A+E waits over 12 hours for mental health patients increased five-fold at NHS trusts in England, new FOI analysis shows, with the Royal College of Nursing (RCN) calling for “urgent and sustained” investment in mental health nursing.
At the RCN’s annual conference in Liverpool and in Mental Health Awareness Week, frontline nursing staff also speak out about “prolonged and degrading” stays in A+Es which are "close to torture".
The RCN’s FOI investigation revealed that over a million (1.3) people presented to A&E departments in a mental health crisis, with waits of 12 hours or more increasing from 1,090 to 5,260 (a 383% rise).
At some hospitals including Manchester Royal Infirmary, waits of over 12 hours after a decision to admit to a mental health unit surged (0 in 2019 to 463 in 2024). This is equivalent to no patients enduring distressing waits all year, increasing to more than 1 patient every day.
These figures come as RCN analysis shows that the number of mental health nurses per every 10,000 mental health patients in England has nearly halved in the last decade. The nursing union is calling for the government’s forthcoming workforce plan and 10 year health plan to contain “serious” measures to bolster the community mental health workforce.
At the RCN’s annual conference, General Secretary and Chief Executive Professor Nicola Ranger is calling for “urgent and sustained investment in community mental health nursing" to ease the overwhelming pressures on emergency departments.
Ranger’s demand to the government comes as nursing staff report long waits for mental health patients in emergency departments – some up to three days – with patients being cared for by security guards, others attempting suicide, and some leaving before receiving any treatment.
Analysis released today by the RCN, shows overnight beds in mental health units have declined by 17% over the last decade (3,699 fewer beds overall). As a result A+Es are struggling to move on patients to receive appropriate care to meet their complex needs, which can be challenging for overworked emergency staff with limited training in mental health care.
Nicola Ranger will caution that rising waits are having a severe impact on the dignity and wellbeing of mental health patients, as well as the nurses faced with the impossible task of delivering care in inappropriate, loud and busy spaces.
Nursing staff in A+E departments report being “excessively burned out” by the demands placed on them and “devastated” they can’t provide better care. They are unable to deal with the scale of the pressures and are urging governments to build the necessary capacity within the community by boosting mental health posts.
According to one senior charge nurse at Nottingham University Hospital, Rachelle McCarthy, “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.”
One director of nursing in London described the “brightly lit, noisy” conditions in her A+E as “close to torture” for mental health patients and said that acute patients will frequently just leave because they’re having to wait so long.
A senior nurse from the South West of England said the level of demand from mental health patients in her hospital had “definitely accelerated to a massive extent”.
“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. They take themselves up to our multi story car park and a whole team of senior nurses and security and the fire service are brought to a halt because they're up there attempting to jump.”
In one London hospital a senior nurse described an incident where a mental health patient who'd been waiting for a mental health bed for three days became “incredibly aggressive, smashed a glass window, threatened staff and threw his own laptop across the room”. Once the situation was de-escalated, he said: “I shouldn’t be treated like this.”
“Everybody knows he is completely correct,” the nurse said.
The brother of one mental health patient who received treatment at an emergency department in the South East described his shock at finding out that his sibling had been monitored for 24 hours by a security guard rather than a health professional. “My brother needed care from a mental health professional, not to be guarded like he was a threat,” he said.
Alexa Knight, Director of England at the Mental Health Foundation, said: “The frequency of people attending A&E experiencing a mental health crisis clearly shows that not enough people are receiving mental health support at the best time – early in their journey.
"By putting in place preventative and community-based early interventions, which evidence shows are cheaper and work more effectively than treating people at crisis point, the UK government could reduce pressure on the NHS, free up the time of nurses and doctors, and help everyone have better mental health. Charities, voluntary sector organisations, and mental health nurses in the community are best placed to support the delivery of these interventions – but they desperately need the funding to do so.”
RCN General Secretary and Chief Executive Professor Nicola Ranger said:
“Severely ill mental health patients waiting days for treatment in stressful and brightly lit A+Es is a scandal in plain sight. These conditions are not “the norm” and nursing staff will not accept them.
“If parity of esteem between mental and physical health is to mean anything, then these utterly degrading waits must end.
“Nothing less than urgent and sustained investment in community mental health nursing can ensure everybody gets timely care in the right place. That is how you turn people’s lives around and ease pressure on emergency departments.”
ENDS
Notes to editors
The RCN sent FOI requests to all UK NHS employers with emergency departments asking for:
The total number of mental health presentations at each trust/health board/board’s largest A&E department each year between and including 2019 and 2024 (response rate: 52%) [There is one anomaly with University Hospitals Dorset providing data for both emergency departments within the trust]
How many of the patients identified in a) waited for more than 12 hours for a bed in a mental health unit after a decision to admit? (response rate: 26%)
[a] The total number of mental health presentations at emergency departments across England was 1.26m (of the trusts who responded). England’s attendance has risen by 2% since 2019.
[b] The average rise in 12h+ waits across all English trusts that responded was 383%
Mental health demand
Over the last 10 years, registered demand in England for secondary mental health services has grown 106% from 1.8m to 3.8m contacts and referrals between 2014/15 and 2023/24.
Yet the MH nursing workforce has not kept pace, meaning fewer nurses per patient. Over the same period the number of registered MH nurses in the NHS in England has only grown 12% (from a monthly average of 36,758 to 41,100). While the number of community MH nurses has grown by 39% (from a monthly average of 14,994 to 20,829), this lags far behind the 106% rise in demand.
In fact, because of the rising demand for services, what was 200 MH nurses serving every 10,000 MH patients in 2014/15 has nearly halved to only 108 MH nurses per 10,000 MH patients by 2023/24.
Community MH nursing
Community mental health nurses care for patients out of hospital settings in anywhere from outpatient clinics to general practice. They typically have a caseload of patients who they visit at home and their work is vital in assessing and managing patients’ conditions. Their care enables patients to live their lives in their communities and reduces the likelihood of a patient needing to be admitted into a mental health unit or attending an emergency department.
