If you need help right now

Keep these three to hand before reading anything else:

  • 999 — if you or someone else is in immediate danger: an overdose has been taken, serious self-harm has happened or is about to, or someone cannot be kept safe.
  • NHS 111, selecting the mental health option — free, 24 hours a day, connecting you to local crisis support and advice. Our 111 guide explains how the service works.
  • Samaritans on 116 123 — free from any phone, day and night, every day, for anyone who needs to talk. You can also text SHOUT to 85258 to reach a trained volunteer by message.

None of these requires you to be at any particular level of "bad enough". If you are frightened by where your mind is, that is reason enough.

A mental health crisis is an emergency — full stop

The health system treats a psychiatric emergency as exactly that: an emergency. Feeling unable to keep yourself safe, acting on thoughts of ending your life, self-harm that needs medical attention, losing contact with reality — hearing or seeing things others cannot, or beliefs that are driving dangerous behaviour — all of these entitle you to urgent care in the same way a broken leg would. Walking into A&E in psychological crisis is a legitimate use of the emergency department, and staff there will not see it any other way.

That said, A&E is not always the best-suited place — and knowing the full menu of options can get you better help, faster.

What actually happens if you go to A&E

Booking in and triage

You register like any other patient; you do not need to perform distress or find perfect words. Something as simple as "I'm having a mental health crisis and I don't feel safe" tells the triage nurse what they need. They will assess your physical state — essential if anything has been taken or any injury exists — and your mental state, and assign a priority like any other patient; how triage works explains the system. Be fully honest about substances, medication doses and self-harm: it is treated as clinical information, never as a confession, and hiding it can make treatment slower or genuinely dangerous.

If waiting feels unsafe — if being alone with your thoughts in a public room is part of the danger — say exactly that at triage. Departments can arrange regular check-ins, a staff-visible seat, or a quieter side room where one exists.

Body first, then mind

Where there is a physical element — an overdose, wounds, intoxication — the physical treatment comes first: monitoring, blood tests, wound care, antidotes where they exist. This ordering can feel like your distress is being sidelined. It is not; it is the necessary foundation, because a psychiatric assessment cannot help you if your body is in danger.

The liaison psychiatry assessment

Once you are physically safe, the hospital's mental health liaison team — psychiatric nurses, with psychiatrist input — sits down with you properly: what led to this point, your history, what support exists around you, and what would genuinely help. Be as honest as you can manage, including about the hardest parts; the assessment shapes everything that follows.

Overnight and at weekends this team is often stretched across a whole hospital, and the wait can be long. Asking for an update is reasonable; so is asking for somewhere quieter to wait.

Where it leads

  • Home, supported by the crisis team — this is what happens most often: the community crisis service picks you up, usually within a day, with a short-term plan to steady things.
  • Voluntary admission — a stay on a mental health ward, agreed with you, where a period of safety and stabilisation is needed.
  • Onward referral — back to your GP, into community mental health services, or into talking-therapy support once the immediate crisis is easing.
  • A Mental Health Act assessment — only where someone's own health or safety, or other people's safety, is judged seriously at risk and they will not accept help; it requires two doctors and an approved mental health professional, with legal safeguards throughout. You retain rights at every stage — our guide to your rights in A&E covers them.

The alternatives that may fit better

An emergency department is bright, loud, crowded and slow — a hard environment for a mind in crisis. If you are safe enough to choose, consider:

Your existing crisis number. Anyone already under mental health services should have a crisis line in their care plan — it connects to people who can see your history, and is nearly always a better first call than a walk-in.

The 111 mental health option. In most of the country this now routes directly to a crisis-trained clinician who can arrange urgent local support without a hospital in sight.

Crisis cafés and safe havens. A growing number of areas run evening and weekend walk-in spaces — calm, non-clinical, staffed by mental health workers — designed for exactly the moment when home feels unsafe but hospital feels wrong. Your local NHS trust's website or 111 can tell you what exists near you.

Samaritans, around the clock. Not a clinical service — a listening one, on 116 123 — and for many people, an hour of being heard is what turns the worst night around.

If A&E is the right call after all, checking live waits lets you choose the calmer of two nearby departments — a small decision that can matter a great deal in crisis.

Standing beside someone else's crisis

If it is not you but someone you love:

  1. Stay. Presence is protection. Do not leave someone alone who cannot keep themselves safe.
  2. Listen more than you fix. You are not required to have answers; you are required to be there.
  3. Quietly reduce risk — move medicines, blades and alcohol out of easy reach where you can do it without confrontation.
  4. Offer to make the call together — 111, Samaritans, their crisis team. Dialling alongside someone is easier than being told to dial.
  5. If they are in immediate danger and refusing help, call 999 anyway. Consent is not required to save a life, and making that call is an act of care, not betrayal.

In the department, stay if they want you there. Your account of recent days — what they said, how they have changed, what has been happening — may be the most valuable information the assessment team receives.

Making the visit itself more survivable

Small preparations blunt the environment's edges: headphones and something familiar to listen to; a written note of what is happening if speaking feels impossible — handing the triage nurse a few lines on your phone works perfectly well; a trusted person beside you; your crisis plan, if you have one, which tells staff what helps and what harms. And afterwards, engage with whatever follow-up is offered even if the crisis has passed by morning — the days after an emergency visit are exactly when the next chapter is decided, as our guide to after your A&E visit explains. If the care you received fell short, you are entitled to say so: our complaints and feedback guide shows how, and speaking up improves the service for the next person in crisis.

Hold on to this

  • Immediate danger: 999. Urgent support: 111, mental health option. Someone to talk to, any hour: Samaritans, 116 123 (or text SHOUT to 85258).
  • A mental health crisis is a real emergency, and A&E will take it seriously — physical safety is treated first, then a specialist team assesses properly.
  • Crisis lines, safe havens and crisis teams often help faster and more gently than a hospital waiting room, when it is safe to use them.
  • Tell triage if waiting feels unsafe; ask for the quiet room; write it down if you cannot say it.
  • Whatever tonight looks like, crisis care exists precisely for this — reaching for it is the strong move, not the weak one.