Access to Services (NHS Oversight Framework series): The Mental Health Crisis in Emergency Care

Part 1 of a 4-part series exploring how acute hospital staff support patients in mental health crisis, and why this directly impacts NHS Oversight Framework metrics that determine organisational performance.

The Strategic Case for Mental Health

The NHS Oversight Framework, introduced in 2025, measures trusts on their ability to admit, transfer or discharge patients within 4 hours and monitors the number of patients spending more than 12 hours in emergency departments. These metrics directly reflect organisational performance ratings.

Yet patients presenting with mental health needs are twice as likely to spend over 12 hours in emergency departments than other patients (Royal College of Emergency Medicine, 2022). Longer wait times create increased distress, heightened risk of escalation or absconding, and increased pressure on overall capacity.

This is a strategic issue. Mental health patient presentations are directly impacting how trusts perform against their NHS Oversight Framework metrics.

Why This Happens

A primary cause of emergency department waiting time breaches is “exit block” – patients waiting in the department after a decision to admit them has been made. These delays, often called “trolley waits,” are among the clearest indicators of broader hospital and system pressure (The King’s Fund, 2024).

For mental health patients specifically, the problem is compounded. A lack of staff knowledge and confidence leads to delays in transferring patients with mental health needs from the emergency department to general inpatient wards. Staff on acute wards do not always feel they have the skills or support to care for people with mental ill health. Staff report a lack of knowledge and confidence in dealing with mental health conditions, which leads to resistance from both the referring and the receiving team. This leads directly to delayed transfers from the emergency department and a lack of timely access to appropriate care (National Confidential Enquiry into Patient Outcome and Death, 2017).

In short, staff across acute hospitals lack the foundational mental health education necessary to perform their job effectively. When they feel unsure how to support a patient in crisis, the system backs up – and organisational performance suffers.

The Solution: Building Staff Capability

Whilst we acknowledge that education cannot provide the whole solution to a complex and systemic issue, we know that improving staff confidence can directly impact access to timely and appropriate care.

Our partner trusts have deployed We Can Talk – a one-hour, self-directed mental health training for hospital staff – and seen measurable results:

• Staff report a 45% increase in confidence in supporting patients in mental health crisis
• Staff feel 60% more knowledgeable in supporting these patients in practical ways

(We Can Talk, 2026)

When staff understand how to support patients in crisis, they move them through the system faster. The bottleneck clears; patients access appropriate care sooner, and trusts are better equipped to meet their 4-hour targets.

Over one million people attend hospital due to their mental health each year. These patients are among the most at-risk of experiencing lengthy delays in emergency departments. Increasing staff confidence in supporting patients in mental health crisis is an essential part of improving emergency care – and is directly linked to NHS Oversight Framework performance.

Stay Updated on the NHS Oversight Framework Series

This is the first in a four-part blog series exploring how acute hospital staff support patients in mental health crisis, and why this directly impacts NHS Oversight Framework performance.

Part 2 – Effectiveness and Experience of Care: The Hidden Crisis of Patient Experience

Part 3 – Patient Safety: Is Mental Health and Safety at Risk?

Part 4 – People and Workforce: Why Patient Mental Health is a Workforce Crisis