Watchdog highlights risks in emergency care

Patients experiencing a mental health crisis are facing serious safety risks when attending emergency departments, according to a warning from the Care Quality Commission (CQC). In its latest findings, the regulator identified significant gaps in how acute hospitals manage people presenting with severe mental health needs, particularly in overstretched A&E environments. The report highlights concerns around long waiting times, inappropriate settings and inconsistent access to specialist support. The CQC noted that emergency departments are often ill-equipped to provide safe, therapeutic care for mental health patients, many of whom require calm, private environments and rapid access to trained professionals. Instead, individuals are frequently treated in busy, high-pressure settings that may exacerbate distress.

Long waits and unsuitable environments

One of the most pressing issues identified is the length of time patients in crisis are required to wait for assessment or admission. In some cases, individuals are left in emergency departments for extended periods, sometimes exceeding 24 hours due to a lack of available mental health beds or community alternatives. These delays can have serious consequences. Patients may experience worsening symptoms, increased anxiety or heightened risk of self-harm while waiting in environments that are not designed for mental health care.

The CQC also highlighted the use of inappropriate spaces, including general waiting areas or temporary holding rooms, where privacy and dignity cannot be adequately maintained. In some instances, patients have been placed under observation in corridors or other unsuitable locations due to capacity pressures. Healthcare staff working in A&E face their own challenges, often lacking the specialist training or resources needed to support complex mental health cases effectively.

Workforce gaps and fragmented pathways

The report points to wider systemic issues underpinning these risks, including workforce shortages and fragmented care pathways between emergency departments and mental health services. Access to liaison psychiatry teams, which provide specialist support within hospitals that varies significantly between trusts. While some hospitals offer 24/7 coverage, others have limited availability, leading to delays in assessment and treatment. The NHS England has previously committed to expanding liaison psychiatry services, but progress has been uneven, particularly in smaller or rural hospitals.

In addition, the lack of community-based alternatives means that many patients who could be supported outside hospital are instead directed to A&E. This not only increases pressure on emergency services but also exposes patients to environments that may not meet their needs. The CQC emphasised that improving coordination between services, including ambulance teams, crisis resolution services and community providers is essential to reducing reliance on emergency departments.

Role of digital tools and data integration

The findings also highlight opportunities for digital health solutions to improve care for patients in crisis. Better integration of patient records across services could enable faster access to clinical histories, helping staff make more informed decisions in emergency settings. Digital triage tools and crisis helplines are already being used in some areas to direct patients to appropriate services before they reach A&E. Expanding these approaches could help reduce demand on emergency departments and ensure that patients receive care in more suitable settings. However, experts caution that technology alone cannot address the underlying issues. Investment in workforce capacity, infrastructure and community services will be critical to delivering sustainable improvements.

Calls for urgent system-wide reform

The CQC has called for urgent action to address the risks identified, urging policymakers and NHS leaders to prioritise mental health within emergency care planning. Recommendations include increasing the availability of mental health beds, expanding community crisis services and ensuring consistent access to liaison psychiatry teams in all hospitals. There is also a growing call for dedicated mental health emergency facilities, separate from general A&E departments, where patients can receive specialised care in a more appropriate environment.

A critical challenge for NHS services

The watchdog’s warning underscores a broader challenge facing the NHS: how to provide safe, effective care for mental health patients within a system primarily designed for physical health emergencies. As demand for mental health services continues to rise, addressing these gaps will be essential to improving patient outcomes and reducing pressure on emergency departments.

For patients in crisis, the stakes are particularly high. Ensuring that they receive timely, appropriate and compassionate care is not only a matter of clinical effectiveness but also of dignity and safety. The CQC’s findings serve as a stark reminder that, despite progress in some areas, significant work remains to ensure that mental health care within emergency settings meets the standards patients deserve.

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