Report outlines how overstretched emergency staff are struggling to give patients at risk of self-harm or absconding proper attention.
Less than half of mental health patients at high risk of self-harm or absconding from hospital were not properly observed during their stay in Accident and Emergency (A&E) last year, as staff remain overstretched and pushed to their limits.
The stark figure comes from new data by Royal College of Emergency Medicine (RCEM), which also found a dip in the winter months, when emergency departments (EDs) are busier.
On average 48.6% of patients considered to be at medium or high-risk of self-harm or absconding were appropriately observed during their stay in 2025, according to data gathered as part of the college’s three-year improvement plan, known as the Quality Improvement Programme (QIP).
This is higher than 2023 and 2024, with averages of 29.1% and 42.8% respectively.
The figure fell to 35% in early December, while the number of full, comprehensive assessments dropped from 40% in the summer to 20% before the new year, again suggesting the added pressure on staff in the colder months.
Comprehensive assessments include the patient being asked about their social history, any further self-harm plans and the trigger for the recent episode before admission.
“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,” said Ian Higginson, RCEM president.
“However, the report shows how much still must be done to safeguard mental health patients in the ED,” he added.
“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.”
In response, the QIP recommended emergency departments focus on the timeliness and quality of the mental health triage, which occurs when the patient arrives, and the comprehensive assessments carried out by doctors to understand the risk of suicide and self-harm.
A worrying picture
The RCEM’s report is the latest to paint a worrying picture of mental health care in the UK. As reported by Healthcare Today, in February the Care Quality Commission’s annual report into the use of the Mental Health Act highlighted staff shortages, a lack of bed and inconsistencies in experiences.
The paper said that with nearly one in ten roles in NHS mental health trusts unfilled and a reliance on agency workers, staff don’t always have the capacity to build a positive relationship with patients.
And with not enough beds available, people are being placed in inappropriate environments. This can include children being placed in adult wards, people placed far from home, and, in some cases, people facing more restrictions than necessary, such as not being able to go outside even though it may be safe to do so.
Last month, the Centre for Mental Health urged health ministers to improve the support, welfare and financial advice available for those undergoing treatment.
The charity argues such help will reduce hospital stays and prevent readmissions as well as reduce pressure on clinical staff to provide help outside of their expertise.