Managing mental health emergencies
The number of patients with mental health issues seeking help in our A&Es has risen by a third in two years, with proportionately more staying longer in our hospitals.
The full extent of the extra pressure on our hard-pressed emergency departments is disclosed in figures provided in response to a Freedom of Information request.
These show that between them The Royal London, Newham and Whipps Cross hospitals are now caring for an average of 78 mental health patients every day – compared to a daily average of 55 two years ago.
For some time we have been working with local partners to increase the availability of mental health beds and services in the community so patients who need specialist treatment can be promptly discharged from our acute hospitals.
However local mental health trusts are also struggling to find suitable follow-up accommodation for their patients who have completed treatment.
The North East London health and care partnership has set up a crisis improvement network to ensure people who need urgent mental health support get the right care in the right place at the right time.
Measures include providing 12 extra mental health beds, drop-in services at local crisis cafes, and professional support for NHS 111 call handlers, ambulance crews and hospital staff.
Another option being canvassed for Whipps Cross hospital would be creating a discrete mental health holding space away from ED, if resources allow.
The FOI request asked us for numbers attending A&E each month with mental health complaints like anxiety or depression, and how long they stayed. The numbers fluctuate but rose from 1,7054 in January 2022 to 2,412 in March this year.
Two years ago 84% of these patients were discharged within 12 hours of arrival, but now it is 75%. The vast majority were adults, although the proportion of under-18s actually fell from 12% to 7% over the period.
The FOI showed a five-fold increase in the numbers spending more than 24 hours in ED. At the beginning of 2022 it was rare that any mental health patient spent more than three days in hospital: by the end of that year stays of four days were not uncommon. In March this year we had ten patients staying longer than five days.
Natalie Acheson, Group Director of Urgent and Emergency Care, said:
“The average length of stay for mental health patients in our EDs has doubled in the last year to about 21 hours, though the figures cover time spent in services like Same Day Emergency Care and clinical decision units too.”
Over the survey period the proportions of mental health patients admitted to a ward or discharged to another hospital remained constant at 12% and 2% respectively.
People with mental health issues visit A&E because they are in crisis or because they are injured, or both. Once we have treated their physical health we work with community services to find specialist help for their mental health needs.
Our emergency departments have designated spaces where we can look after them safely and appropriately, but these are not designed for long stays. We track the progress of our mental health patients every day and the average wait in A&E is currently 21 hours.