Mental health patients waiting more than 12 hours in A&E for beds as services face ‘desperate’ situation

Exclusive: ‘It’s desperate, there’s no two ways about it’

Mental health services are at their most pressured ever (Getty Images/iStockphoto)

NHS mental health services are facing a “desperate” situation as all hospitals across the country are dangerously full and leaked data shows hundreds of patients waiting over 12 hours in A&E, The Independent can reveal.

The news comes as the spread of Omicron risks outbreaks in mental health hospitals, with a large hospital in London forced to close its doors to new admissions on three wards.

In response to the growing bed pressures in the capital over the past month the NHS has commissioned 40 beds from private sector hospitals run by The Priory Group, The Independent understands.

NHS data, seen by The Independent, has revealed that almost all mental health hospitals in London have been at “black alert” levels of bed availability during October and November, meaning their beds were nearly 100 per cent full.

A senior national source has warned the situation is similar across the country, with nearly all mental health trusts 94 per cent full and services at their most stressed ever.

The Independent can also reveal that thousands of mental health patients across the capital attended A&E in crisis each week from September to November, with 50 patients a week waiting more than 12 hours for a bed, compared with 35 during the same period last year.

Sources have said the true length of A&E waits are often hidden, with many waits sometimes days. One senior director said they had a patient wait 60 hours for a bed recently, while another senior clinician reported an 18-hour wait.

The findings come after NHS leaders last week warned that 1.4 million people have been left waiting for mental health care across England during the pandemic.

Leaders admitted that 12-hour waits for these patients have worsened, while referrals to mental health crisis services have increased by 75 per cent since Spring 2020.

One senior nurse working in south London said: “I’ve not known this level of pressure. I think staffing is the main concern; we’re not able to get staff to cover posts. I’ve only got two nurses and I should have six or seven. We are in a bit of a crisis now, to say the least. We’re in this situation where people are being told to go to A&E, and they’re waiting for days, sometimes.

We are in a bit of a crisis now, to say the least. We’re in this situation where people are being told to go to A&E, and they’re waiting for days, sometimes

Senior nurse in London

“It’s desperate, there’s no two ways about it. We are fire-fighting, and we’re not alone.”

Central and North West London Hospital was forced to close three of its wards this month following a Covid outbreak, taking 17 adult mental health beds out of circulation. Sources speaking to The Independent fear these outbreaks will become increasingly common amid the spread of Omicron in the capital.

Paul Farmer, chief executive for mental health charity Mind, said he was “deeply concerned” over the scale of unmet need in mental health services and called for the government to commit new funding to services, which have all been stretched following the pandemic.

One A&E consultant from the northwest, Marc Buchanan, said the situation was similarly dire across the country.

He said: “I would say that there is a there is a crisis in mental health crisis care. After initial mental health assessments, if further support or assessment is required, there are huge waits. This includes waiting for home treatment, the crisis team or for a formal Mental Health Act assessment.

“If a bed is required there are further delays. This can mean patients in crisis have to stay in emergency departments or on medical wards for days with no therapeutic support.

“In paediatrics it is worse. Very few areas have a commissioned true children’s mental health crisis services and there is a shortage of paediatric mental health beds, which means that children with mental health problems are either kept in A&E for long periods of times – I am aware of this being weeks – or on children’s wards. Again, this is not a therapeutic environment. Unfortunately paediatric crisis care support is even more in crisis than the adult services.”

Leaked data showing bed availability in London showed the capital had just 10 children’s beds out of 140 available in mid-October. Sources in the east of England told The Independent this week that almost 150 children’s mental health beds were closed, which was causing huge pressures.

‘The worst part is the wait’

One 22-year-old woman from south London, Hannah Belfon, told The Independent she has been admitted to hospital nine times since 2020 and each time has had to wait for hours.

During her first admission in 2018, to South London and Maudsley Foundation Trust, she was almost sent to the Isle of Wight because of the lack of mental health beds in the capital, before her parents refused.

Data leaked to The Independent revealed that during one week in November, just 3 per cent of beds for women were available in the capital and on one day, 40 patients had been sent miles away from home to “out of area placements”.

It is not clear how far these patients were sent, however the most recently published data from the NHS showed across England there were 240 patients in mental health beds miles away from their homes.

After the decision was made she would need to be admitted under the Mental Health Act in December 2018, Ms Belfon said: “I was left waiting three days as there were no beds within my area. I think one of the worst parts about the whole experience of going into hospital is the wait: it could be one day, two days, three days or it could be less than 12 hours.”

Each time she was admitted to hospital in 2020, she said she “always had to wait at least 12 hours to see the on-duty doctor but before I’ve got to hospital, I’ve had to wait about eight hours to see the psychiatric team at my local A&E and then they say I have to go into hospital.”

During 2019, after she was discharged, Ms Belfon described herself as being in a worse position than before and although she and her family sought help from local community mental health team, she was initially told to go to A&E instead.

She said: “I’ve had to fight for a referral. I got in contact with my MP. It was awful. The only reason why they put in their referrals was because I said to them, ‘If I die, you’re going to have blood on your hands.’ Bear in mind I’d previously been in and out of mental health hospitals at least six times before I was even offered community therapy.”

Michael Holland, medical director at South London and Maudsley Foundation Trust said: “The Covid-19 pandemic has compounded existing challenges across already stretched mental health services – there is high demand across our community services which unfortunately means people sometimes are currently waiting longer to receive treatment.

“We have increased our capacity by working with our partners and alliances across the system and we continue to work with our partners to prioritise our resources to ensure people in our communities who are most vulnerable and in need of urgent treatment receive the support they need as soon as possible.”

‘Desperate’ situation

According to a leaked internal report for London, the number of children attending A&E departments each week, needing help for mental health issues, reached a high for this year of 210 in October and almost approached this level again in November.

An average of eight children a week since September have been admitted onto acute hospital wards as there were not enough mental health beds available. And figures also showed that on one day in October, just 10 children’s mental health beds were available in the capital out of 140.

The figures come as demand for children’s services continues to increase across the country. NHS leaders warned last week children’s mental health services had experienced an “unprecedented” surge in patients needing urgent care for complex eating disorders.

Reports, seen by The Independent, also showed just 86 out of 2,324 beds for adults were free in the second week of November with similar levels for the beginning of November and October, in London.

One senior director in London, speaking anonymously with The Independent, said they’d seen a child wait 60 hours for a bed earlier this month, while another emergency care doctor said patients in their A&E were waiting for 18 hours.

Waits for mental health beds in others areas are reported to be similar. According to the board papers of a major hospital in Wirral, it has had 29 patients wait more than 12 hours in A&E since April and all were mental health patients waiting for ongoing care.

Commenting on the figures uncovered by The Independent, Paul Farmer, chief executive of charity Mind said: “It’s deeply concerning to hear the scale of unmet mental health need. The current picture is bleak and without additional funding coming the situation will worsen, especially as we approach winter.

“High numbers of urgent and emergency referrals across the country show too many people reaching crisis point for their mental health without getting the help they need earlier on. The government and NHS must act on this now.

He said mental health services were “stretched” during the pandemic, adding: “The recent Spending Review was a major missed opportunity to support both children and adults currently missing out. To reverse this mental health crisis, the UK government must commit to significant investment in mental health services across the country.”

The source explained that as a result of people not getting access to services during lockdowns last year, the people now coming to services are more unwell. “There is that danger. You quite often get rises in demand around wintertime, for a whole set of reasons. I hope we see some share of the NHS’s winter funding, because we’re not seeing any of the new money from the government, none of that has been allocated.”