A new report from The Royal College of Emergency Medicine finds that patients presenting with mental health problems are twice as likely to spend 12-hours or more in Emergency Departments than other patients.
National data show that nearly one in eight (12%) mental health patients presenting to an Emergency Department in crisis face a 12-hour stay from time of arrival, compared with nearly one in 16 (6%) of all attendances.
A recent SNAP survey of Emergency Departments found that more than one third of clinical leads reported patient stays of 72 hours or more in the last week, for patients with mental health needs.
‘Mental Health Emergency Care’ is the latest report in our series of explainers looking at the web of issues facing Emergency Departments. The report highlights that while patients with mental health presentations account for a very small proportion of Emergency Department attendances, they spend a disproportionate amount of time waiting for a mental health bed if they need admission.
Often, it is the patients who are most unwell and vulnerable that wait the longest. Those of greatest concern are patients waiting for a mental health bed, patients waiting for an assessment under the Mental Health Act, and Children and Young People presenting in crisis.
The prevalence and complexity of the mental health needs of children and young people increased during the pandemic, while capacity is struggling to meet surging demand.
Half of Emergency Departments in England reported waits of 12 to 24 hours for a child or young person to see a specialist mental health professional, despite the accepted standard for adults being a one hour wait to be seen.
If admission is needed, 46% of Emergency Departments reported that children and young people will wait more than 48 hours for a bed, with two respondents reporting a wait of five days in the Emergency Department.
The report looks in detail at factors contributing to these long waits, such as the reduction in mental health beds, inadequate numbers of children and adolescent mental health professionals, and poor organisation of professionals to assess patients under the Mental Health Act. It also examines the consequences for patients and departments and makes wide reaching recommendations.
Commenting on the findings of the report, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The system is failing patients who present to Emergency Departments in mental health crisis.
“Those waiting the longest are children and young people, patients waiting for admission to a bed, and patients waiting for assessment under the Mental Health Act. It is unacceptable.
“We know long waits in a busy and crowded environment are harmful for any patient, but for these patients it can cause deep distress and upset and worsen their mental state. We must do more to ensure that these patients are seen, treated, and directed to the right care quicker.
“These patients presenting to Emergency Departments are extremely vulnerable, they are in crisis and seeking Emergency Care, yet are left waiting for hours and even days, before being treated and admitted.”
The explainer also shows that the UK has only 37 psychiatric beds per 100,000 population – far lower than the OECD average of 71 psychiatric beds per 100,000 population – and that since 1987, over 48,000 NHS mental health beds have been cut in England, with 5,000 mental health beds having been cut since 2011 alone.
Dr Henderson said: “Data show that bed occupancy at mental health trusts averaged nearly 90% between 2017-20, 5 percentage points higher than the recommended 85%. The NHS mental health bed numbers are clear; capacity does not meet demand.
“While the move towards a provision of community mental health care has been positive, the cuts to emergency mental health care beds have been devastating. Now, the most vulnerable and desperate patients are truly suffering.
“We urgently need to see an increase in mental health bed capacity, so we are able to admit these patients to a bed and provide the care they urgently need. We regularly hear heart-breaking stories of young people being admitted a long way from their home and family.
“We urge the new Prime Minister and new Health Secretary to prioritise Mental Health care provision in Emergency Departments, especially ahead of winter.
“We are failing these patients and they are suffering; our report and supporting survey show the extent of this crisis. We need urgent action now. To ensure we are able to quickly and effectively help vulnerable patients in crisis the government must increase mental health bed capacity in Trusts.
“Capacity for Children and Adolescent Mental Health Services (CAMHS) is especially important, and CAMHs should be expanded to 24/7 so that children and young people can be assessed and triaged whenever they present at Emergency Departments, rather than face long waits for these services to open.”
First Minister Nicola Sturgeon’s briefing from St Andrew’s House this morning:
Good morning,
I am joined here today as you can see by the Chief Medical Officer.
Now today’s full Covid statistics will be published later on today, so I’m not going to provide all of the detail of those right now.
