This instalment of Royal College of Emergency Medicine (RCEM)’s Acute Insight Series summarises key issues in mental health emergency care and provides recommendations for policymakers, NHS England, Integrated Care Systems, and Trusts to enable patients to access emergency mental healthcare in a safe, efficient, and timely manner.
To improve the experiences and outcomes of patients with mental health needs in accessing urgent and emergency care (UEC), change needs to be instigated at three distinct levels of policy and decision making: by the UK Government, NHS England, and by Integrated Care Systems.
For the UK Government and devolved administrations:
- Significantly increase adult, children, and young people Mental Health bed capacity in NHS Trusts.
- Provide funding to expand the provision of Children and Adolescent Mental Health services, ensuring they are available 24 hours a day, seven days a week to assess or at least triage children and young people presenting to the ED in crisis.
- Workforce planning should be in place to train professionals for these services, to ensure they are staffed overnight and at weekends, enabling the units to accept emergency admissions out of hours.
- Continue to invest in Liaison Psychiatry services, to honour the commitment to provide not just minimum Core 24 services but to deliver enhanced and comprehensive services in bigger trusts.
- Provide funding for preventative and community mental health services, especially eating disorder services, to keep up with growing demand.
- Amend the Mental Health Bill in order to introduce standards, national reporting and scrutiny of the quality and access to care provided to patients detained or due for assessment for possible detention under Emergency Mental Health legislation.
For NHS England:
- Publish, on a regular basis, the number of patients presenting with Mental Health symptoms experiencing stays over 12 hours from their time of arrival to when they leave the department to be admitted, transferred, or discharged.
- Introduce the one-hour standard to be seen by a mental health professional from referral from ED, for all ages, as recommended in the Clinical Review of Standards.
- Introduce standards for hospital security teams and mandatory training in Mental Health, so all teams can provide safe restraint when there is no other option and is absolutely necessary.
- Review and improve how Section 12 (2) doctors are commissioned and paid in order to ensure timely assessments for patients detained under the Mental Health Act.
- Carry out a national review of the numbers of Approved Mental Health Professionals to ensure patients detained under the Mental Health Act have timely access to assessment.
For Integrated Care Systems (ICS):
- Ensure universal coverage of crisis response services in every community. These include ambulance – mental health joint response cars, 24/7 phone lines and crisis cafes.
- Prioritise early intervention multidisciplinary services to address the underlying unmet need in High Intensity Use. There should be robust evaluation of services to see which models work best.
- Hold Mental Health and Acute Trusts jointly accountable for patients with mental health needs enduring delays of 12 hours or more in EDs from their time of arrival to when they leave the department to be admitted, transferred, or discharged.
- Support Mental Health trusts and Emergency Departments to develop acute assessment spaces with Mental Health Professionals to care for patients.