A new report from the Royal College of Nursing has highlighted concerns regarding the corridor care of individuals experiencing a mental health crisis.
Key issues include inadequate facilities, insufficient psychiatric hospital beds and the inappropriate placement of mental health patients in general hospital settings.
These factors contribute to compromised patient safety, delayed care, and increased strain on healthcare staff.
A recurring theme in the corridor care report is the shortage of psychiatric hospital beds, leading to prolonged stays in emergency departments (EDs) or general hospital wards.
Mental health patients are often placed in environments that are neither safe nor appropriate for their needs. Some patients remain in emergency departments for up to five days due to a lack of available psychiatric beds.
In interviews with frontline nursing staff, this situation has been found to contribute additional stress for both patients and healthcare staff – with EDs not designed to provide long-term mental health care.
Mental health (MH) patients, the report found, are frequently being positioned in corridors, general wards or non-clinical spaces due to overcrowding. Such placements lead to a lack of privacy and dignity, increased anxiety and distress for both mental health and physical health patients and create safety concerns, including the risk of self-harm or harm to others.
Nursing staff report having to provide one-on-one care for sectioned patients in corridors, which is challenging and often distressing for other patients nearby. Some mental health patients are left in waiting areas, offices or makeshift spaces that lack essential safety measures such as panic buttons and appropriate monitoring equipment.
The lack of suitable facilities for mental health assessments and crisis intervention can lead to delays in treatment and increased risks for patients. Examples from the report include:
- Patients in crisis being assessed in corridors or waiting areas, compromising confidentiality and the quality of care
- Increased likelihood of patients absconding due to a lack of supervision, sometimes requiring police intervention to ensure their safety
- The use of makeshift observation areas where patients are continuously monitored, which can feel intrusive and exacerbate distress
When asked about instances of having to deliver care in an inappropriate setting, nursing respondents shared the following stories:
“I covered the ED and the wards. Patients were often in corridors when referred to me. It was often inappropriate to try to try and undertake initial risk assessments due to lack of privacy when the one allocated room we had for MH patients was often in use by other MH staff – or taken for use by the ED staff due to their lack of space for assessments.”
“I was expected to complete a psychiatric assessment of a suicidal elderly person in an ED corridor. There were no private rooms available. The person’s assessment was delayed past the allowable time due to this situation.”
“A patient was admitted to the ward (an acute psychiatric admissions ward) during a night shift when a bed was not available. I am unsure if attempts were made to find a bed out of catchment. We had to set up a makeshift bed (mattress on the floor) in the quiet room. It was a completely inappropriate situation for a very unwell acutely psychotic patient. The room did not have an adjoining bathroom, so the patient had to use the staff bathroom, which was not ligature proof.”
“I work on a psychiatric ward. Rooms that should be used for therapeutic interventions, interviews, assessments, 1-1s and visits have been turned into bedrooms. Firstly, they are not fit to be used as bedrooms and secondly it reduces the space available for the things the rooms should be used for.”
“I manage a CAMHS Psychiatric Liaison Service across three Emergency Departments. All three EDs are often overwhelmed by patients meaning there is often a lack of appropriate space to complete assessments and treatment.”
When asked to share instances of when patient care or safety compromised, respondents shared the following stories:
“A patient recommended for detention under MHA 1983 was not detained due to lack of beds and forced to remain in community. Avoidable harm happened.”
“There is no extra staffing capacity to attend these patients. We already run below numbers on a daily basis and then we are expected to stretch even further to care for patients in corridors. Working on an AMU we have multiple MH patients and high level of violence and aggression incidences mostly in corridors this furthers the risk of other patients being harmed. They are also monitored less due to RNs being stretched.”
“After triage from AED staff, our MH patients with risks (e.g. suicide) were often being left to sit alone in the waiting room as there were no staff to sit with them and may abscond as result.”
“There is a them and us atmosphere in A&E resulting in MH patients being dehumanised, putting them at risk as many will not attend again due to feeling stigmatised.”
In looking at the impact on frontline nursing staff, the report found several persistent issues exist.
Healthcare professionals described the pressure they face when managing mental health crises in inappropriate settings. Many expressed frustration, emotional exhaustion, and moral distress, as they feel unable to provide adequate care due to systemic failures.
The corridor care report highlighted that the way mental health patients are treated in EDs often leads to feelings of dehumanisation and stigmatisation. Many patients may be discouraged from seeking help in the future due to negative experiences in crisis care settings. This situation is particularly concerning for individuals who require urgent psychiatric intervention but may choose to avoid hospital-based care due to previous distressing encounters.
Patients who meet the criteria for detention under the Mental Health Act often experience delays in being transferred to appropriate psychiatric facilities. These delays arise due to a lack of available beds and lengthy administrative processes. In some cases, patients remain in general hospital settings under observation while awaiting formal sectioning, leading to further distress and an increased risk of deterioration.
The report underscored the need for system-wide changes in the provision of mental health crisis care. Recommendations stemming from frontline nurse interviews include:
- Increased investment in psychiatric beds Addressing the shortage of psychiatric hospital beds to ensure timely admission and appropriate care for mental health patients
- Improved crisis response infrastructure Expanding community-based crisis services to reduce the reliance on emergency departments for mental health emergencies
- Dedicated mental health spaces in hospitals Establishing designated assessment and treatment areas for mental health patients to ensure privacy, dignity, and safety