I can though confirm that the overall situation in Scotland does remain stable at this stage.
We have in recent days been seeing cases declining slightly.
We knew, however, that the weeks ahead would present real risks to this stability.
Colder weather forcing us indoors. Festive socialising. And a deteriorating situation in many countries across Europe.
However, over the past few days a new risk has emerged in the form of the Omicron variant and it is that that we want to update you on today.
I am going to set out what we know so far about the new variant – though I stress there is still much that we and the rest of the world do not know about it.
I will also give the most up to date information we have on numbers of cases identified so far here in Scotland – though I expect that this will be a developing situation in the days ahead.
I will set out the actions we have considered it appropriate to take so far on a precautionary basis.
And of course I will remind everyone what we can all do – must do, in fact – to help contain the spread of the virus in general but this new variant in particular.
Firstly, what do we know at this stage?
And as I said a moment ago, the most important point to make – which was underlined in a briefing issued by the World Health Organisation last night – is that there is still a huge amount that we do not know about the variant.
The number of mutations that it has – and the nature of these – and some of the very early indications from Southern Africa have raised the concern that this variant might be more transmissible than Delta which of course is currently the dominant variant in Scotland and many other countries.
However, much more data and analysis is required to be certain of this and, if it is more transmissible, to understand by how much.
Further work is also needed to confirm what impact this variant might have on the effectiveness of vaccines and the risk of re-infection.
The WHO said yesterday that preliminary evidence suggests there might be an increased risk of re-infection but stressed that information at this stage is still limited.
It also said that there is currently no information to suggest that the symptoms from Omicron are any different to the symptoms from other variants.
In other words, although again more data is still required, there is no evidence at this stage to suggest that the disease caused by Omicron is more severe.
Now the days and weeks ahead will tell all of us much more about the nature of this variant and therefore its implications, if there are implications, for our response to the pandemic.
What we do know at this stage, though, confirms in my view that we should treat it seriously, and we should continue to act on a precautionary basis at this stage.
While we all hope that the emerging understanding of it will reduce rather than increase our level of concern, there is no doubt that this presents – potentially – the most challenging development in the course of the pandemic for quite some time.
Let me turn now to the situation in Scotland. We have stepped up our surveillance in recent days and I want to thank public health teams for the work they are doing to ensure that we are able to detect cases of this variant quickly.
As we confirmed earlier today, that enhanced surveillance has identified 6 cases of the Omicron variant in Scotland so far – 4 of these are in Lanarkshire and 2 in Greater Glasgow & Clyde.
Now it is important for me to stress that the contact tracing of these cases is still ongoing. However, at this stage, we know that not all of them have any recent travel history to, or known links with others who have travelled to, the countries in Southern Africa where the variant was originally detected.
This suggests that there might already be some community transmission of this variant in Scotland but again let me stress there is no evidence yet that this is sustained – nor any evidence from the enhanced surveillance that it is widespread at this stage.
However, evidence of even limited community transmission underlines the importance of all of us increasing our compliance with the protections that are in place.
And I will turn now to the actions we have taken.
We have already reintroduced some travel restrictions – even with evidence of community transmission locally, these travel measures are important and I will say more about them shortly – but given that Omicron is already present in Scotland, we also need to consider carefully what steps are necessary and proportionate to reduce transmission here.
Some protections that the UK Government has announced in recent days in relation to England – for example the requirement to wear face coverings in some settings – are of course already in place, and in fact more extensive already, here in Scotland.
So at this stage, we are asking people, everyone across the country, to significantly step up and increase compliance with all existing precautions – face coverings, hygiene like washing hands and surfaces, getting vaccinated and of course testing yourselves regularly with lateral flow devices and, from now on, testing yourself before mixing socially with people from other households.
We are also reminding people to work from home if possible. As of today, I’m asking employers to make sure they are maximising the potential of home working.
However, this may be, and is likely to be, a fast-moving situation – so our response will be kept under close review as we learn more about the risk Omicron poses, and the nature of transmission here in Scotland.
