Mental health cases at A&E reach crisis level – as waits get longer and specialised beds dwindle
“We’ve got two,” explains Emer Szczygiel, emergency department head of nursing at King George Hospital, as she walks inside a pastel coloured room.
“If I had my time back again, we would probably have four, five, or six because these have helped us so much in the department with the really difficult patients.”
On one wall, there’s floral wallpaper. It is scored through with a graffiti scrawl. The words must have been scratched out with fingernails.
There are no other implements in here.
Patients being held in this secure room would have been searched to make sure they are not carrying anything they can use to harm themselves – or others.
Emer Szczygiel wishes the hospital had more of the ‘ligature light’ mental health rooms
There is a plastic bed secured to the wall. No bedding though, as this room is “ligature light”, meaning nothing in here could be used for self harm.
On the ceiling, there is CCTV that feeds into a control room on another part of the Ilford hospital’s sprawling grounds.
“So this is one of two rooms that when we were undergoing our works, we recognised, about three years ago, mental health was causing us more of an issue, so we’ve had two rooms purpose built,” Emer says.
“They’re as compliant as we can get them with a mental health room – they’re ligature light, as opposed to ligature free. They’re under 24-hour CCTV surveillance.”
The rooms have a CCTV camera in the ceiling that feeds through to the main control room
There are two doors, both heavily reinforced. One can be used by staff to make an emergency escape if they are under any threat.
What is unusual about these rooms is that they are built right inside a busy accident and emergency department.
The doors are just feet away from a nurse’s station, where medical staff are trying to deal with acute ED (emergency department) attendances.
The number of mental health patients in a crisis attending A&E has reached crisis levels.
Some will be experiencing psychotic episodes and are potentially violent, presenting a threat to themselves, other patients, clinical staff and security teams deployed to de-escalate the situation.
The team were already dealing with five mental health cases when Sky News visited
Like physically-ill patients, they require the most urgent care but are now facing some of the longest waits on record.
On a fairly quiet Wednesday morning, the ED team is already managing five mental health patients.
One, a diminutive South Asian woman, is screaming hysterically.
She is clearly very agitated and becoming more distressed by the minute. Despite her size, she is surrounded by at least five security guards.
She has been here for 12 hours and wants to leave, but can’t as she’s being held under the Mental Capacity Act.
Her frustration boils over as she pushes against the chests of the security guards who encircle her.
“We see about 150 to 200 patients a day through this emergency department, but we’re getting on average about 15 to 20 mental health presentations to the department,” Emer explains.
“Some of these patients can be really difficult to manage and really complex.”
Emer Szczygiel says the department gets about 15 to 20 mental health presentations a day
“If a patient’s in crisis and wants to harm themselves, there’s lots of things in this area that you can harm yourself with,” the nurse adds.
“It’s trying to balance that risk and make sure every emergency department in the country is deemed a place of safety. But there is a lot of risk that comes with emergency departments, because they’re not purposeful for mental health patients.”
In a small side room, Ajay Kumar and his wife are waiting patiently by their son’s bedside.
He’s experienced psychotic episodes since starting university in 2018 and his father says he can become unpredictable and violent.
Ajay and his wife were watching over their son, who’s been having psychotic episodes
Ajay says his son “is under a section three order – that means six months in hospital”.
“They sectioned him,” he tells us.
“He should be secure now, he shouldn’t go out in public. Last night he ran away [from hospital] and walked all the way home. It took him four and a half hours to come home.
“I mean, he got three and a half hours away. Even though he’s totally mental, he still finds his way home and he was so tired and the police were looking for him.”
Mr Kumar said his son ran away from hospital and walked for hours to get home
Now they are all back in hospital and could be waiting “for days”, Ajay says.
“I don’t know how many. They’re not telling us anything.”
Matthew Trainer, chief executive of Barking, Havering and Redbridge University Hospitals NHS Trust, is at pains to stress nobody is blaming the patients.
“We’ve seen, particularly over the last few years, a real increase in the number of people in mental health crisis coming into A&E for support,” he says.
“And I don’t know if this is because of the pandemic or wider economic pressures, but what we’re seeing every day is more and more people coming here as their first port of call.”
‘More and more’ people in mental health crisis are showing up at A&E, says Mr Trainer
The hospital boss adds: “If you get someone who’s really distressed, someone who is perhaps experiencing psychosis etc, I’m seeing increasing numbers of complaints from other patients and their families about the environment they’ve had to wait in.
“And they’re not blaming the mental health patients for being here.
“But what they’re saying is being in a really busy accident & emergency with ambulances, with somebody highly distressed, and you’re sat there with an elderly relative or a sick child or whatever – it’s hard for everyone.
