For Those Regularly In Mental Health Crisis, A&E Visits Might Not Always Feel Like The Best Option

Of course, A&E often saves lives, but there are a number of ways we could improve mental health services in their current state

After a few days of yet another mental health crisis reaching its peak, you are unsure what to do. It’s the middle of the night when services are closed. Waiting until the morning to speak to your primary mental health worker during office hours is too long to wait, mainly to avoid a crisis progressing further. You feel unsafe, at risk and unable to trust yourself.

On countless occasions, I’ve found myself in this situation and my case is far from unique. Like anyone who has been in this position will know, it’s troubling and distressing. Emotions are overwhelming. Intrusive thoughts are dominating. Mental state is totally erratic. And during anti-social hours, you have only one option to keep yourself safe from harm: to call the out of hours mental health rapid response line or the non-emergency 111 number. And I have no shame in admitting calling the helplines many times and has certainly saved my life, more than once.

Calling helplines are helpful. They can prevent a person from self-harming and acting on suicidal thoughts. At least, they can provide a listening ear, guidance and support. However, if you even hint at being at risk the default response is inevitably the same: go to A&E. After having been sent to hospital on a number of times to see the Mental Health Liaison Team, I question: is A&E always the safest and most appropriate place to send someone in a mental health crisis?

Whilst we are all too aware that A&E departments are infamously over-stretched and under-resourced, they can’t always be treated as the ‘Anything & Everything’ service. Unless a person with serious mental health problems has immediate medical issues to be addressed, that’s one thing. Though they cannot simply be dumping grounds for people for all mental health problems, who can be better triaged and assessed in more appropriate environments.

Too often, people who are in hospital to be seen by a mental health nurse can wait anywhere between four and 12 hours. And not every hospital in the country has the luxury of a specialist nurse on site 24/7, if at all. Don’t get me wrong, after many hours of waiting to be seen by the nurse, it can seriously help. They can offer brief interventions to stabilise you and create a safety plan for the here and now. Yet, I still think this current set up is far from ideal for people regularly in crisis.

One scheme to alleviate the pressures on A&E services is a successful pilot in London where they send a specialist ambulance with a mental health nurse and paramedic in blue lights. They say The London Ambulance Service scheme aims to treat patients at home, which is often a better environment for those experiencing a wide range of mental health problems. When an emergency mental health call comes in, the 999 call handlers work alongside a mental health nurse in the control room to decide whether to dispatch the mental health car.

Ultimately, it makes sense as to treat someone where they are, so that their social needs are better understood to inform appropriate care moving forward. After all, hospitals are superficial environments and people in crisis may not be in a position to communicate what they need, in the way they need to.

And, we all know we all have a long way to go in improving mental health services. Despite the limited availability for out of hours services currently, A&E simply isn’t the place for everybody.

Useful websites and helplines:

  • Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
  • Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
  • The Mix is a free support service for people under 25. Call 0808 808 4994 or email:
  • Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on