There is a particular cruelty in asking someone to navigate a complicated system at the moment they are least able to do so.

A person in severe psychological distress may be expected to decide whether to call a GP, NHS 111, a crisis line or an ambulance. They may have to repeat their story to several strangers, establish that they meet a threshold and wait in an environment designed mainly for physical emergencies. Their family may be frightened and unsure what information they are allowed to receive. None of this means the professionals involved do not care. It means the route to care can demand clarity, persistence and stamina at a time when all three may be difficult to summon.

I do not approach this as an abstract policy question. Living with mental-health conditions has shown me how much harder it is to explain what is wrong, pursue an answer and make decisions when so much of your energy is already being spent on getting through the day.

That is why the NHS's current plan for dedicated mental-health emergency departments deserves attention. It envisages 85 of them in England, backed by investment of up to £120 million, with centres co-located with or close to at least half of major emergency departments by 2029. They are intended to offer rapid specialist assessment in calmer, more therapeutic surroundings than a conventional A&E.

The principle is sound. A crowded waiting room filled with harsh light, noise and uncertainty can intensify distress. A specialist setting should be better equipped to understand psychiatric symptoms, consider physical-health needs and connect a patient to appropriate follow-up. It may also reduce pressure on general emergency departments and prevent police officers or ambulance crews from spending hours waiting for a handover.

But a better place to experience a crisis is not the same as a system that prevents avoidable crises. If ministers treat these departments as the headline solution to mental-health care, they will have built a more dignified last resort while leaving the long road towards it largely unchanged.

Crisis does not begin at the hospital door

For many people, the decisive failure occurs weeks or months earlier. They ask for help when symptoms are worsening but before their situation becomes an emergency. They are told to wait, referred elsewhere or offered support that does not match the complexity of their needs. Their condition then deteriorates until urgent care becomes the only route left.

The Care Quality Commission's latest community mental-health survey makes that progression difficult to dismiss. Of 12,319 adults who responded, 31 per cent said they had waited three months or longer for an appointment. Around a third of those who sought help from crisis services said they did not receive the support they needed. The figures describe separate experiences, but together they reveal the same structural weakness: help is too often hardest to obtain before distress becomes acute.

Waiting is not a neutral interval. Someone may lose sleep, withdraw from other people, struggle at work or fall out of education. Daily tasks can become harder. Parents, partners and friends may quietly take on responsibilities they are not trained or resourced to carry. By the time emergency intervention arrives, the human and financial cost is greater than it would have been if consistent support had begun earlier.

The most important promise is the one before an emergency

The NHS is also piloting six 24-hour neighbourhood mental-health centres. Their proposed model is strikingly simple: people can walk in, telephone or be referred; there is no “wrong door”; and a joined-up team provides continuing support close to home. That approach deserves at least as much public attention as the emergency departments.

Continuity matters because mental-health care is not a single transaction. Trust can take time to establish, particularly when a person has previously felt dismissed or misunderstood. Having to begin again with each new professional can turn treatment into a sequence of assessments rather than a path towards stability.

Fragmentation is especially damaging when somebody's needs cross the boundaries that services have drawn. Many people live with more than one mental-health or neurodevelopmental condition, yet services are often organised around a single diagnosis. If each team recognises only its own part of the picture, that person can be passed between services or misread as unwilling to engage.

Neighbourhood provision will succeed only if “open door” describes the reality rather than the sign outside. A service can be open around the clock and still be inaccessible if it has too few clinicians, narrow eligibility criteria or nowhere suitable to refer people for continuing treatment. The test is not whether a centre exists. It is whether someone asking for help receives useful help while they are there.

The Government says 8,500 additional mental-health workers have been recruited since June 2024, reaching its target early. That is substantial progress and should be recognised. Yet a national total cannot tell patients whether the team in their area has the right mix of psychiatrists, psychologists, nurses, therapists, peer-support workers and social-care staff. Nor does recruitment alone guarantee that experienced workers will stay in posts where demand is relentless and morale is fragile.

Buildings make policy visible. The workforce makes it real.

Families and carers cannot remain an afterthought

Mental illness rarely affects only the person with the diagnosis. Families and friends often notice deterioration first, help with appointments, manage practical problems and remain present after formal services step back. They can be crucial to safety and recovery, yet they are frequently left to find their own way through the system.

Confidentiality is essential, but it is sometimes invoked too broadly. A professional may be unable to share private clinical details and still be able to listen to a relative's concerns, explain how the service works or give general advice about support. Treating carers with respect does not require taking control away from the patient.

The CQC survey found that 45 per cent of respondents whose family or carers were involved during a crisis said those people had not been given the information or support they needed. New emergency departments should make this a design issue from the start: clear guidance, named points of contact and a distinction between receiving information and disclosing it. Families should not have to learn the rules in the middle of an emergency.

Judge the policy by what happens next

Opening dates and numbers of buildings will be easy for the Government to announce. The more important measures will be less photogenic.

How long does a person wait for a specialist assessment? Are physical-health needs checked as well as immediate psychiatric symptoms? Is there a clear plan before the person leaves? Does the receiving community team make contact promptly, or is the patient handed another telephone number and expected to start again? Are fewer people sent far from home for inpatient care? Do patients from poorer areas, minority communities and rural places receive the same standard of treatment?

The NHS should publish these outcomes in a form the public can understand, broken down far enough to expose regional inequality. It should also ask patients and carers whether they felt safe, heard and involved. A department that moves people through quickly but sends them back into the conditions that produced the crisis has improved flow, not necessarily care.

There is also a danger that a specialist door becomes an excuse for every other door to close. General A&E staff will still encounter people with both physical and mental-health needs. GPs will still be the first contact for many. Schools, universities, workplaces and councils will still notice distress before hospitals do. Dedicated departments must strengthen that network, not encourage the rest of it to regard mental health as somebody else's responsibility.

The ambition should be fewer preventable emergencies

Mental-health emergency departments could end a longstanding indignity. Their purpose should be precise: provide skilled, compassionate treatment during a crisis and connect each patient to care that continues after they leave.

Success will not be measured by footfall or ribbon-cuttings. It will be seen in shorter waits, reliable follow-up and fewer people deteriorating while asking for help. A humane crisis door matters. A health service worthy of the name must also make sure it is not the first door that finally opens.

If you need support: In England, call NHS 111 and select the mental-health option for urgent help. Call 999 where there is an immediate risk to life. Samaritans can be reached free at any time on 116 123.

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