“There’s no blame in this. It’s something we’ve got to work together to try to fix.”
New Freedom of Information data gathered by the Royal College of Nursing shows that over the last five years, more than 1.3 million people in a mental health crisis presented to A&E departments.
That’s expected to be a significant underestimate however, as only around a quarter of English trusts handed over data.
For these patients, waits of 12 hours or more for a mental health bed have increased by more than 380%.
Over the last decade, the number of overnight beds in mental health units declined by almost 3,700. That’s around 17%.
The Department for Health and Social Care told Sky News: “We know people with mental health issues are not always getting the support or care they deserve and incidents like this are unacceptable.
“We are transforming mental health services – including investing £26m to support people in mental health crisis, hiring more staff, delivering more talking therapies, and getting waiting lists down through our Plan for Change.”
Claire Murdoch, NHS England’s national mental health director, also told Sky News: “While we know there is much more to do to deal with record demand including on waits, if a patient is deemed to need support in A&E, almost all emergency departments now have a psychiatric liaison team available 24/7 so people can get specialist mental health support alongside physical treatment.
“The NHS is working with local authorities to ensure that mental health patients are given support to leave hospital as soon as they are ready, so that space can be freed up across hospitals including A&Es.”
Patients in a mental health crisis and attending hospital are stuck between two failing systems.
A shortage of specialist beds means they are left untreated in a hospital not designed to help them.
And they are failed by a social care network overwhelmed by demand and unable to provide the early intervention care needed.
Four people have been charged after £7m of damage was caused to two Voyager aircraft at RAF Brize Norton.
The investigation into the incident early on Friday 20 June was led by counter-terror police.
They have been charged with conspiracy to enter a prohibited place knowingly for a purpose prejudicial to the safety or interests of the UK – and conspiracy to commit criminal damage.
Two Voyager aircraft at RAF Brize Norton were damaged. PA file pic
The four charged have been identified as:
• Amy Gardiner-Gibson, 29, of no fixed abode
• Daniel Jeronymides-Norie, 35, from London
• Jony Cink, 24, of no fixed abode
• Lewie Chiaramello, 22, from London
They will appear at Westminster Magistrates’ Court later today.
A 41-year-old woman arrested last week on suspicion of assisting an offender has been released on bail until 19 September.
Meanwhile, a 23-year-old man detained on Saturday was released without charge.
Last month’s incident at RAF Brize Norton in Oxfordshire was claimed by the activist group Palestine Action.
Yesterday, MPs voted to proscribe the group as a terrorist organisation.
The legislation passed with 385 MPs voting in favour, while 26 were against.
UK
No 10 backs Chancellor Rachel Reeves and says she ‘is going nowhere’ after tearful appearance in Commons
Rachel Reeves has not offered her resignation and is “going nowhere”, Downing Street has said, following her tearful appearance in the House of Commons.
A Number 10 spokesperson said the chancellor had the “full backing” of Sir Keir Starmer, despite Ms Reeves looking visibly upset during Prime Minister’s Questions.
Politics latest: ‘A moment of intense peril’ for PM
A spokesperson for the chancellor later clarified that Ms Reeves had been affected by a “personal matter” and would be working out of Downing Street this afternoon.
Politics latest: Reeves looks visibly upset in Commons
UK government bond prices fell by the most since October 2022, and the pound tumbled after Ms Reeves’s Commons appearance, while the yield on the 10-year government bond, or gilt, rose as much as 22 basis points at one point to around 4.68%.
Downing Street’s insistence came despite Sir Keir refusing to guarantee that Ms Reeves would stay as chancellor until the next election following the fallout from the government’s recent welfare U-turn.
Tory leader Kemi Badenoch branded the chancellor the “human shield” for the prime minister’s “incompetence” just hours after he was forced to perform a humiliating U-turn over his controversial welfare bill.
Speaking at Prime Minister’s Questions, Ms Badenoch said: “This man has forgotten that his welfare bill was there to plug a black hole created by the chancellor. Instead they’re creating new ones.”
Turning to the chancellor, the Tory leader added: “[She] is pointing at me – she looks absolutely miserable.
“Labour MPs are going on the record saying that the chancellor is toast, and the reality is that she is a human shield for his incompetence. In January, he said that she would be in post until the next election. Will she really?”
Not fully answering the question, the prime minister replied: “[Ms Badenoch] certainly won’t.
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Welfare vote ‘a blow to the prime minister’
“I have to say, I’m always cheered up when she asks me questions or responds to a statement because she always makes a complete mess of it and shows just how unserious and irrelevant they are.”
