The NHS is opening a network of mental health A&Es across England to relieve pressure on hospitals and emergency services.
The units will be staffed by specialist doctors and nurses, providing around-the-clock support for patients who are feeling suicidal or experiencing symptoms such as psychosis or mania.
Patients can walk in or be referred by GPs and the police to the units, which are set to be open 24/7 and designed to provide a “calm and welcoming” environment in contrast to the “noise and chaos” of major hospitals
Last year 250,000 people went to A&E due to a mental health crisis, but one in three had to wait more than 12 hours, with existing NHS care described as “inadequate and inappropriate”.
Ten NHS trusts have now launched separate units for mental health emergencies, some on the sites of existing A&Es, which are open to walk-in patients as well as to those referred from GPs and the police.
The scheme is expected to be expanded nationally to dozens of locations as part of the ten-year NHS plan, being published this summer by the Labour government.
Sir Jim Mackey, the chief executive of NHS England, told The Times: “Crowded A&Es are not designed to treat people in mental health crisis. We need to do better, which is why we are pioneering a new model of care where patients get the right support in the right setting.
“As well as relieving pressure on our busy A&Es, mental health crisis assessment centres can speed up access to appropriate care, offering people the help they need much sooner so they can stay out of hospital.”
The new units will help to relieve pressure on overcrowded hospital A&Es, amid an ongoing “corridor care” crisis.
Last year a record 1.7 million patients had to wait at least 12 hours in A&E in England, with delays linked to thousands of avoidable deaths. Mental health patients are twice as likely to experience long waits as other patients, with some waiting up to 18 days to get a bed.
The UK’s public services have struggled to cope with a rise in demand from patients experiencing mental health crises, prompting the Met Police to announce it will no longer go to mental health calls.
Claire Murdoch with Mitsi the miniature pinscher, who greets patients at the crisis assessment centre in Ladbroke Grove
JOSHUA BRATT FOR THE TIMES
Claire Murdoch, the NHS national director for mental health, said: “I would certainly hope to see these mental health A&Es across the country over the next decade.”
The new services provide a “full and holistic assessment” of a patient’s mental health needs, and aim to address the root causes of a crisis. Murdoch said that expanding the model would enable early intervention to help keep people out of hospital, in work, and provide an “economic gain to wider society”.
Inside a mental health A&E: ‘Anyone who walks in gets assessed within ten minutes’
This is not your typical A&E waiting room. For a start, there are two “emotional support dogs” — miniature pinschers called Maxwell and Mitsi — cuddling up to patients. Sunshine is streaming in through the windows and colourful artwork adorns the walls. Fresh fruit, biscuits, tea and coffee are laid out for everyone, and the shelves are stacked full of board games to help people pass the time.
The Mental Health Crisis Assessment Service in Ladbroke Grove, west London, is among the first of the new wave of “mental health A&Es” being rolled out on the NHS. The unit is run by Central and North West London NHS Foundation Trust (CNWL), which serves a third of London’s population. It has been set up specifically to provide a “warm, welcoming and peaceful” environment for people having a mental health crisis, such as those feeling suicidal or manic, or having psychotic thoughts.
Trained staff are available around the clock for those suffering a mental health crisis
JOSHUA BRATT FOR THE TIMES
“Anybody who walks in is seen by a mental health specialist within ten minutes,” said Toti Freysson, the mental health nurse who manages the service. “Normally in A&E they would have to wait for hours, surrounded by the noise and the chaos. Most of the people we see have suicidal thoughts. Here, they can come in and sit with their families. We are able to intervene early and link them up with treatment in the community. It means we can get them home much sooner.”
The unit is staffed around the clock by a team of mental health nurses, doctors and healthcare assistants. The staff see about 300 patients a month. There are three bedrooms, so patients can stay for several nights without having to be formally admitted to hospital or detained under the Mental Health Act. Some get medication such as antipsychotics or sedatives, while nurses also provide immediate coping strategies.
Dr Mehtab Rahman, a consultant psychiatrist at the centre, said: “Often A&E is the most inappropriate place for mental health patients. These are people who might be hearing voices in their head telling them to kill themselves — imagine having to wait four to six hours to be seen.”
Providing quick support means even the most severely ill patients have often stabilised after a night or two and are ready to go home, Rahman said. Had such patients gone to major A&Es, they would have probably been admitted to a mental health ward and “stayed for weeks on end”.
