the fire brigade to follow in an attempt to stop them.
A&E staff are so busy dealing with patients seeking help with physical health emergencies that security guards rather than nurses sometimes end up looking after mental health patients.
The findings are included in research by the Royal College of Nursing. Its leader, Prof Nicola Ranger, called the long waits facing those in serious mental ill health, and the difficulties faced by A&E staff seeking to care for them, “a scandal in plain sight”.
Its findings, based on freedom of information requests to NHS trusts in England and evidence from senior nurses, found that at least 5,260 people a year in a mental health crisis wait more than 12 hours for a bed after a decision has been made to admit them – up from barely 1,000 in 2019.
The RCN’s research into “prolonged and degrading” long stays in A&E also disclosed that:
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Some trusts that previously had no long waits for mental health patients now have hundreds.
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The number of people seeking help at A&E for mental health emergencies is rising steadily and reached 216,182 last year.
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The recruitment of mental health nurses has lagged far behind the rise in demand.
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The number of beds in mental health units has fallen by 3,699 since 2014.
Rachelle McCarthy, a senior charge nurse at Nottingham university hospitals NHS trust, said: “It is not uncommon for patients with severe mental ill health to wait three days. Many become distressed and I totally understand why. I think if I was sat in an A&E department for three days waiting for a bed I would be distressed too.”
The director of nursing at a London trust said the “brightly lit, noisy” environment in her A&E was “close to torture” for those in mental distress and that patients often got so frustrated that they left.
A senior nurse in the south-west of England said: “Lots of people will just come and wait and be patient. But as you can imagine, some of them are in severe crisis. They want to leave. They want to self-harm. They are massively distressed and struggling.”
In 2019 Manchester Royal Infirmary had no 12-hour waits before finding a bed for a mental health patient after a decision had been made to admit them. But last year 463 experienced such a delay, the RCN found.
Alexa Knight, the director of England at the Mental Health Foundation thinktank, said the findings showed that too few people with mental ill health were receiving help soon enough after they started struggling. She said the NHS needed to ramp up provision of community-based early intervention services, to reduce the risk of people ending up in such crisis that they went to A&E.
Ranger urged ministers to ensure “urgent and sustained investment in community mental health nursing [to] ensure everybody gets timely care in the right place”.
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The NHS statistics obtained by the RCN seriously underestimate the extent of waits longer than 12 hours and also the number of people seeking help at A&E for a mental health emergency. That is because only 26% and 52% of the 145 NHS trusts from which they sought information provided figures on those two issues.
Minesh Patel, the associate director of policy and campaigns at the mental health charity Mind said: “Long wait times in A&E can be difficult for everyone. But for the people attending A&E in mental health crisis – and more than 700 do every day – the impacts can be significant.
“When people may have attempted suicide, self-harmed, or experienced psychosis, they need timely and urgent help. They are being let down by a system that is overwhelmed and depleted.”
A Department of Health and Social Care spokesperson said: “People with mental health issues are not getting the support or care they deserve, and we know that many NHS staff feel burnt out and demoralised, having been overworked for years.
“That’s why this government is investing an extra £680m in mental health services this year, to help recruit 8,500 more mental health workers, and put mental health support in every school.
“We have also launched one of the world’s first 24/7 mental health crisis support services via NHS 111 and announced a £26m investment in new crisis centres, to ensure patients can get timely support from a trained mental health professional.”