Mrs Badenoch interjected: “How awful for the chancellor that he couldn’t confirm that she would stay in place.”
The prime minister’s watered-down Universal Credit and Personal Independent Payment Bill, aimed at saving £5bn, was backed by a majority of 75 in a tense vote on Tuesday evening.
A total of 49 Labour MPs voted against the bill – the largest rebellion in a prime minister’s first year in office since 47 MPs voted against Tony Blair’s Lone Parent benefit in 1997, according to Professor Phil Cowley from Queen Mary University.
After multiple concessions made due to threats of a Labour rebellion, many MPs questioned what they were voting for as the bill had been severely stripped down.
They ended up voting for only one part of the plan: a cut to Universal Credit (UC) sickness benefits for new claimants from £97 a week to £50 from 2026/7.
Ms Badenoch said the climbdown was proof that Sir Keir was “too weak to get anything done”.
Read more:
The PM faced down his party on welfare and lost
Labour welfare cuts ‘Dickensian’, says rebel MP
Ms Reeves has also borne a lot of the criticism over the handling of the vote, with some MPs believing that her strict approach to fiscal rules has meant she has approached the ballooning welfare bill from the standpoint of trying to make savings, rather than getting people into work.
Experts have now warned that the welfare U-turn, on top of reversing the cut to winter fuel, means that tax rises in the autumn are more likely – with Ms Reeves now needing to find £5bn to make up for the policy U-turns.
Asked by Ms Badenoch whether he could rule out further tax rises – something Labour promised it would not do on working people in its manifesto – Sir Keir said: “She knows that no prime minister or chancellor ever stands at the despatch box and writes budgets in the future.
“But she talks about growth, for 14 years we had stagnation, and that is what caused the problem.”
Prosecutors are considering whether to bring further criminal charges against Lucy Letby over the deaths of babies at two hospitals where she worked
The Crown Prosecution Service said it had received “a full file of evidence from Cheshire Constabulary asking us to consider further allegations in relation to deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital”.
“We will now carefully consider the evidence to determine whether any further criminal charges should be brought,” it added.
“As always, we will make that decision independently, based on the evidence and in line with our legal test.”
Letby, 35, was found guilty of murdering seven children and attempting to murder seven more between June 2015 and June 2016 while working in the neonatal unit of the Countess of Chester Hospital and is currently serving 15 whole-life orders.
Letby worked at the Countess of Chester Hospital and Liverpool Women’s Hospital
She is understood to have carried out two work placements at Liverpool Women’s Hospital, where she trained as a student, between October and December 2012, and January and February 2015.
Police said in December that Letby was interviewed in prison as part of an investigation into more baby deaths and non-fatal collapses.
A Cheshire Constabulary spokesperson said: “We can confirm that Cheshire Constabulary has submitted a full file of evidence to the CPS for charging advice regarding the ongoing investigation into deaths and non-fatal collapses of babies at the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women’s Hospital as part of Operation Hummingbird.”
Detectives previously said the investigation was looking into the full period of time that Letby worked as a nurse, covering the period from 2012 to 2016 and including a review of 4,000 admissions of babies.
Letby’s lawyer Mark McDonald said: “The evidence of the innocence of Lucy Letby is overwhelming,” adding: “We will cross every bridge when we get to it but if Lucy is charged I know we have a whole army of internationally renowned medical experts who will totally undermine the prosecution’s unfounded allegations.”
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Three managers at the hospital where Lucy Letby worked have been arrested on suspicion of gross negligence manslaughter.
On Tuesday, it was confirmed that three managers at the Countess of Chester hospital had been arrested on suspicion of gross negligence manslaughter in a separate investigation.
Read more from Sky News:
‘Catastrophic failure’ that led to Heathrow power outage revealed
Man charged with murder of 93-year-old woman in Cornwall
Police said the suspects, who occupied senior positions at the hospital between 2015 and 2016, have all been bailed pending further inquiries.
There is also an investigation into corporate manslaughter at the hospital, which began in October 2023.
A public inquiry has also been examining the hospital’s response to concerns raised about Letby before her arrest.
In May, it was announced the inquiry’s final report into how the former nurse was able to commit her crimes will now be published early next year.
Earlier this year, Letby’s lawyers called for the suspension of the inquiry, claiming there was “overwhelming and compelling evidence” that her convictions were unsafe.
In February, an international panel of neonatologists and paediatric specialists told reporters that poor medical care and natural causes were the reasons for the collapses and deaths.
Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hopes her case will be referred back to the Court of Appeal.
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