Mental health patients deserve much more from Accident and Emergency departments

Over the last few years patients have become accustomed to long waits in A&E amid rising fears for patient safety.

In February 2023 the Kings Fund reported that A&E performance continues to decline and that waits for emergency admissions have increased to record levels, yet resources to treat A&E patients have not kept pace with demand.

Factors such as the time of day, day of the week and whether it is a public holiday or not will often have a significant impact on how long a patient is waiting to be seen in A&E.

The waiting times for mental health patients in A&E are of particular concern. Labour has obtained data from a Freedom of Information request that indicates that patients suffering from mental health issues were left waiting more than 5.4 million hours in A&E last year.

Shadow mental health minister Dr Rosena Allin-Khan has said:

“Waiting lists are soaring and patients are being left to languish in emergency departments, instead of receiving appropriate mental health treatment.”

Patients can be left waiting for many hours to see a member of the mental health liaison team and they may already have experienced a long wait before being triaged.

For someone who is experiencing a mental health crisis, the wait can be excruciating and worsen their mental health condition. This can sadly lead to devastating consequences. I have had cases involving patients who have left A&E while waiting to be seen and immediately attempted suicide, resulting in their death or serious, life-changing injuries.

I have had cases involving patients who absconded from A&E and immediately attempted suicide which resulted in their death or their sustaining serious, life-changing injuries.

I have seen mental health patients abscond from A&E before receiving the care they so desperately need for a number of reasons including:

• Inadequate prioritisation of mental health patients on the basis of their presenting complaint, meaning that patients with physical (but less urgent) needs were seen before them.
• Inadequate handover between emergency services and A&E staff meaning that key information as to the patient’s condition was not relayed. If key information had been communicated and been given appropriate consideration, it would have made a difference to the prioritisation of the patient.
• The failure of A&E staff and clinicians to recognise obvious signs of distress in mental health patients’ presentation while they were waiting and escalate accordingly.
• Inadequate assessment of patients’ risk of suicide and absconding.

In addition to mental health patients absconding from A&E, I also have experience in cases relating to the care they received by the mental health liaison team in the emergency department. I have had cases in which mental health patients were discharged due to an inadequate assessment of risk of harm/suicide.

I also have a case in which a factor, as to whether to discharge a mental health patient or not, appears to have been a lack of available beds. Shortage of beds is a real issue and it needs to be addressed urgently.

It is imperative that mental health patients are given the care they require and that clinicians aren’t put in the position where they feel they have to discharge patients who they may otherwise not, due to a shortage of beds.

In addition to funding for more beds and more staff, funds should also be spent on improving the facilities for mental health patients in A&E departments. Mental health patients are frequently left (for long periods of time) in dingy rooms which are dehumanising and as such often add to the distress that they are already experiencing. In my view, investing in A&E facilities is not only hugely important to ensure that patients are treated with dignity but also from a patient safety perspective.

I believe that there must also be a real focus on improving the training of clinicians and other staff in the A&E department to recognise signs of distress and know when they should be escalating concerns, to ensure that patients experiencing mental health issues are cared for and treated appropriately.