Eight days waiting in A&E: inside the crisis in NHS mental health care

speople who suffer from mental illness Increasingly struggling to access help at every level NHS – From record numbers facing ‘unacceptable’ delays in referrals to patients waiting up to eight days in A&E for a hospital bed.

The numbers he saw The Independent Nearly four times the number of people waiting more than 12 hours appear in Emergency departments two years ago.

In the community, more than 16,000 adults and 20,000 children who must receive NHS care are unable to access vital services each month.

Almost 80 per cent of those eligible for health service advice are left waiting more than three months for a second appointment, which is when treatment usually begins.

Health leaders say they are “deeply concerned” about the lack of resources available to deal with the high demand – and warn that the cost of living crisis will exacerbate the problem.

Arranged on the emergency department floor

Monica Smith went to A&E in Lewisham last month after her Psychological health She deteriorated when her medication ran out and she was unable to get any more.

“I was told, ‘We can’t find any beds — there isn’t a bed in the whole country or the whole region,’ said the 32-year-old, so we’ll have a bed at A&E and hope to get one in the morning.” “

Monica began to hallucinate and was given medication to calm her down, but in the morning there was still no bed. Doctors tried to get her home, she said, but that crisis services called her three times over the following days, each time deciding she was very ill.

Instead, Monica stayed in an annex off A&E with other mental health patients. She said, “I was on this, like, tidy, like mental health rank on Earth.”

It took nearly eight days for her to be transferred from A&E to a ward.

The South London and Maudsley NHS Trust, which runs mental health services in the area, said there was a high demand for beds, but had increased capacity. The Lewisham and Greenwich Trust said it had no choice but to keep patients at A&E while they wait for beds.

Long waiting times for mental health patients in crisis are echoed in emergency departments across the country. Internal NHS data shows that at the end of last month one in four mental health patients in A&E had to wait more than 12 hours to be seen – far higher than those waiting for emergency physical care.

The wait to actually get a bed can be much longer; In September, the Royal College of Emergency Medicine published a briefing in which doctors reported a wait of 15 and 20 days.

Shadow Mental Health Minister Dr Rosina Aline Khan said The Independent: “No one should find themselves stuck in a mental health crisis in emergency departments because they are unable to access vital treatment. Without timely access to treatment, mental illness only gets worse.”

Have you been affected by these issues? Email rebecca.thomas@independent.co.uk

12-hour wait times topped 5,000 in August — up from less than 1,500 two years ago, though the total number of emergency admissions remained relatively stable.

Saffron Cordery, of NHS Providers, who represents hospital heads, said: “Trust leaders are extremely concerned about the persistent mismatch between capacity and demand for mental health services, which can lead to a lack of treatment in an appropriate local setting and unacceptably long waits.”

She said the impact of the cost-of-living crisis — increased stress, debt and poverty — had already led to a 72 percent increase in demand for trust funds.

Struggle to even get a diagnosis

The crisis is exacerbated by community services that cannot intervene before cases become so serious that emergency care is required.

Teams are constantly “fighting the fire”, said Neil Anthony Murphy, a senior community mental health nurse from Manchester who retired in June, finding patients often unwell due to short-term services, known as IAPT (which stands for Improved Access). psychological therapies), but were unable to receive care from community mental health teams.

He said: “Community mental health teams are not a sponge that can absorb everything. Patients deteriorate to the point of being referred to a service, which is already very bad and then you are told you are on a waiting list. It will only get worse and you end up in a crisis… so they are told The only place you can go is A&E.”

Referrals to community services have increased by 30 per cent since the pandemic, according to the NHS.

data obtained The Independent It shows that, since March, the NHS has missed its targets for the number of patients who should receive care from NHS community mental health teams by 16,000 per month. For children, the average is 20,000.

The actual number of patients not receiving care could be higher because the data does not show the total number of referrals he receives each month.

For many patients who need an NHS consultation, it means they may have had little more than an initial phone call in over three months. Thousands each month didn’t even get that.

19-year-old Natasha, whose name has been changed, has struggled to access community mental health care in the east of England since she was diagnosed with severe depression and anxiety at the age of 13, her mother said. The Independent. Last year, she was told that no treatment could be offered to her because she had completed the only course of treatment available.

After Natasha attempted suicide earlier this year, her mother was told there would be an eight-hour wait for an ambulance. “I told the GP, I don’t know where to go for help,” she said. “Nothing has changed since 2017. We’re terrified that it’s going to get to the point, either she ends up being a cut or, worse, she’s having a moment where she’s really hurting again, she can’t cope and you know, she does and she Working “.

Despite this, Natasha is no closer to getting the new diagnosis and reviewing the medications her mom says she desperately needs.

Shortage of funding and staff

Behind these growing waiting lists and missed targets are the lack of resources and overburdened staff.

According to an internal NHS briefing document in August, healthcare leaders were warned that bed occupancy within mental health boxes was 96 per cent, well above ‘safe’ levels. About 70 per cent of patients waiting to leave the hospital were unable to do so due to a lack of adequate care available.

In terms of childcare, the document warned that services only met 27 percent of demand last year, while the supply of beds was described as “severely constrained”. One-third of the unavailable beds were due to the absence of the labor force.

Shaun Duggan of the NHS Confederation, which represents mental health trusts, said: “Demand for mental health support is at an all-time high and continues to rise rapidly, and the side-effects of the pandemic on the mental health of residents mean they are under intense pressure and already overworked in many areas.

“It is time for the government to wake up to this pressure on mental health services with leaders and their staff still doing all they can as demand continues to rise.”

The NHS admitted that the cause of the pressure was a “combination of increased staff absenteeism, issues with discharging patients to social care and increased numbers of people needing mental health support due to the pandemic”.

But a spokesperson said £150m had been set aside to build hospital admission alternatives over the next three years. The Department of Health and Social Care said last year that a further £500m had been spent on tackling waiting times and expanding the range of talking therapies.

Healthcare leaders and charities have also called on the government to commit to publishing its 10-year mental health strategy with plans to meet employment needs across the sector.

Vicky Nash, of the mental health charity Mind, said the figures he had revealed The Independent It was a “shocking indication of how close our mental health system is to breaking down”.

She said: “These services have a chance to make a difference before someone reaches a crisis point – and failure to do so means more people will need intensive support, which inpatient mental health services are not always in a position to provide in a timely manner.” way now.

NHS mental health services cannot continue if they are underfunded and staffed. As these numbers show, it is simply not sustainable. The UK government must act now, before problems in our mental health system become irreparable.”