15.05.26
The Chair of RCEM’s Mental Health Sub Committee, Mark Buchanan, explains what patients are facing when they arrive at Emergency Departments in mental health crisis and what the College has been advocating for to ensure conditions improve for not only patients, but for the workforce.
The Royal College of Emergency Medicine has repeatedly highlighted the growing crisis of patients who are experiencing mental health emergencies facing prolonged delays in emergency departments while they await appropriate inpatient mental health beds. Across the UK, emergency departments are increasingly being used as places of safety for patients in acute psychological distress, often for many hours, or even days. These delays reflect wider pressures on mental health services, including insufficient inpatient capacity, workforce shortages and limited access to community support services.
Prolonged stays in the emergency department can have significant consequences for patients struggling with their mental health. The emergency department environment is often busy, noisy, overstimulating and poorly suited to therapeutic mental health care.
In this environment, feelings of anxiety, distress, agitation and vulnerability can be easily exacerbated. Delays in accessing specialist psychiatric assessment and definitive treatment may also increase the risk of deterioration, self-harm, absconding, or repeated crisis presentations. Furthermore, extended boarding in emergency departments can compromise patient dignity, privacy and continuity of care.
The impact of mental health-related admissions extends beyond the individual patient and places substantial pressure on emergency department operations. Patients awaiting mental health beds frequently require enhanced observation, dedicated staffing and secure environments; reducing clinical capacity and contributing to overcrowding, increased waiting times, ambulance handover delays and reduced flow throughout the department, ultimately. affecting the timely delivery of care for all patients attending the emergency department.
RCEM continues to advocate for improved mental health service provision, increased inpatient capacity and better integration between emergency and psychiatric services, to address these ongoing challenges. RCEM also continues to raise significant concerns regarding the growing pressures associated with the management of mental health emergencies within urgent and emergency care settings.
This Q&A recording from RCEM Annual Conference 2026 features Dr Mark Buchanan discussing practical tools and key legal considerations for mental health triage in the Emergency Department. Part of the B11: Mental Health session, it expands on “How to legally keep patients safe in the ED” and highlights real-world challenges faced by clinicians. This video is hosted on RCEM’s On-Demand platform and is available to watch as part of the full conference programme.
In an interim report, the Heath Safety Service Investigation Board (HSSIB) highlighted significant legislative and systemic gaps that create challenges in safely managing patients experiencing mental health crises within emergency departments. The report identified ongoing concerns regarding the availability of appropriate places of safety, inconsistencies in legal frameworks and the difficulties clinicians face when balancing patient autonomy with the need to maintain safety.
Alongside this, GIRFT has published standards for urgent and emergency care relating to mental health emergencies, aiming to improve consistency of care, patient flow and multidisciplinary working across systems. These standards emphasise the importance of integrated pathways, timely specialist assessment and collaborative working between emergency medicine and mental health services. The implementation Right Care Right Person and associated reforms have also generated significant concern within emergency medicine.
RCEM continues to engage nationally regarding the practical impact of these changes on patient and staff safety.
Despite ongoing national advocacy, patients continue to experience lengthy delays awaiting mental health beds and definitive onward care. During these periods, emergency departments remain responsible for delivering safe, compassionate and effective care to patients in crisis. It is essential that emergency medicine teams work collaboratively with mental health colleagues to provide empathetic support, ongoing risk assessment, therapeutic engagement and appropriate escalation where required. Shared ownership of care during prolonged emergency department stays is vital to ensuring patient safety and preserving dignity throughout the patient journey.
Read RCEM’s Advisory Statement on the Care for Patients in the Emergency Department Awaiting a Mental Health Bed and the College’s Mental Health Tool Kit.