Dear Editor,
Mason and colleagues note that crisis presentations to emergency departments have become a default route to care, partly because of poor access to community services, and that plans to evaluate the new mental health emergency departments are limited.[1] Our experience in a general adult community mental health team (CMHT) in North London supports both points.
The Community Mental Health Framework for Adults and Older Adults introduced a "no wrong door" approach to accessing care.[2] In our experience, this has led to a significant increase in the number of patients referred to community mental health teams with no proportionate increase in funding. The Health and Social Care Committee reports that mental health gets "less than 10% of NHS expenditure" against over 20% of the disease burden, and that implementation of the framework has been "uneven and in parts inadequate".[3]
In our borough, 1.3% of residents were recorded on GP registers as having a severe mental illness in 2022/23, which is above London and national averages.[4] Our team serves the east of the borough, where deprivation is highest,[5] and covers a large number of GP practices with a high volume of referrals. Our population also includes many refugees, asylum seekers and people affected by trauma, for whom long waits carry particular risk.[3] In a national survey, 78% of patients waiting for mental health treatment said they had used emergency or crisis services while they waited.[6] Some people present to the crisis and home treatment team, A&E and the Mental Health Crisis Assessment Service (MHCAS) whilst they wait for an assessment.
We face persistent high demand and increasing complexity, as the active caseload in our team has grown substantially in the past year. In response, since August 2026, consultant psychiatrists, psychologists, managers and resident doctors have screened new referrals at a multidisciplinary meeting at first twice a week and now daily to try to meet demand. In the first two months, the meeting redirected a substantial proportion of the referrals it discussed. Consultants also resolve many referrals through discussion with GPs, and none of this appears in routine data. We have not yet measured whether redirected patients were seen elsewhere or re-referred. The caseload continues to grow, in part because intake still exceeds discharge.
There is a four-week benchmark, measured in the Trust and nationally.[3,7,8] Nationally, the median wait for community mental health care is 45 days, and one in ten people wait more than 251 days.[3] In our team, waits are well beyond four weeks for most of the referred patients. The issue is that, despite the benchmark, there is complacency in the system about resolving outliers, as the associated risk and its connection with increased presentations to emergency services are not recognised systemically.
New walk-in centres and mental health emergency departments are welcome.[9] But they will not reduce crisis presentations if the community teams behind them cannot redirect or discharge patients in proportion to demand. We urge that their evaluation includes community waiting times and CMHT caseload flow, including the proportion of new referrals redirected or discharged, and that investment in emergency care accounts for the community capacity on which it depends.
References
1. Mason S, Marincowitz C, Guthrie E. Urgent care for mental health in the NHS. BMJ 2025;390:r1782. doi:10.1136/bmj.r1782
2. National Collaborating Centre for Mental Health. The Community Mental Health Framework for Adults and Older Adults. NHS England and NHS Improvement, 2019. https://www.england.nhs.uk/wp-content/uploads/2019/09/community-mental-h... (accessed 12 Oct 2026).
3. House of Commons Health and Social Care Committee. Community mental health services. Fourth report of session 2024–26. HC 566. 2 Dec 2025. https://publications.parliament.uk/pa/cm5901/cmselect/cmhealth/566/repor... (accessed 12 Oct 2026).
4. Haringey Council. Mental health in Haringey: key insights. Adult social services market position statement. https://haringey.gov.uk/care-support-adults/adult-social-care-policies-d... (accessed 12 Oct 2026).
5. Care Quality Commission. London Borough of Haringey: local authority assessment. 7 Feb 2025. https://cqc.org.uk/care-services/local-authority-assessment-reports/hari... (accessed 12 Oct 2026).
6. Royal College of Psychiatrists. Hidden waits force more than three quarters of mental health patients to seek help from emergency services. 10 Oct 2022. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2022/10/1... (accessed 12 Oct 2026).
7. NHS England. Mental health access and waiting time standards. https://www.england.nhs.uk/mental-health/resources/access-waiting-time/ (accessed 12 Oct 2026).
8. NHS England. NHS England proposes new mental health access standards. July 2021. https://www.england.nhs.uk/2021/07/nhs-england-proposes-new-mental-healt... (accessed 12 Oct 2026).
9. Department of Health and Social Care. Major expansion of community mental health support across England. 6 Aug 2026. https://www.gov.uk/government/news/major-expansion-of-community-mental-h... (accessed 12 Oct 2026).
Urgent mental health care depends on community capacity