Children and young people in England experiencing a mental health crisis are waiting up to three days in emergency departments before receiving a bed in a specialist unit, according to NHS figures. A children's nurse working in an emergency department described such lengthy waits for under-18s in acute distress as 'frankly barbaric' but noted that these delays are 'becoming far more normal.'
Impact on Patients and Staff
Some young patients become so distressed and disruptive that staff are increasingly using medication to sedate them to manage their behavior. The Royal College of Nursing (RCN) stated that these delays highlight a 'catastrophic system-wide failure' by NHS mental health services to intervene early and prevent school-age children from reaching crisis point. Seeking help at A&E, the RCN added, is often 'damaging and potentially traumatising' for these children.
Rising Numbers and Lengthy Waits
Freedom of information requests by the RCN to NHS trusts in England revealed that the number of under-18s in mental health crisis forced to wait at least 12 hours before admission to a mental health unit has more than trebled, from 237 in 2019 to 802 in 2025. Three trusts—Barts Health trust and Lewisham and Greenwich trust in London, and Morecambe Bay trust in Cumbria—reported that children and young people had spent three days or more waiting in A&E for a bed.
One A&E nurse described such long waits as 'extremely distressing' for both patients and staff. Another nurse 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.'
Changing Nature of Mental Health Needs
Dr. Sam Jones, research officer for mental health at the Royal College of Paediatrics and Child Health (RCPCH), noted that children in mental health crisis are 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.
Half a Million Children Affected Since 2019
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 that provided data reported treating a total of 330,367 such patients between 2019 and 2025. Extrapolating to include the 45 trusts that did not respond, the RCN estimates that all trusts saw approximately 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.'
Calls for Action
The RCN and RCPCH are urging ministers and NHS leaders to accelerate the rollout of a planned network of mental health emergency units, so that under-18s can receive appropriate care away from A&E. Rebecca Gray, 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 facing very long waits in an inappropriate or even harmful setting. This is bad for patients and staff.'
An NHS England spokesperson responded: '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 being rolled out in schools to provide earlier help and prevention.'
