Thousands Waiting More Than 24 Hours in A&E With Mental Illness

The latest figures on mental health waits in emergency departments tell a bleak but familiar story. One in 10 people who arrived at an A&E in England last month with a mental health need remained there for more than 24 hours. In some departments, the proportion climbed above one in three. The data is clinical in its presentation but human in its implications. It exposes a system stretched far beyond its intended design, a model built for trauma and acute illness now becoming the default holding space for people in severe psychological distress.

The issue is not new, yet the scale and normalisation of these waits reveal something more concerning. Behind each 24 hour stay is a person experiencing crisis, a family in turmoil, and clinical teams trying to deliver care in environments never configured for the complexity of mental health. A&E cubicles become temporary wards, corridors become overflow spaces, and clinicians become both first responders and overnight guardians. The result is frustration for staff, worse outcomes for patients and increasing pressure on already strained acute services.

How Mental Health Became an Emergency Department Burden

The reasons behind the escalation are well understood. Bed shortages in inpatient mental health units continue to drive prolonged waits, particularly for people who require specialist support under the Mental Health Act. Community mental health teams, often limited by staffing shortages and rising demand, cannot absorb the overflow. Crisis resolution teams, designed to act as a bridge between community and acute care, are inconsistently available across England.

For many people in crisis, A&E has become the only accessible and guaranteed point of contact. The result is a queue that was never formally designed but has become embedded over time. Patients experiencing acute psychological distress remain in departments for long periods while waiting for space, assessment or capacity in another part of the system.

A&E Staff Are Bearing the Weight of System Gaps

Emergency clinicians have long warned that these waits create risks for both physical and mental health safety. They describe patients becoming increasingly distressed the longer they wait, staff struggling to maintain one to one supervision, and a lack of private or therapeutic space. Even where liaison psychiatry teams are present, assessments often cannot be progressed without a clear onward pathway. Clinicians find themselves reviewing the same patient repeatedly over many hours, sometimes through an entire night and into the following day.

These pressures extend well beyond mental health care. Long stays block cubicles and bays that are needed for trauma, stroke, cardiac events and other time critical emergencies. The entire department slows, and the effect ripples into ambulance handovers and elective recovery.

A Story of Capacity, Not Competence

None of this reflects a failure of emergency clinicians. Instead, it highlights structural issues across the wider NHS. Mental health bed capacity remains limited. Crisis pathways are inconsistent. Community alternatives are patchy. Workforce shortages affect both acute hospitals and mental health providers. When these pressures converge, the consequences are most visible in A&E waiting rooms.

Trusts reporting the highest proportions of 24 hour waits often describe a similar pattern. Presentations are more complex. More young people arrive in crisis. Access to specialist beds is slow. In some areas, delayed access to local authority support adds to already long waits.

The Case for Rapid Redesign

Solving this requires more than small-scale adjustments. Trusts that have trialled redesigned pathways, such as co-locating crisis hubs near A&E, expanding 24 hour community teams and embedding mental health professionals at the front door, are reporting early improvements. These models help reduce pressure on emergency departments and give patients timely access to the right expertise.

National and local policymakers will need to accelerate these reforms if the NHS is to avoid further escalation over winter. A&E should not become the default destination for people in psychological crisis. The new data is a reminder that mental health remains one of the NHS’s most visible pressure points and one that requires urgent system-wide redesign.

The challenge now is to convert these numbers into momentum. Integrated care boards need to prioritise crisis pathways. Mental health providers need to build capacity. Local authorities need to strengthen social care support. Above all, the NHS must recognise that prolonged waits in emergency care are not simply operational failures but profound human ones.