Mental Health Crisis: When and How A&E Can Help

A&E is there for mental health emergencies too

A&E is not only for physical injuries and illness. If you or someone you are with is in a mental health crisis — at immediate risk of harming themselves or others, or experiencing a severe psychiatric episode that makes them unable to keep themselves safe — A&E is a valid and appropriate destination. You will not be turned away, and you are not wasting anyone's time.

Mental health emergencies include:

• Active suicidal intent — a plan to end your life that you are about to act on, or have already acted on (such as taking an overdose)
• Self-harm requiring medical treatment — deep cuts, burns or injuries that need wound care, or ingestion of harmful substances
• Psychotic episodes — seeing or hearing things that are not there, severely disorganised thinking, or paranoid beliefs that are putting you or others in danger
• Severe panic or dissociation — where you feel so disconnected from reality that you cannot function or keep yourself safe
• Extreme agitation or aggression triggered by a mental health condition, where there is a risk of harm

What happens at A&E for a mental health crisis

Arrival and triage

You arrive and check in the same way as any other patient. At triage, the nurse will assess both your physical safety (especially if you have taken substances or self-harmed) and your mental state. You should be open about what has happened, including any substances taken, self-harm, or suicidal thoughts. Staff need accurate information to help you safely.

The triage process applies to mental health presentations in the same way as physical ones — your clinical urgency determines your priority. If you have taken an overdose or are actively self-harming, you will be triaged as high priority. If you are in severe distress but physically safe, you may wait longer, and this can feel difficult. Let staff know if your distress escalates while you wait.

Physical assessment first

If there is any physical component — an overdose, self-harm injuries, substance intoxication — A&E will treat the physical issue first. This is not dismissing the mental health component; it is ensuring your immediate physical safety. Blood tests, wound treatment, monitoring of vital signs and sometimes activated charcoal or antidotes for overdoses may be needed before a psychiatric assessment can begin.

Psychiatric assessment

Once you are physically stable, a mental health liaison team — sometimes called the psychiatric liaison service, crisis team, or RAID team — will assess you. This team usually includes psychiatric nurses and sometimes a psychiatrist. They will talk to you about what has happened, your mental health history, your current circumstances, and what support is available to you.

The wait for the mental health team can sometimes be long, particularly during nights and weekends when the team may be covering the whole hospital. This is a known gap in the system, and advocacy groups have pushed for better funding of 24-hour liaison services. If you are waiting a long time, ask staff for an update on when the team will be available.

Possible outcomes

After assessment, several things may happen:

• Discharge with crisis team follow-up — the most common outcome. You are connected with the community crisis team, who will contact you within 24 hours (usually by phone or home visit) to begin a short-term support plan.
• Voluntary admission — if you agree, you may be admitted to a psychiatric ward for a period of observation and stabilisation.
• Admission under the Mental Health Act — in rare cases where you are assessed as posing an immediate risk to yourself or others and are refusing voluntary treatment, a Mental Health Act assessment may be arranged. This requires two doctors and an approved mental health professional. You have rights during this process and should be informed of them.
• Referral to community services — for less acute presentations, you may be referred to your GP, a community mental health team, or talking therapy services.

Alternatives to A&E for mental health crises

A&E is not always the best setting for mental health support. Emergency departments are noisy, brightly lit, clinical environments with long waits — none of which is ideal when you are in severe psychological distress. Several alternatives exist:

Crisis lines

• Samaritans — call 116 123 (free, 24/7), email jo@samaritans.org, or visit a branch. For listening and support, not clinical intervention.
• Crisis text line — text SHOUT to 85258 (free, 24/7). Trained volunteers respond via text.
• NHS 111 — option 2 connects you to a mental health crisis line in many areas. Our 111 guide covers how the service works.
• Your local crisis team — if you are already known to mental health services, your care plan should include a crisis contact number. Call this before going to A&E.

Crisis cafes and safe spaces

Many areas now operate crisis cafes — sometimes called safe havens or crisis houses — where you can walk in during evenings and weekends for face-to-face support in a calm, non-clinical environment. Staff are trained in mental health support and can help you stabilise without the pressures of an A&E department. Ask your GP or local NHS trust for details.

999 for immediate danger

If you are about to act on suicidal thoughts, or someone is at immediate risk of serious self-harm, call 999. Paramedics can provide immediate safety and transport to A&E. This is not an overreaction — it is exactly what the service is for.

Supporting someone else in crisis

If you are with someone who is in a mental health crisis:

• Stay with them. Do not leave them alone if they are at risk.
• Listen without judgement. You do not need to fix the problem — being present and hearing them is valuable.
• Remove means of harm if you safely can. Put medications, sharp objects or alcohol out of reach.
• Encourage them to seek help. Offer to call 111, Samaritans, or their crisis team together.
• If they refuse help and are in immediate danger, call 999. You do not need the person's consent to call an ambulance if their life is at risk.

At A&E, you can stay with the person unless asked to leave by clinical staff. Your observations about their behaviour — what they said, what they did, how they have been in recent days — are valuable diagnostic information. Share this with the triage nurse and the mental health team.

Your rights during a mental health A&E visit

You have the same rights as any other patient. You are entitled to be treated with dignity, to have your condition explained, and to consent to or refuse treatment (with limited exceptions under the Mental Health Act). You can ask for a same-sex clinician, an interpreter, or an advocate. Our patient rights guide covers these in full.

If you feel your mental health crisis was not taken seriously at A&E, or that you were treated dismissively, you have the right to raise a complaint through the hospital's PALS service.

After the crisis

Reducing the distress of a mental health A&E visit

A&E environments are not designed for mental health crises. The bright lights, noise, unfamiliar faces and clinical smells can intensify distress. Some practical steps can help:

• Bring headphones — music or a podcast can create a small pocket of calm in a chaotic environment
• Ask for a quiet space — many departments have a dedicated quiet room for mental health patients. If one is available, request it.
• Bring a trusted person — having someone you trust with you provides emotional grounding and practical advocacy
• Write things down — if speaking is difficult, write your key symptoms, history and concerns on your phone or a piece of paper and hand it to the triage nurse
• Bring your crisis plan if you have one — it tells staff what works for you and what does not
• Be honest about substances — if you have taken alcohol, recreational drugs or extra doses of medication, tell staff. This is clinical information, not a moral judgement, and withholding it can delay your care or lead to dangerous interactions

The A&E environment and self-harm risk

If you are attending A&E because of self-harm thoughts and are worried about the wait, tell the triage nurse explicitly. They can arrange observation or check-ins during your wait. You can also ask for any items you are concerned about to be held by staff until you leave.

After the crisis

A mental health crisis is not a one-off event for most people — it is usually part of a longer journey. After discharge, the most important step is engaging with the follow-up offered. This might be crisis team visits, a GP appointment, a referral to therapy, or a medication review. Our after discharge guide covers follow-up care for both physical and mental health presentations.

Building a crisis plan for next time — including contact numbers, coping strategies, people to call and a list of things that help — makes future crises more manageable and may help you access support before reaching the point of needing A&E.

Bottom line

A&E will see you for a mental health emergency. You are not wasting time and you will not be turned away. But if you can safely access crisis lines, crisis cafes or your local crisis team first, these services often provide better-suited support faster. For immediate danger — to yourself or others — call 999 without hesitation. If you do need to attend in person, check live wait times to find the least busy department near you.