A key part of our initial response will be to continue to identify cases as quickly as we can and, where possible after that, break the chains of transmission.
To that end, additional testing will be undertaken in areas where cases have been identified.
Now, our local response will complement the UK-wide travel restrictions that aim to avoid importing new cases while we are trying to curb community transmission.
Even with cases already here, it is really important to do what we can to prevent new seeding of the variant from elsewhere.
So in line with the rest of the UK, we have reinstated the red list of countries, and to date 10 countries from southern Africa have been added to that red list.
Anybody travelling back to Scotland from those 10 countries must enter managed quarantine for 10 days on their arrival.
In addition, anyone arriving in Scotland from anywhere outside the common travel area, will be asked to take a PCR test on the second day after arrival, and self-isolate until they get the result of that test.
We know, however, that the incubation period for this virus is very often more than 2 days.
So our view is that it would be sensible on a precautionary basis for these travel rules to be tightened further.
That’s a view shared by the Welsh Government.
I had a called yesterday with First Minister Mark Drakeford and he and I have this written this morning a joint letter to the Prime Minister.
We are proposing a tougher four-nations approach to travel restrictions at this stage that would see people arriving in the UK from overseas asked to self-isolate for eight days. Under our proposal, they would take a PCR test on day eight of their arrival, as well as on day 2.
We believe this measure would be more effective in identifying cases of this variant which result from overseas travel, and therefore help us prevent further community transmission from imported cases.
Now as we know from earlier stages of the pandemic, with so many people travelling to Scotland and indeed to Wales via airports in England, anything less than a four-nations approach to requirements like this will be ineffective. So we hope that a four-nations agreement can be reached.
A four-nations approach obviously requires the four nations to discuss these issues together, and hear the best advice available.
So Mark Drakeford and I have also called on the Prime Minister today to immediately convene a COBRA meeting – with representation from each nation – to discuss what additional steps we might have to consider and how we work together to tackle this new risk.
Mark Drakeford and I are also conscious of the very real concern businesses and staff will feel at the possibility of further protections becoming necessary.
Now let me stress we all hope this will not be necessary but it is prudent to plan ahead and so we have also sought confirmation that – should any further protections be necessary – Treasury funding will be available to any of the four nations that require to activate business support schemes.
Now, given the serious tone and content of my statement today, I want to stress this.
It is always important – and we’ve learned this over these past two years – in the face of new developments in this virus to prepare for the worst, to act on a precautionary basis.
But that does not mean that we are not hoping – because we are hoping – for something considerably short of the worst. We are still hoping for the best, and hoping that our developing understanding of this variant will reduce rather than increase our concern.
I very much hope that additional protections can be avoided. And while we will act on a precautionary basis we will also seek to act at all times in a proportionate manner.
I want to end by stressing what we can all do. Vaccination remains our most important line of defence.
We had already outlined last week that the Scottish Government was working to accelerate even further the booster vaccine programme. We will now step up those efforts more.
We are expecting a statement later today from the JCVI conforming its updated advice on vaccination.
The Scottish Government is getting ready to operationalise any new recommendations from the JCVI – for example in relation to the interval between second doses and boosters, or the range of people who can now receive booster jags and we will do that as quickly as is possible.
Vaccines do remain our best line of defence and I want to stress this point
If – and it is still an if – vaccines do prove to be less effective against this new variant, vaccination will still be hugely important.
Less effective does not mean ineffective.
If anything, the new variant makes it more important – not less important – to get all doses of the vaccine.
Over the weekend, 40-49 year olds became able to book boosters through NHS Inform.
Older age groups can already do so.
So if you are 40 or over, go to the website, book a booster for when you are due it.
And if you haven’t yet had your first or second doses, please book an appointment to get them now.
The Scottish Government will consider carefully in the coming days any further actions that are necessary, as we get more information about this variant and the extent of its presence here.
