Adults and even children with pressing mental health concerns are waiting for days in England’s A&E departments before they receive appropriate care, The Lead can reveal.
Although most are admitted, transferred, discharged or leave within 12 hours, freedom of information requests disclose some patients are waiting far longer.
Of 66 acute trusts that responded to our request, more than half (40) reported patients having waited longer than 96 hours in A&E between January 2022 and March this year. Patients waited up to 96 hours at 10 further trusts, up to 72 hours at nine and up to 48 hours at nine more.
Just four of the trusts reported a maximum waiting time of 24 hours or less.
“These are people at their most vulnerable, forced to wait days while in states of fear or confusion, in environments that will make their symptoms worse,” a senior NHS source told The Lead. “Hospital staff do their best to look after these people, despite not having the specialist training or resources to do so. They can often end up victims of violence and aggression themselves.”
Longest individual waits in A&Es in hours between Jan 2022 and March 2024, according to FOI data:
- East Sussex Healthcare Trust — 376
- Milton Keynes University Hospital NHS Foundation Trust — 364
- Ashford and St Peter's Hospitals NHS Foundation Trust — 316
- East and North Hertfordshire NHS Trust — 276
- Mid and South Essex NHS Foundation Trust — 248
- Lewisham and Greenwich NHS Trust — 242
- Northampton General Hospital NHS Trust — 227
- University Hospitals Dorset NHS Foundation Trust — 198
- King's College Hospital NHS Foundation Trust — 190
- East Lancashire Hospitals NHS Trust —183
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Although multi-day waits are the exception, some trusts’ average waits are far in excess of targets. At Barts in London, the average wait for mental health patients in A&E was 21 hours this June. At Barking, Havering and Redbridge University Hospitals Trust in Romford, it was 24.
Extremely long waits are occurring across the country, according to Lord Ara Darzi, who last week published a damning investigation into the state of the NHS. A&E waits for people with “a mental health flag” hit nearly 30 hours in May, the report states.
“One patient with complex mental health needs spent more than 18 days in an A&E department in August,” he wrote. “In 2023-24, more than 80,000 people with mental health crises waited more than 12 hours, and more than 26,000 waited for more than 24 hours in A&E departments.”
In fact, 2023 was the worst year since records began for long mental health waits in A&E, according to the Royal College of Emergency Medicine, with some 20.6% of patients attending with a primary mental health diagnosis waiting 12 hours or more.
Children wait for days in ‘last resort’ emergency rooms
In some cases, children are spending upwards of 96 hours in emergency departments. Barking, Havering and Redbridge University Hospitals Trust has seen some children wait in A&E for more than four days over the period of The Lead’s FOI. At Stockport NHS Foundation Trust, one child waited a week.
The situation is far from improving, with news of shockingly long A&E child waits continuing to emerge. Last week, the Health Service Journal revealed one child spent 44 days at Barking, Havering and Redbridge University Hospitals Trust as they waited for a care placement to open up.
The NHS source explained patients were turning to A&Es as “a last resort” because there simply “isn’t enough investment in beds — and most importantly — the staff to make sure they can access inpatient services when they need them”.
Community teams and home treatment teams were also “stretched too thin,” meaning people “don’t receive the care they need”.
‘Completely inappropriate places’ for people in crisis
Some A&Es have space set aside for mental health patients, who may attend with a combination of mental and physical issues, or in a mental health crisis.
Trusts told The Lead they had dedicated cubicles, beds and rooms to house mental health patients attending emergency departments. But, as a spokesperson for Barts Health NHS trust, which has designated mental health spaces in its A&E, said: “these are not designed for long stays”.
As Lord Darzi wrote: “Bright, busy and noisy A&E departments are completely inappropriate places for someone in mental distress.”
‘No space’ in dedicated crisis units
In many cases, acute trusts without their own mental health services are hosting patients as they wait for capacity to open up at mental health trusts. These organisations often have liaison teams in place in emergency departments at partner acute hospitals.
Yet some patients still face prolonged waits for care once they’ve been transferred to such trusts. Mental health providers such as Central and North West London Foundation Trust have set up their own waiting facilities, which are intended to provide a better environment than acute emergency departments.
But a Central and North West London NHS Foundation Trust patient told The Lead she still faced a prolonged wait in a crisis unit, after having already endured a 35-hour A&E wait at a West London acute hospital.
Amanda*, who has used the trusts’ services for more than 20 years, told The Lead the new centre was supposed to cover the period a patient would spend waiting in A&E. “The trouble is, there are no spaces available so you get stuck in A&E anyway,” she said.
In the unit itself, she said she waited for hours in a chair. “I found trying to sleep on this horrible recliner thing awful,” she said. “I have severe arthritis and I was in agony.”
She told The Lead patients could spend days waiting for appropriate care on the unit, despite expecting to stay for 12 hours or less.
Central and North West London NHS Foundation Trust did not confirm the average length of time patients waited for a bed when asked by The Lead, nor how many beds and reclining chairs it had at each of its crisis units.
‘Unacceptable and distressing’
Trusts told The Lead that long waits for mental healthcare were “unacceptable”.
Matthew Trainer, chief executive at Barking, Havering and Redbridge University Hospitals Trust said: “Patients with mental health needs are waiting too long in our hospitals to be transferred to the right services. This is unacceptable and distressing for both patients and our staff, and it’s something we regularly discuss at our Board meetings.”
“We’re working closely with mental health trusts and councils to reduce delays and we’ve adapted our A&Es to provide calmer environments for patients while they’re waiting. Despite these efforts, too many people continue to wait too long in the wrong place.”
A spokesperson from North East London NHS Foundation Trust, which provides mental health services in the area, said that young people can face “particularly long waits” for care as there was a “growing demand for children’s mental health and neurodevelopmental services.”
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“We are also seeing young people with increasingly complex needs, who often require input from different local agencies, such as social care, which take time to resolve.”
The spokesperson said tackling long waits was the trust’s “absolute priority,” adding that it was working to secure “further investment to reduce staff shortfalls.”
An overall lack of mental health beds is a major driver of long waits in A&Es. A spokesperson from Lancashire and South Cumbria Foundation Trust told The Lead that some A&E patients were waiting for mental health inpatient beds to open up, while others also needed care for a physical issue.
The trust has increased its bed provision and used private beds, but there still weren’t enough spaces in the community to care to house patients medically fit to leave hospitals. Long stays within trusts, whether for physical or mental health beds, create bottlenecks and slow down flow within the entire facility.
Lancashire and South Cumbria NHS Foundation Trust chief medical officer Gareth Thomas said the trust reviewed more than 90% of mental health patients within an hour of attendance.
“Unfortunately, sometimes there are delays when patients require an admission for inpatient care,” he added. “These reasons can include the need to treat a physical health condition in combination with a mental health condition. During this time we aim to keep our patients safe, offering care and support from a mental health team.”
Hospitals across the country are challenged by growing demand for mental health services, according to a spokesperson from King’s College Hospital NHS Foundation Trust. “In recent years, we have seen a big increase in the number of patients accessing emergency care for mental health reasons,” the spokesperson told The Lead.
NHS England did not respond to The Lead’s request for comment.
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