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Speak with most accident and emergency clinicians about mental health patients attending emergency departments and they’ll likely tell you these patients suffer the longest waits.

Unfortunately waits for these patients are not captured within national data sets and so there is no way to know what the scale of the situation is.

However, new data collected by NHS organisations for London would suggest the picture is rather grim. According to reports obtained by HSJ, between July and the end of September there were more than 400 12-hour breaches for mental health patients across London’s EDs. 

This is relatively new data, HSJ understands, and so there is little to compare it to 2019. However, a trawl through recent acute trust board papers would suggest A&E waits for mental health patients are becoming a concern again.

It’s important to note this and national data on all 12-hour waits almost certainly underestimates the picture. This is because waits are a measure from the time a decision to admit is made, which can take more than 12 hours, rather than total time in A&E.

For mental health patients the decision to admit can be a particularly “grey” area. New clinical standards trials are piloting a new measure, which will start the clock from when a person arrives at A&E, which should address the issue.

Although they are an A&E target, 12-hour waits are often a signal of wider bed pressures. This data obtained from London would suggest the mental health sector is suffering with bed capacity at the moment.

According to the Royal College of Psychiatrists the biggest thing that would be done to help with this would be to allow mental health trusts access to the national winter discharge programme.

Readers may remember the sector was explicitly excluded from the recent £558m discharge funding, despite delayed discharges being a key pressure not only on mental health emergency care but also wider acute systems.

Regional riddle

A very striking trend has emerged in the weekly mortality data published by the Office for National Statistics, in which the South East region seems to have had significantly higher numbers of excess deaths than other parts of the country.

Analysis of official data by HSJ shows the region, which excludes London, had almost 900 excess deaths in the 10 weeks to 2 October (around 10 per 100,000 population), which accounted for almost three-quarters of the national total in that period.

Excess deaths means the number taking place above the seasonal average of previous years.

Deaths in people’s homes — as opposed to in hospitals or care homes, for example — more than accounted for the total excess. Meanwhile, only 132 of the region’s deaths in this period mentioned covid-19 on the death certificate.

What’s not immediately clear is what’s causing the South East to be such a significant outlier, but possible explanations for excess mortality during the pandemic have included disruptions to normal health services, as well as anxiety among patients about attending hospital or GP surgeries.