22 April 2025
A new report from the Royal College of Emergency Medicine reveals patients who are suicidal or who have self-harmed spent on average nearly 11 hours in A&E last year.
Some of the most vulnerable patients – those presenting in mental health crisis– are enduring increasingly longer waits in Emergency Departments.
That’s according to the findings of a study being carried out by the Royal College of Emergency Medicine which that, despite the standard of care patients received improving, reveals the average time a person in mental health crisis spent in A&E last year (2024) was almost 11 hours – an hour more than in 2023.
RCEM’s new report – Mental Health (Self-Harm) 2023-24 – published today (22 April 2025) is part of the College’s Clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments.
The three-year QIP focuses on the level of care these patients are receiving in the A&E from the moment they arrive through the doors of the department and how their experience and quality of care can be improved. Today’s report reflects the findings of the second year of the programme.
Across the UK, 146 Emergency Departments collated and analysed data, capturing the experiences of almost 20,000 (19,819) patients who needed urgent care due to self-harm.
Of these patients, 81.8% (16,202) had a mental health triage when they arrived in the ED to gauge their risk of self-harm and/or leaving the department before an assessment or treatment is complete.
The outcome of this was then used to determine where the patient should be placed in the ED, and the level of observation they needed to keep them safe.
While that’s an increase of 7% compared to 2023, RCEM recommends EDs aim to provide this initial assessment to all (100%) of eligible patients.
Meanwhile, an average of 42.8% of patients considered to be medium or high-risk received an appropriate level of observation during their stay in ED – a significant improvement compared to year one’s mean of 29.1%.
Despite an 8% rise in documented cases of patients receiving compassionate care, 62% lacked evidence of getting this vital level of support while in A&E.
In response to these findings, the QIP team made a series of recommendations for individual departments, aiming to enhance assessments, as well as compassionate and practical care.
Responding to the report, RCEM President Elect, Dr Ian Higginson, who leads on Clinical Quality for the College said: “The College’s Quality Improvement Programmes are vital pieces of work which put raising the standard of care our patients receive at their very heart and I thank all the departments who have signed up and have contributed to this important piece of work.
“People in mental health crisis are among the most vulnerable patients our members and their colleagues care for. And the sad reality is that they don’t receive the support they need in our Emergency Departments.
“And while it’s encouraging to see the standard of care improving and much better awareness of how we as on-the-ground clinicians can best support people, they are still being failed by wider issues such as overcrowding, lack of specialist care facilities and not enough dedicated mental health in-patient beds.
“Emergency Departments are not the ideal environment for people in mental health crisis – they are busy, noisy, bright and increasingly crowded. And while clinicians will always do what they can to give people the best care possible, the causes and solutions to the problems within our department, lie outside it.
“Emergency Medicine teams will keep going, but ultimately there is only so much they can do until those with responsibility for designing and resourcing systems to care for these patients give this issue the priority it deserves.”
The findings of RCEM’s Mental Health QIP reflects data on mental health patients from NHS England.
In 2019, 16,605 patients with a primary diagnosis of mental health waited 12 hours or longer in ED to be admitted, discharged or transferred.
Last year (2024), 65,881 mental health patients did.
Meaning one in four mental health patients experienced this wait in 2024, compared to one in 10 of all other patients.
That’s despite mental health attendances accounting for less than 2% of total attendances.
