Most people with mental health issues do not receive good treatment at A&E, leading to repeated visits, report finds

More than half of people with mental health problems receive a “double whammy” of poor care in general hospitals which increases patients’ risk of dying, according to a major new NHS inquiry.

Only 46% of patients with serious mental health conditions were well looked after when they attended hospital with a physical ailment such as heart trouble, a group of independent experts found.

Many A&E unit staff lack the knowledge or confidence to care properly for mentally ill people, according to a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

Substandard care that mentally ill patients receive for physical health problems results in many of them repeatedly returning to A&E , the NCEPOD team found when they analysed the medical records of 552 patients who sought help at an acute or general hospital.

“Good care was only provided to 46% of patients in this study, showing patients who had a mental health condition suffered the double-whammy of both poor physical and mental healthcare,” said co-author Dr Vivek Srivastava, who is the NCEPOD clinical coordinator and a consultant in acute medicine.

“The systems don’t exist to train hospital staff appropriately in the care of patients who also happen to have a mental health condition, so immediately there is an issue with having the confidence to care for this group of patients.

“Once someone is admitted to hospital it is likely to expose any underlying issue such as a mental health problem, and staff need to have the confidence to deal with this, and have access to and know how to refer to mental health services,” he added.

Poor physical health care leads directly to patients with a mental health condition staying longer in hospital, Srivastava added. “They are often discharged into the community inappropriately and then bounce back in and out of hospital if the underlying health condition is not treated properly.”

Inadequate treatment of such patients matters because they are already more likely to die than other people, the report says. “It is well established that patients with severe mental illness develop co-morbid physical health conditions, like heart disease, about a decade earlier in their life. They are also more likely to die more than a decade earlier than those without mental health conditions.”

Prof Sally Davies, the government’s chief medical officer, has estimated that 60% of the excess mortality among people with a mental health condition could be avoided if they received better care.

Prof Lesley Regan, president of the Royal College of Obstetrics and Gynaecology and chair of NCEPOD, said: “For many years mental healthcare in the NHS has been underfunded, and you may rightly conclude from this new NCEPOD report that patients with mental health conditions are seriously disadvantaged when treated for physical disorders in hospital. I fear that the patients we studied could well be only the tip of the iceberg.”

The Department of Health said it was improving how A&E services cared for people with mental illnesses. “We have invested £247m to make sure support will be available for people who come to A&E needing mental health care. The NHS is also working to develop the mental health skills of all staff so that issues are identified earlier and patients receive the care they need,” a spokeswoman said.

• This article was amended on 26 January 2017. An earlier version said incorrectly that Prof Lesley Regan was the ex-president of the Royal College of Psychiatrists.