A&E is in crisis. Where does that leave us?

The media has been inundated with headlines about the A&E crisis recently. Well, the whole of the NHS is really. Around New Year’s Eve professionals were worried about how A&E would cope with a notoriously busy time of year on top of the current over stretched system.

Recently there has been an influx of posters and other resources being used by the NHS to help people decide whether or not they really need to visit A&E for treatment or if out of hours GPs, walk in centres etc may be better to go to. It strikes me as kind of “self triage” system. However what these resources seem to omit is what to do when you are in a mental health crisis. In all my years in mental health services, the thing that has been communicated to me the most is that in crisis you should go to A&E. Even crisis teams tell you to go to A&E in crisis. Seems fairly straightforward. But what happens when you get there?

I appreciate that A&E departments are primarily used to treat those in urgent need of physical treatment. But where do you go if you’re in psychological distress? Especially if out of office hours and you have no crisis team. In my experience, a majority of the time, unless you are in immediate physical danger then many staff have no time for you. (There are exceptions and I have had some amazingly positive experiences but on the whole it’s been largely negative.) While I understand that if you present at A&E in distress but not having harmed yourself you probably won’t be seen immediately, there is a difference between waiting a reasonable amount of time to speak to someone and being blatantly ignored. I feel that crisis is not being taken seriously unless you have harmed yourself/others. For instance you can tell anyone who will listen that you’re suicidal but unless you actually attempt then many won’t listen. Actions do not define the extent of someone’s distress. We should not have to wait for someone to act in a risky way to acknowledge their crisis.

This then leads to the “but am I really ill enough? Do I deserve this treatment?” Because you cannot see mental illness, it can be hard to judge the severity of someone’s difficulties by looking at them. It’s not like a visible wound where a doctor could say “yes… That needs stitches”. But when crisis is not acknowledged it can stir up a whole load of questions in an individual – why are they not listening? Do I not actually need the help I think I need? Someone who had just broken their wrist would probably not question whether or not they need a plaster cast. So why do we question whether or not we are worthy of help? Where does the government urging people to stay away from emergency departments fit into the needs of those experiencing a crisis who don’t feel as though they can go to A&E? I can’t help but feel as though many vulnerable people are being put off going to emergency departments despite needing help urgently for their mental health. The tone of many articles I have read could definitely be misinterpreted as telling people to basically stay as far away as possible from hospital.

If you are in crisis and and feel as though you are unable to keep yourself safe, please do reach out. If you do not want to go to A&E, the Samaritans are an amazing organisation.

I’m not sure that I actually got to the point that I was trying to make but I hope that it did make some sense somewhere haha. I just felt like reflecting on things that I had heard in the news over the last few weeks.

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