Going to A&E in a mental health crisis

Emergency departments were built for broken bones and chest pain. They are not designed for someone in a mental health crisis, and most people who go describe it as one of the hardest nights of the whole thing.

That is worth saying honestly rather than pretending otherwise. It is also not the whole story: sometimes A&E is the right place to be, and going is the reason some people are still here.

When A&E is the right call

Go, or get someone to take you, if:

• you have seriously harmed yourself and need physical treatment
• you feel unable to keep yourself safe in the next few hours
• you have taken something and need medical attention — this is urgent, and it matters more than any embarrassment about it
• someone with you is frightened for your immediate safety

If it is that urgent, phone the emergency number for your country rather than travelling.

Emergency numbers by country →

When something else is probably better

A&E is a blunt instrument and there are usually gentler routes that get you seen faster:

• NHS 111, mental health option (England) — routes you to your local crisis team, 24/7. Often the fastest way to a mental health professional rather than an emergency nurse.
• Your crisis team directly, if you are already under one. They will have given you a number; it is on the letter.
• A crisis café or safe haven. Many areas now run evening drop-ins staffed by mental health workers, specifically to keep people out of A&E. Search your area plus "crisis café" or "safe haven" — they are badly publicised and often excellent.
• A crisis line, if what you need is to talk rather than to be treated.

Find services in your country →

What the wait is actually like

Long. Frequently four to twelve hours, sometimes more.

You will be triaged quickly — usually within twenty minutes — and then you wait, often in a bright, loud, crowded room, which is close to the worst possible environment for the state you are in. If a mental health liaison team is involved, they are typically a separate team from the A&E staff and you wait for them separately.

Knowing this in advance does not fix it, but it does stop the wait itself feeling like evidence that nobody cares or that you were not believed.

What to take

1. Someone, if at all possible

   The single biggest difference. Someone to sit with you, to speak for you when you cannot, and to notice if you have been forgotten for three hours.

2. A phone charger

   You may be there most of the night. A dead phone in an emergency department at 3am is genuinely awful.

3. Your medication, or a photo of the boxes

   They will ask exactly what you take and at what dose, and "some white ones" costs you time.

4. Your safety plan, if you have one

   It answers half of what you will be asked, at a point where talking is hard. Make one →

5. Headphones, water, something warm

   Small things. The environment is the hardest part and anything that dampens it helps.

Saying it so you are heard

Triage is fast and it sorts by urgency. What you say in that first minute determines a great deal about what follows, and understatement is the common error.

Say the actual thing, plainly:

"I'm having thoughts of suicide and I don't feel able to keep myself safe tonight."

Not "I've been feeling a bit low." Not "I probably shouldn't be here." The sentence above is the one that gets you into the right pathway.

If you have already harmed yourself, say so at triage even if it seems minor. Physical assessment takes priority and it changes the order of things.

If you cannot speak — which happens, and is common — write it on your phone and show them. Nobody will think that strange.

More wording you can use →

What happens

Roughly:

1. Triage. A nurse takes brief details and sorts urgency.
2. A wait. The long part.
3. Medical assessment, if you need physical treatment.
4. Mental health assessment, by a liaison psychiatry team — a specialist team, not the A&E nurses. They will ask much the same things any assessment does. What that is like →
5. A plan. Most often: home, with a referral to a crisis team and follow-up within days. Sometimes: admission, usually voluntary. Occasionally: nothing more than the conversation, which can feel like a dismissal and is not intended as one.

Most people go home the same night. Being sent home is not a judgement that you were not serious enough — and it is very rarely detention either.

If you feel dismissed

It happens, and it is one of the most damaging experiences in this whole landscape, because it teaches people not to come back.

• Ask directly for the mental health liaison team. By name. If you have been waiting hours and have not seen them, ask whether you have been referred to them at all — sometimes the referral is what has been missed.
• Ask for the nurse in charge if you are getting nowhere.
• Have your companion ask. Bluntly, it often lands differently, and that is worth using rather than resenting in the moment.
• Do not leave without a plan. "What do I do if this gets worse tonight?" should have a concrete answer before you walk out.

If it went badly afterwards, PALS (the Patient Advice and Liaison Service) exists for exactly this and complaints do change local practice. That is for later, though. Not tonight.

Afterwards

The days after an A&E visit are a higher-risk period, and follow-up often does not arrive on time.

• You should be contacted by a crisis or home treatment team within days. If nobody has rung by the time they said, ring them — referrals do get lost.
• Tell your GP what happened. The letter may not have arrived yet, and it is often the GP who ends up holding things together.
• If you were admitted and are now home, the first days are the ones to plan for. The first 72 hours after a hospital stay →