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Eight days waiting in A&E: Inside the crisis in NHS mental health care

by Ozva Admin

PPeople suffering from mental illness are finding it increasingly difficult to access help at all levels of the NHS, from record numbers facing “unacceptable” delays in referrals to patients waiting up to eight days in the ER for a hospital bed.

Figures seen by the independent show nearly four times as many people waiting more than 12 hours in emergency departments than two years ago.

In the community, more than 16,000 adults and 20,000 children who should receive NHS care are unable to access vital services every month.

Nearly 80 percent of people eligible for health service advice are left waiting more than three months for a second appointment, which is when treatment usually begins.

Health leaders say they are “deeply concerned” about the lack of resources available to handle increased demand, warning that the cost-of-living crisis would further exacerbate the problem.

A mattress on the floor of the emergency department.

Monica Smith went to A&E in Lewisham last month after her mental health deteriorated when she ran out of medication and couldn’t get any more.

The 32-year-old said: “I was told: ‘We can’t find beds, there are no beds in the whole country or in the whole region, so we’re going to have a bed at A&E and I hope you can get a bed in the morning.’ ”.

Monica started hallucinating and was given medication to calm her down, but in the morning there was still no bed. Doctors tried to send her home, she said, but crisis services evaluated her three times over the next few days and each time decided she was unwell.

Instead, Monica stayed in an A&E annex with other mental health patients. She said: “I was on this, like, mattress, like a mental health mattress on the floor.”

It took nearly eight days for her to be moved from A&E to a theater.

South London and the Maudsley NHS Trust, which runs mental health services in the area, said there was high demand for beds but capacity had increased. Lewisham and Greenwich Trust said they have no choice but to keep patients on A&E while they wait for beds.

The long waits for mental health patients in crisis are repeated in emergency departments across the country. Internal NHS data shows that, at the end of last month, one in four mental health patients at A&E had to wait more than 12 hours for treatment, a far higher proportion than those waiting for emergency physical care.

The wait to receive a bed can be much longer; in September the Royal College of Emergency Medicine published a report in which doctors reported waits of 15 and 20 days.

Shadow Mental Health Minister Dr Rosena Allin-Khan said the independent: “No one should find themselves stuck in a mental health crisis in emergency departments because they can’t access vital treatment. Without access to timely treatment, mental illnesses only get worse.”

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These 12-hour waits exceeded 5,000 in August, compared with less than 1,500 two years earlier, even though the total number of emergency admissions remained relatively stable.

Saffron Cordery, from NHS Providers, who represents hospital heads, said: “Trusted leaders are deeply concerned about the continued mismatch between capacity and demand for mental health services, which may result in a lack of treatment in the appropriate local environment and unacceptably long waits. .”

She said the impact of the cost of living crisis — increased stress, debt and poverty — had already led to a 72 percent increase in trust lawsuits.

The struggle to even get a diagnosis

The crisis is exacerbated by community services unable to intervene before cases become severe enough to require emergency care.

Neil Anthony Murphy, a senior Manchester community mental health nurse who retired in June, said teams were constantly “putting out fires”, finding that patients were often unwell for short-term services, known as IAPT (which stands for Improving Access to Psychological Therapies) , but was unable to receive care from community mental health teams.

I don’t know where to go for help

He said: “Community mental health teams are not a sponge that can soak up everything. Patients deteriorate to the point where you are referred to a service, it is already poor enough, and then they tell you that you are on a waiting list. You’re going to get worse and you’re going to end up in a crisis… so they tell them the only place you can go is A&E.”

Referrals to community services have increased by 30 per cent since the pandemic, according to the NHS.

Data obtained by the independent shows that, since March, the NHS has missed its own targets for the number of patients who should receive care from NHS community mental health teams by 16,000 per month. For children, the average is 20,000.

The actual number of patients not receiving care could be even higher, since the data does not detail the total number of referrals you receive each month.

For many patients who need NHS advice, it means they may have received little more than an initial phone call in more than three months. Thousands every month haven’t even had that.

Nineteen-year-old Natasha, whose name has been changed, has been struggling to access community mental health care in the east of England since she was diagnosed with severe depression and anxiety at age 13, her mother said. the independent. Last year, she was told that she could not be offered any treatment because she had completed the only course of therapy available.


mental health beds occupied in August

Following an attempt by Natasha to take her own life earlier this year, her mother was told there would be an eight-hour wait for an ambulance. “I told the GP I don’t know where to go for help,” she said. “Nothing has changed since 2017. We’re terrified it’s going to get to the point, either he ends up having to be sectioned or worse, he has a moment where he really hurts again, he can’t cope and you know. , she does it and it works.”

Despite this, Natasha is still nowhere near getting the new diagnosis and medication review her mother says she desperately needs.

No funds and no staff

Behind these growing waiting lists and unfulfilled objectives is a lack of resources and staff at the limit.

According to an internal NHS briefing paper from August, healthcare leaders were warned that bed occupancy within mental health trusts was 96 per cent, well above “safe” levels. About 70 percent of patients waiting to leave the hospital were unable to do so due to a lack of adequate care available.

On childcare, the document notes that services covered only 27 percent of demand last year, while the supply of beds was described as “severely restricted.” A third of the unavailable beds were due to the absence of the staff.

These services have the opportunity to make a difference before someone reaches crisis point.

Sean Duggan from the NHS Confederation, who represents mental health trusts, said: “Demand for mental health support is at an all-time high and continues to rise rapidly, and the knock-on effects of the pandemic on the mental health of the population they mean they are under heavy pressure and are already working beyond their capacity in many areas.

“It is high time the government paid attention to this pressure on mental health services with leaders and their staff continuing to pull out all the stops as demand continues to skyrocket.”

The NHS admitted that the cause of the pressure was “a combination of increased staff absence, problems discharging patients into social care and an increasing number of people needing mental health support due to the pandemic.” ”.

But a spokesman said £150m had been committed to building alternatives to hospital admission over the next three years. The Department for Health and Social Care said a further £500m was spent last year to tackle waiting times and expand talk therapies.

Healthcare leaders and charities have also called on the government to commit to publishing its 10-year mental health strategy with plans to address staffing needs across the sector.

Vicki Nash, from mental health charity Mind, said the figures discovered by the independent they were “a shocking indication of how close our mental health system is to collapse.”

She said: “These services have the opportunity to make a difference before someone reaches crisis point, and failure to do so will mean more people will need intensive support, that inpatient mental health services are not always available. able to deliver in a timely manner. right now.

“NHS mental health services cannot continue without sufficient funding and staff. As these numbers show, it’s simply not sustainable. The UK government must act now, before the problems in our mental health system are beyond repair.”

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