NHS England published its Model Emergency Department guidance on 9 February 2026, setting out how high-performing emergency departments should be structured, staffed and operated. It’s the most comprehensive framework for ED design in years — and mental health runs through it.
The guidance explicitly names mental health conditions alongside frailty and learning difficulties as vulnerabilities that overcrowding makes harder to identify and manage safely. It calls for trauma-informed practice, de-escalation training, and rapid mental health assessment — with liaison services expected to deliver a 1-hour response time for referrals from the ED. It references mental health EDs co-located with Type 1 emergency departments. And it acknowledges what we’ve been saying for years: that staff need appropriate training to recognise and respond to vulnerability, even in patients who appear low risk.
This matters because it confirms, at a national policy level, that mental health care in acute hospitals is not a specialist-only concern. It is everyone’s responsibility.
The EEMAC model and what it means for mental health patients
The most significant structural change is the introduction of Extended Emergency Medicine Ambulatory Care (EEMAC) — a pathway for patients who need longer than 4 hours of assessment but are expected to be discharged, not admitted. Patients can now spend up to 12 hours total under emergency medicine care: 4 hours in ED, then up to 8 hours in an EEMAC area.
For mental health patients, this is a double-edged sword. On one hand, it creates a legitimate pathway for the kind of extended assessment that lower-risk mental health presentations often require — rather than those patients being treated as 4-hour breaches. On the other hand, the EEMAC Operating Principles specifically exclude patients in acute mental health crisis who are at risk to themselves or others, or who are likely to require admission. These patients are expected to remain in the main ED or be moved to specialised mental health areas — meaning the highest-need mental health patients are not covered by this new pathway.
This creates a gap. The guidance is clear that EEMAC should not be used for patients awaiting transfer to other areas of the hospital. But we know from experience that when staff on acute wards lack confidence in supporting mental health patients, exit block happens — not because ward beds aren’t available, but because receiving teams don’t feel equipped to accept the transfer. The Model ED guidance doesn’t solve that problem. Workforce education does.
Training is in the guidance — but not the detail
The document calls for staff to be “trained in trauma-informed practice and de-escalation techniques.” It references the need for “appropriate training in recognised safeguarding or vulnerability issues.” But it stops short of specifying what foundational mental health education should look like for all ED staff, or how trusts should ensure that the workforce across the whole hospital — not just the emergency department — is equipped to support patients in mental health crisis once they leave the front door. The burden of defining clear patient pathways and workforce preparation is left to individual trusts, with no national standard for what that education should include.
This is the gap. The Model ED guidance outlines what trusts’ emergency departments should look like. It doesn’t tell them how to ensure their workforce is prepared for the mental health presentations that will walk through the door.
What trusts should take from this
The direction of travel is clear. NHS England is building a framework where mental health care in acute hospitals is structurally embedded, not bolted on. Between the NHS Oversight Framework, the CQC’s commitment to closely scrutinise mental health care in all acute inspections, and now the Model ED guidance, trusts are being assessed on their ability to support patients in mental health crisis from every angle.
The policy framework is tightening, and trusts need a mental health education strategy that equips all staff to meet the standard now expected of them.
For the published evidence showing how mental health presentations directly affect the metrics by which acute hospital trusts are judged, read our briefing report: The NHS Oversight Framework, Acute Hospitals, and Mental Health.