New data finds around half of high-risk mental health patients not properly observed

Nation.Cymru Team

Royal College of Emergency Medicine (RCEM) data finds that around half of higher-risk mental health patients in Emergency Departments were not properly observed during their stay last year.

The new data published today, 11 May, which is the first day of UK Mental Health Awareness Week. The data is published in the 2025 annual report for the Mental Health and Self Harm Quality Improvement Programme (QIP).

RCEM’s QIPs are designed to improve care and awareness of particular issues in Emergency Departments among clinicians, offer recommendations on practice and in turn drive improvements to patient care.

Today’s report is the final one for the QIP on Mental Health and Self Harm, which ran from 2022-2025 and tracked progress in the care for patients attending EDs across the UK at risk of self-harm and absconding.

It measured EDs against three standards:

• Patients having a mental health triage by clinicians on arrival to gauge their risk of further adverse events, including self-harm or leaving without assessment.
• Patients deemed medium or high-risk of further self-harm or absconding should be observed during their whole length of stay in the ED
• Assessment of patients presenting with self-harm by an ED clinician should include a brief assessment of ongoing risk, the type of self-harm inflicted, the trigger for the episode, a brief social history and any current thoughts of further self-harm

The report found that an average of 48.6% of patients deemed medium or high risk of self-harm and absconding from the ED were appropriately observed last year.

This is a significant improvement on 2023, where the average was 29.1%, and a slight improvement on the 2024, when it was 42.8%.

Observation rates, the report found, dipped to an average of below 35% in early December 2025 – one of the busier times of year for EDs, which adds further barriers for staff in delivering high quality care including patient observation.

Almost three quarters (76.1%) of patients presenting with self-harm underwent a mental health triage, lower than in year 2 (81.7%) of the QIP, but slightly better than year 1 (74.6%). Meanwhile, mean average times to triage increased from 42 minutes in year 2 to 45 minutes in year 3 and may be indicative of increasing demands on ED services.

The report also found:

• The vast majority (92.12%) of patients presenting with self-harm had the type of self-harm recorded
• Meanwhile, just 45.6% had an adequate social history recorded, around half (51.8%) were asked about further self-harm plans or thoughts, and less than three-quarters (71.8%) had the trigger for the episode recorded

40% of patients, during the summer, were asked about all four of these areas. In early December 2025, only around 20% were asked.

The report noted that performance against the clinical standards was likely impacted by the high demand and pressures facing EDs, particularly in winter.

Evidence of compassionate and practical care for patients presenting with mental health needs was recorded in 40.7% of cases. The data shows an improvement on year 2 (38%) and year 1 (30%).

Based on these findings, the QIP report made a series of recommendations aimed at driving further improvements for each clinical standard for care of mental health patients in ED.

Improvement 

Dr Nirmal James, Topic Lead for the QIP, said: “This final report has shown an improvement in addressing certain key factors of health care quality including compassionate and practical care.

“However, the high demands facing EDs will likely have had an impact on delivery of some of key standards covered by the QIP.

“It is encouraging to see some of our most vulnerable patients are being observed throughout their stay in ED far more than they were before we embarked on this project.

“However, there is still scope for improvement, and I hope the findings and recommendations from this QIP can continue to drive improvement in patient care.”

Important work

Dr Ian Higginson, RCEM President, said: “The College thanks all sites and individuals who took part in this QIP for their contributions towards this important piece of work.

“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,

“However, today’s report shows how much still must be done to safeguard mental health patients in the ED.

“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.”