Mental health A&E programme ‘not far away’

The aim would be to free up pressure on acute emergency departments, as well as providing a better experience for patients with mental health needs, who often wait for appropriate care for many hours.

NHS England CEO Sir Jim Mackey said in a recent interview that he hoped the 10-Year Health Plan would “bring about the ability to build things again [in the NHS] without being in a very long queue for national money”.

An example he gave was: “If we need to build an emergency department for people with mental health crisis… They’re things we’ve struggled with over the last few years, the inability to turn good ideas into action… I think that’s not far away again.”

He was hopeful the plan would therefore “release a lot of energy”, he said in a video interview with North East and North Cumbria Integrated Care Board CEO Samantha Allen.

The proposal may be included in the upcoming urgent and emergency care plan or the 10-Year Health Plan, according to senior sources.

Other well-placed sources said the units would need to be staffed 24/7 and would require a large capital investment. They may be situated at or near an existing ED. 

Some similar facilities are already operating, such as Essex Partnership Trust’s mental health urgent care department and Central and North West London Foundation Trust’s crisis assessment service.

Waits of several days remain common for patients in mental health crisis in mainstream EDs, and coroners’ warnings to ICBs highlight multiple similar cases of poor mental health crisis care, and a lack of coordination across services, for people with complex needs.

There have even been reports of patients spending several weeks in departments, although they are often waiting for care and housing placements or inpatient mental health beds.

Local leaders said liaison psychiatry would need to be retained in acute EDs, since many patients have both physical and mental health needs – meaning additional staff will be needed overall. There are already widespread concerns about inadequate crisis support staffing, as shown in a survey revealed last month by HSJ.

Andy Bell, chief executive of the Centre for Mental Health, said too many people in mental health emergency faced long waits in EDs and delays in accessing treatment.

“It is vital that the NHS invests in what works and carefully explores the most effective ways to respond to mental health emergencies,” Mr Bell said.

However, he stressed that it is essential that any model used widely is “robustly tested for its safety and effectiveness”.

“Very often, people in mental health emergencies also need urgent physical treatment. So the NHS cannot artificially separate urgent mental and physical health care. All emergency departments need to be able to respond to mental health emergencies, with expert advice and support available around the clock,” Mr Bell stressed.