Children in mental health crisis waiting up to three days in A&E for specialist bed in England

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Nurses’ union criticises ‘catastrophic system-wide failure’ in NHS as more under-18s getting stuck in emergency wards

Children and young people in England having a mental health crisis are spending up to three days in an A&E unit before they get a bed in a specialist unit, NHS figures reveal.

One children’s nurse who works in an emergency department said such long waits for under-18s who were in acute distress were “frankly barbaric” but “becoming far more normal”.

Some of those who end up stuck in A&E become so troubled and disruptive that staff are increasingly using medication to sedate them to manage their behaviour.

The Royal College of Nursing (RCN) said the delays highlighted a “catastrophic system-wide failure” by NHS mental health services to intervene to stop school-age children ending up in crisis. Seeking help at A&E was often “damaging and potentially traumatising” for them, it said.

Freedom of information requests by the RCN to NHS trusts in England also found that the number of under-18s in mental health crisis forced to wait at least 12 hours before being admitted to a mental health unit had more than trebled, from 237 in 2019 to 802 in 2025.

Three trusts – Barts Health trust and Lewisham and Greenwich trust, both in London, and the Morecambe Bay trust in Cumbria – told the union that children and young people had spent three days or more waiting in their A&E for a bed.

One A&E nurse said such long waits were “extremely distressing” for the patients involved and for the staff looking after them. Another said: “A&E is just seen as this big receptacle for all children who are dysregulated or in crisis. But A&E is not respite for children with mental health concerns. It can often exacerbate their trauma.”

Dr Sam Jones, the research officer for mental health at the Royal College of Paediatrics and Child Health (RCPCH), said children in mental health crisis were now often more unwell than in the past.

“Alongside rising levels of poor mental health, the nature of need is changing fast. Problems are more complex and severe, more younger children are affected and rates of self-harm and eating disorders continue to rise,” Jones said.

The RCN estimates that almost 500,000 under-18s have sought help for mental health problems at A&E units in England since 2019. Two-thirds (80) of the trusts it asked for data provided it. The responses showed that hospitals treated a total of 330,367 such patients between 2019 and 2025.

When it extrapolated that number to include the 45 trusts that did not reply, it estimated that all trusts saw a total of about 492,350 children and young people in severe mental health distress.

Prof Nicola Ranger, the RCN’s general secretary and chief executive, said: “Half a million children and young people attending A&E in a mental health crisis is evidence of a catastrophic system-wide failure.”

The RCN and RCPCH are urging ministers and NHS bosses to speed up the rollout of a planned network of mental health emergency units so that under-18s can seek help away from A&E.

Rebecca Gray, the director of the NHS Alliance’s mental health network, said: “Too often young people with mental illness end up going to hospital emergency departments and [are] facing very long waits in an inappropriate or even harmful setting. This is bad for patients and staff.”

An NHS England spokesperson said: “Busy A&Es are not the right place for anyone in a mental health crisis, which is why children can access 24/7 support through NHS 111, combining crisis assessment, rapid response and home treatment where needed.

“The NHS has also expanded mental health services, with 70% more children accessing support than before the pandemic, while mental health support teams are also being rolled out in schools to provide earlier help and prevention.”

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