Around half of higher‑risk mental health patients attending emergency departments (EDs) were not properly observed during their stay last year, according to new data published by the Royal College of Emergency Medicine (RCEM).
The findings, released on 11th May during UK Mental Health Awareness Week, come from the final report of RCEM’s Mental Health and Self Harm Quality Improvement Programme (QIP), which ran from 2022 to 2025.
The QIP aimed to improve care for patients attending EDs at risk of self‑harm or absconding, setting out clear clinical standards and tracking progress across emergency departments nationwide.
The programme assessed performance against three key measures:
- Whether patients received a mental health triage on arrival
- Whether medium‑ to high‑risk patients were observed throughout their ED stay
- Whether assessments included key elements such as risk, triggers and social context
The final report provides a comprehensive picture of how services have performed and where improvements are still needed.
The report found that 48.6% of high‑risk patients were appropriately observed during their ED stay in the last year. While this represents a notable improvement from 29.1% in 2023, and 42.8% in 2024, the RCEM says the figure remains too low to ensure safe, consistent care for vulnerable patients.
Observation rates were also found to drop significantly during periods of peak demand. In early December 2025, one of the busiest times of year, they fell to below 35%, highlighting the impact of seasonal pressures on emergency care.
The report shows that 76.1% of patients presenting with self‑harm received a mental health triage on arrival.
Although this is an improvement on the programme’s first year (74.6%), it represents a decline from the 81.7% recorded in year two, suggesting some regression as pressures on services have increased.
Average waiting times for triage also rose, from 42 minutes in year two to 45 minutes in year three, indicating growing demand on ED services.
While some areas of practice show strong compliance, others remain inconsistent.
The report found:
- 92.1% of patients had the type of self‑harm recorded
- But only 45.6% had a full social history documented
- 51.8% were asked about ongoing thoughts of self‑harm
- 71.8% had the trigger for their episode recorded
During the summer months, around 40% of patients were assessed across all four key areas. However, in early December 2025, this dropped to just 20%, again reflecting the impact of system pressures.
The report also assessed the presence of compassionate and practical care, a key element of patient experience. Evidence of this was found in 40.7% of cases, showing improvement compared to 38% in year two, and 30% in year one. Despite progress, the RCEM says there is still significant room for improvement in ensuring consistent, person‑centred care.
The RCEM highlights that performance against key standards is closely linked to the intense pressures facing emergency departments, particularly during winter.
High patient demand, staffing constraints and overcrowding can all make it more difficult for clinicians to deliver consistent observation, timely assessments and holistic care.
These challenges are especially significant for mental health patients, who often require additional time, resource and specialist support.
Based on the findings, the report sets out a series of recommendations aimed at improving care for patients presenting with mental health needs in emergency settings.
These include:
- Strengthening processes for continuous observation of high‑risk patients
- Improving timeliness and consistency of mental health triage
- Ensuring more comprehensive clinical assessments, including social context and future risk
- Supporting staff with the resources needed to deliver compassionate, high‑quality care
The recommendations are intended to help emergency departments deliver safer, more consistent care even in the face of rising demand.
RCEM President Dr Ian Higginson commented:
“The College thanks all sites and individuals who took part in this QIP for their contributions towards this important piece of work.
“The improvements made to care are a testament to the hard work of our staff who have been able to make positive changes despite an extremely challenging environment.
“However, today’s report shows how much still must be done to safeguard mental health patients in the ED.
“This final report has also further exposed just how difficult it is to drive improvements to patient care while our departments are overstretched, and staff are pushed over their limits.”
While improvements have been made over the course of the programme, the report highlights persistent gaps that could impact patient safety and outcomes. Strengthening support for mental health patients in Eds, including proper observation, timely assessment and holistic care, remains a critical priority for the NHS.
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