Children and young people in England experiencing a mental health crisis are spending up to three days in emergency departments before being admitted to a specialist unit, according to NHS figures released on Wednesday. The Royal College of Nursing (RCN) described the situation as a 'catastrophic system-wide failure' of mental health services.
Distressing delays for vulnerable patients
A children's nurse working in an emergency department described the long waits for under-18s in acute distress as 'frankly barbaric' but noted that such delays are 'becoming far more normal.' Some young patients become so agitated and disruptive that staff are increasingly resorting to sedation to manage their behaviour.
The RCN warned that seeking help in A&E can be 'damaging and potentially traumatising' for young people. One nurse said the long waits were 'extremely distressing' for both patients and staff. Another added: '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.'
Sharp rise in waiting times
Freedom of information requests submitted 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 and Lewisham and Greenwich in London, and Morecambe Bay in Cumbria—reported that children and young people had spent three days or more waiting in A&E for a bed.
Dr Sam Jones, research officer for mental health at the Royal College of Paediatrics and Child Health (RCPCH), said children in crisis are 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,' he said.
Half a million children affected
The RCN estimates that nearly 500,000 under-18s have sought help for mental health problems at A&E units in England since 2019. Two-thirds of the trusts surveyed provided data, showing hospitals treated 330,367 such patients between 2019 and 2025. Extrapolating to include non-responding trusts, the RCN estimates 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.'
Calls for alternative care settings
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 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 defended current efforts, stating: '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.'
