The National Audit Office recently confirmed what emergency department staff have been saying for years: despite £6.6bn spent on emergency care, A&E is not getting better (NAO). Waits are longer, corridors are fuller, and on an average day in England more than 2,000 people are being cared for in A&E corridors.
This is not a story about staff not working hard enough. Emergency departments are full of people working flat out, around the clock, in challenging conditions. Where money has been directed from the top, the front line has too often been left to absorb the consequences of decisions made far above it.
The Royal College of Nursing has argued, rightly, that the money must go upstream — into social care and community nursing — so that patients well enough to leave hospital actually can, freeing the beds A&E depends on (RCN, via Nursing Times). That case is sound.
But there’s a group of patients almost entirely absent from the funding debate — and they are among those who wait the longest, in the settings least able to help them: people who come to hospital in a mental health crisis.
The longest waits fall on the most vulnerable
The Royal College of Emergency Medicine reports that patients presenting in mental health crisis are twice as likely to spend 12 hours or more in an emergency department than other patients: nearly one in eight, against one in 16 of all attendances (RCEM, Mental Health Emergency Care). Some wait far longer — cases of 72 hours or more are not rare.
For a person in acute distress, twelve hours in a bright, loud, crowded department is not simply a delay. It can be the difference between a bad day and a traumatic one. And these patients are not waiting in a specialist mental health setting — they are waiting in the main department, cared for by general emergency staff who chose emergency medicine, and who in most cases have never been given any training in how to support someone in a mental health crisis.
Spending where it matters most
Spending has risen, and with it more staff and more diagnostic capacity — a 23% rise in emergency nurses and a 34% rise in hospital doctors since 2021, the NAO reports. And still, performance has barely moved.
That should tell us something the funding debate keeps missing: the crisis is not only about how many staff there are or how fast patients move through. It’s also about what happens in the hardest encounters — and whether staff have been equipped for them, or left to manage alone.
When no one has prepared you to support a person in crisis, the toll is real. An A&E matron, describing exactly this, told ITV News: “you just do feel so, so helpless” (ITV News). Staff can avoid that helplessness with adequate training in this area. It doesn’t require an overhaul or a revolutionary approach to ‘solving’ the mental health crisis.
Before we conclude that only drastic action will work, it’s worth asking whether we’ve even tried the simple things first. Training is one of them — achievable, low-cost, and evidence-based.
The support no one is funding
The A&E debate is dominated by vast numbers — billions of pounds, millions of attendances, thousands of corridor patients. Against that, it’s easy to overlook the things that cost little and directly change the encounter.
Giving every member of hospital staff the confidence to support someone in a mental health crisis is one of them. It needs no new building or pathway. It builds on the compassion staff already have and the expertise they’ve already earned — and it changes what those long, difficult hours feel like, for the patient and for the person caring for them.
We would never send staff onto a ward without safeguarding training. Yet acute staff meet people in mental health crisis constantly, with no equivalent preparation. That isn’t inevitable. It’s a choice made above their heads — and it can be unmade.
Fixing flow is essential. So is standing behind the staff who are already there.
None of this argues against the NAO’s conclusions. Investment in social care and community services is genuinely needed, and flow genuinely matters. But flow is about how fast people move through the system. It says nothing about what happens to them — or to the staff caring for them — while they wait. And for patients in mental health crisis, and the people holding those departments together, waiting is where the harm lands.
As the NHS decides where the next round of funding goes, it’s worth remembering that not every improvement costs billions. Some of the most meaningful change comes from properly backing the staff who are already there, on the worst day of someone’s life, doing their best in a situation no one prepared them for.