Before anyone leaves, the staff “make sure they have a plan”, said Selena Cox, the deputy head of urgent care. This might involve linking people up with local homelessness, debt or addiction charities, or arranging visits from a home treatment team. Staff aim to address the root cause of what brought people to a crisis point. “We tell people they can come back whenever they want. Sometimes all people need is that safe space and a safe environment.”
Murdoch believes that the earlier the NHS can deal with a mental health crisis, the better
JOSHUA BRATT FOR THE TIMES
As we are shown out of the centre, one young man walks in who has been here before. He breaks into a relieved smile as staff wave and welcome him in.
Mental health A&Es can ‘stop the massive cost of a crisis’
Many patients having a mental health crisis fall through cracks in the current system. “The overwhelming majority don’t want hospital, but do want help,” said Murdoch, a mental health nurse by background who is chief executive of the CNWL trust as well as national NHS director.
“We’ve heard so many times from people and their families, saying ‘I knew I needed help, and I couldn’t get it — or what I got was inadequate. It had to wait until I needed detaining under the Mental Health Act and admitted to hospital against my will’.”.
By offering early specialist intervention in a “calm, relaxing environment”, separate mental health A&Es are designed to stop a crisis spiralling to the point where patients need lengthy stays in hospital.
“It can be their first port of call,” Murdoch said. “The earlier we can catch a crisis, the less damage is done to people’s lives. Often when people get into a full-blown crisis, they might take an overdose and damage their liver. They might really trash a relationship because they’ve become hard to live with. They might lose a job, they might lose a friendship. So by the time they get to crisis, they’ve lost a lot.
Patients can stay at the centre in Ladbroke Grove for a few nights to help them recover
JOSHUA BRATT FOR THE TIMES
“By treating earlier, there is an economic gain to wider society. We can keep people in work, get them back to work sooner, stop some of the other massive costs of a crisis. It’s a no-brainer.”
Preventing hospital admissions will also save the NHS money. “A hospital bed is about £500 a night, every night,” Murdoch said. “Once you’re admitted to hospital, it’s likely that you will be there for several days or weeks. The whole thing is a very expensive intervention. Here, you might stay two or three nights to be assessed, whilst we sort out your very complex needs.”
Crisis centres could also help lift the strain of other emergency services, taking referrals from police. The Metropolitan Police has stopped attending mental health 999 callouts in London, saying this frees up 17,000 hours a month to fight crime.
Government has committed £26 million to new centres
Last year 250,000 patients went to A&E in mental health emergencies. While many — such as those who have overdosed or self-harmed — need hospital, Murdoch believes the majority would be better served by a dedicated mental health A&Es and the NHS “wants to see them across the country”.
More funding would be needed for a larger national network of mental health A&Es
JOSHUA BRATT FOR THE TIMES
The units have been set up by a small number of NHS trusts, with the government committing £26 million to opening new crisis centres. The planned larger national rollout would need extra funding for staff and capital investment to build new facilities.
The Darzi report, commissioned by Labour last year to investigate the state of the NHS, called for a greater proportion of the NHS budget to be spent on mental health. It highlighted that A&E waits for mental health patients had been getting “worse and worse since the pandemic”. Analysis showed that 26,000 people in a mental crisis had to wait more than 24 hours in A&E over a year.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said that to end long A&E waits the government must provide funding to “address the overarching problem, which is a lack of beds”.
He added: “If we had adequately resourced in-patient mental health beds in the system, those who need them could be moved through any A&E quickly and into the right place to receive the most appropriate care.
“A busy A&E department is not a pleasant place for anyone in need of care. But for someone experiencing a mental health crisis, being exposed to the noise, constant activity and bright lights can be even more distressing and prolong recovery.”
Mitsi and Maxwell, the emotional support miniature pinchers at the unit in Ladbroke Grove
JOSHUA BRATT FOR THE TIMES
Andy Bell, chief executive of the Centre for Mental Health charity, said that new mental health A&Es must be backed by “robust research” to ensure they were safe. “One of the real concerns is that many also need urgent physical healthcare,” he said. “It is not always possible to separate out what’s a mental health crisis from what’s a physical health crisis.”
Baroness Merron, minister for mental health, said: “Too often, people experiencing mental health crisis are not getting the support or care they deserve, and so it is vital that we continue to provide a range of services like this one.
“Backed by an extra £680 million in government funding this year, we are transforming mental health services — investing £26 million in new mental health crisis centres, hiring more staff, delivering more talking therapies, and getting waiting lists down through our plan for change.”