But the point I want to end on, and indeed stress at this stage, is that the same measures that have worked against previous strains of this virus, will also help us curb any transmission of this new variant.
So if in recent weeks you’ve been sticking a bit less rigorously to all of the public health advice, which I think is entirely understandable and I am sure we are all in that position to a greater or lesser extent, now is the time to start following all of that advice rigorously again.
Every one of us can make a difference in protecting ourselves and each other.
So let me just end with a reminder of what all of us can do and what it is really important that all of us do at this stage.
These steps are now vital so I am asking everybody not to see this as optional.
Firstly, get vaccinated.
It is the single most important thing we can do to protect ourselves and each other.
Secondly, test for Covid regularly. As I said, we will be increasing testing in areas where the new variant has been identified.
But for all of us, wherever we are, even if we are feeling fine, regular lateral flow testing is a really important way of finding out if we might have the virus.
So on any occasion that you are intending to socialize, or mix with people from other households – whether that is in a pub, a restaurant, a house or even a shopping centre – please do an LFD test. You can get kits online, or pick them up from local pharmacies or test centres. They are free so get as many as you need and keep your supply topped up.
And finally, comply with all of the existing protections.
Wear face coverings on public transport, in shops, and whenever you are moving about in hospitality settings.
Keep windows open if you have people in your house to improve ventilation because we know that helps.
Follow all advice on hygiene. It is time to go back rigorously to washing our hands, to cleaning surfaces.
And as I said earlier, please work from home right now if you can.
The Economy Secretary will be meeting business organisations later this afternoon and stressing that home working when possible will help us get through the winter and also this latest risk more safely.
The discovery of the new variant makes these measures more important than ever before. They will make a difference. And by sticking to them, we give ourselves the best possible chance of enjoying the more normal Christmas we are all looking forward to, but enjoying not just a more normal Christmas but a safer Christmas too, and hopefully avoiding the need for any tighter protections in the weeks to come.
So please, let’s all of us make sure that we up our compliance right now. This of course is a concerning development but if we take it as a reminder not to let our guard slip, then I hope we can protect the stronger position that we had already got ourselves into.
So please, get vaccinated, test yourself regularly, and follow all of the protections that are in place.
Thank you to everybody for doing all of these things and for what I know everybody will be seeking to do in the weeks ahead.
Council Leaders urge citizens to help limit Covid spread
City council leaders have urged residents to continue and renew efforts to help limit the spread of the Covid virus following the emergence of the new Omicron variant in Scotland.
The call from Council Leader Adam McVey and Depute Leader Cammy Day comes after First Minister Nicola Sturgeon gave a national update earlier today (Monday).
The First Minister stressed the importance of getting vaccinated, carrying out lateral flow tests regularly and rigorously following existing advice, including wearing masks, sanitising hands and surfaces and working from home where possible.
Council Leader Adam McVey said: “With the emergence of the new Omicron variant it’s essential that we follow a precautionary approach. While we’re still learning about this variant it’s right that we take action to protect ourselves and those around us.
“We must continue our efforts to limit its transmission, particularly as we head into the coldest winter months. First and foremost that means getting vaccinated – get both your jags and, if eligible, your third, booster dose.
“It’s also crucial that we test ourselves regularly, especially if we’re mixing with others, and, of course, carry on following the public health guidance on handwashing, face-coverings, ventilation and meeting outdoors wherever possible.
“There’s so much we can do to slow the virus’s spread and, hopefully, enjoy the more ‘normal’ Christmas we’ve all been waiting for.”
Depute Leader Cammy Day said: “The latest developments demonstrate that, while we’ve been making strides to limit the spread of the Covid virus, we need to remain alert.
“We can’t let all the sacrifices we’ve made so far go to waste – now is the time to redouble our efforts, look after one another and follow the rules.
“Together we can help limit the spread of the virus, reducing pressure on our health and care services over the winter and the need for further restrictions.”
Community test centres and mobile test centres are open for people with no Covid symptoms. Full details of these, and how to order home lateral flow testing kits, are available online.
