In its analysis, Nuffield Trust looks at existing A&E data to explore the mental health care provided currently in A&Es, as well as the gaps and challenges new specialist services will need to overcome to improve care for people in mental health crises. The analysis found mental health presentations in A&E are increasingly complex, high risk and difficult to manage.
Between April 2024 and March 2025, mental health needs made up approximately 2% of attendances. However, because people with mental health complaints wait longer, they make up a bigger proportion of people in A&E at any given moment – roughly 3%. The number of mental health attendances per year for ‘bizarre behaviour' has risen from approximately 43,000 to 64,000, hallucinations from 12,000 to 20,000 and physical aggression from 14,000 to 21,000 over the past six years. This adds to the pressures already facing emergency departments and exacerbates an already existing gap between the needs of mentally ill people in A&E and appropriate environments and staffing.
In addition, the think-tank found that despite being pitched as a service to ‘reduce crowding' and ‘speed up access to care' in emergency services, mental health A&E centres were not well suited to reducing overall A&E waits and addressing key drivers of very long waits, such as a lack of inpatient mental health beds. It states that without wider investment in community and inpatient services, bottlenecks will persist regardless of where patients are seen. The report reveals a significant proportion of people attending mental health A&Es will have physical health diagnoses and will require physical treatment. But the capacity for mental health A&Es to provide physical treatment is often inconsistent or unclear. For example, the North London Foundation Trust's service excludes patients with an ‘urgent medical need', whereas the new service in Tooting includes ‘psychological difficulties in the context of physical illness' but excludes patients with ‘serious medical conditions'.
This also raises concerns for attendees' ability to identify the most appropriate service for their needs.
In conclusion, the analysis notes mental health A&E centres represent a crucial opportunity to reach vulnerable and suicidal people that the NHS has previously failed to engage. It adds mental health A&Es are a welcome step towards more compassionate crisis care, but to meet their own expressed aims, they require an integrated approach that addresses the workforce, the number of hospital beds available for mental health patients and the complex intersection of physical and mental health.
Nuffield Trust fellow and author of the analysis, Bea Taylor said: ‘The dreadfully long waits we see in A&E today would have been unthinkable before the pandemic and the Government hopes that new A&Es dedicated to mental health will play a part in getting our emergency care services back on track. However, our analysis shows that patients' mental health needs are becoming more complex and it can be very difficult to disentangle mental and physical health problems. Providing people in a mental health crisis with compassionate care in an appropriate setting is a laudable reason for setting up mental health A&Es, but if the priority for Government is to reduce long waits overall, they are likely to fall short.'
