When a child is in crisis: what happens at A&E

Figures published on 2 September put a number on something most families only ever meet once. In England during 2025, there were 75,491 emergency department attendances by children and young people aged 6 to 17 with a recorded mental health concern, a rise of 36 per cent on the 55,525 recorded in 2019 (Royal College of Paediatrics and Child Health, 2026). If you have found this page at eleven o'clock at night because you are trying to work out whether to get in the car, the national total is not the useful part. What helps is knowing what A&E is set up to do, what it is not, what should happen once you have been booked in, and what you can reasonably ask for while you are waiting.

What the new figures count, and what they do not

The Royal College of Paediatrics and Child Health obtained the data through a Freedom of Information request to NHS England submitted in April 2026, covering emergency department attendances in England from 2019 to 2025. The steepest rise sits with the youngest children in the dataset. Attendances by six to nine year olds went from 3,870 in 2019 to 6,269 in 2025, a 62 per cent increase. Time spent in the department rose faster than attendances did: stays of more than 12 hours went from 1,964 to 6,235, and stays of more than 72 hours from 55 to 338 (Royal College of Paediatrics and Child Health, 2026). Two things are worth holding onto when you read those numbers. They count attendances rather than individual children, so a young person who came three times appears three times. And a recorded mental health concern is a flag on an attendance record, not a diagnosis. What the figures show clearly is a change in where distress is turning up, and how long children are staying once it does.

When A&E is the right call

Emergency departments exist for emergencies, and some mental health situations are exactly that. Go to A&E or call 999 if your child has taken an overdose, has injured themselves seriously, is unconscious or drowsy, or if you cannot keep them physically safe where you are right now. Overdose deserves its own line, because the intuition most parents have about it is wrong. Many people feel completely fine in the early hours after taking too much paracetamol, and a child who says they feel normal is not evidence that nothing has happened. The advice from emergency departments is unambiguous: seek medical help immediately if you think too much has been taken, even if the person seems okay (University Hospitals Sussex NHS Foundation Trust, 2025). Take the packet or bottle with you if you can find it, and do not wait to see whether symptoms develop. For a young person who is distressed and possibly unsafe but has not harmed themselves, there is a route between doing nothing and sitting in A&E. Calling 111 and choosing the mental health option connects you to a trained mental health professional at any hour, for any age including children, and they can advise, refer into the local crisis service, or tell you that this is in fact an A&E situation (NHS England, 2024).

What should happen when you arrive

NICE guideline NG225, published on 7 September 2022, is the reference point for how a young person who has self-harmed should be treated in an emergency department, and it is specific about the first few minutes. At initial assessment or triage, staff should establish as soon as possible how severe the injury is and how urgently physical treatment is needed, your child's emotional and mental state and level of distress, whether there is immediate concern about their safety, whether there are safeguarding concerns, whether they will accept medical treatment and mental healthcare, the appropriate level of nursing observation, and whether they already have a care plan (National Institute for Health and Care Excellence, 2022). The guideline also sets expectations for the physical environment. There should be a private designated area where a psychosocial assessment can happen without being overheard, and the waiting area for people who have self-harmed should be close to staff who can provide care, support and observation. Mechanical restraint should not be used in an emergency department to prevent self-harm or to stop someone leaving.

The assessment is the reason you are there

The physical treatment is rarely the hard part. The part that changes what happens next is the psychosocial assessment, and NG225 puts it near the front of the queue rather than at the end. A young person attending after self-harm should be referred to a crisis response service, or an equivalent specialist mental health service or suitably skilled mental health professional, as soon as possible after arrival. An age-appropriate liaison psychiatry professional or suitably skilled mental health professional should see and speak to them at every attendance, not only the first. The assessment is not a form-filling exercise: its stated purpose is to build a working relationship, develop a shared understanding of why the young person harmed themselves, make sure they get the care they need, and give the family information. Two lines in that section matter if you are the one asking questions. The psychosocial assessment should not be delayed until medical treatment is finished, and it should not be delayed if your child is admitted to a ward for their injuries (National Institute for Health and Care Excellence, 2022).

One thing NICE says should never decide the outcome

Parents are sometimes told that their child has been assessed as low risk and can go home. NG225 is direct about this. Risk assessment tools and scales should not be used to predict future suicide or repetition of self-harm, and should not be used to decide who gets treatment or who is discharged. Global risk stratification into low, medium or high risk should not be used for either purpose. What should happen instead is a risk formulation carried out by a mental health professional as part of every psychosocial assessment, with the focus on your child's needs and how to support their immediate and longer-term safety (National Institute for Health and Care Excellence, 2022). If a discharge decision is being explained to you purely in terms of a risk category, it is entirely reasonable to ask what the formulation says and what the plan is. You are not being difficult. You are asking for the thing the guideline says should exist.

What to take, and how to get through the wait

Given that stays over 12 hours have more than tripled since 2019, plan for a long one even if you hope it is short. Take any medicines your child is on, or photograph the boxes. Take an existing care plan or clinic letter if there is one, because staff cannot look up records from a service they do not share a system with. Take chargers, food, water and something familiar and quiet: a hoodie, headphones, a book. Take a second adult if you possibly can, so somebody can step outside without your child being left alone. If your child will not talk to you, NG225 makes two points that help. Even if a young person has not consented to their family being involved in their care, family members can still give information to the team, so what you have seen at home is not off limits. And where a young person cannot say out loud that they are in trouble, the guideline explicitly supports alternative ways of communicating, including writing things down, agreed safe words or phrases, and emotional wellbeing passports (National Institute for Health and Care Excellence, 2022). Setting one of those up on a quiet day is worth more than any conversation you will manage in a corridor. On safety at home, the guideline suggests considering removing items that could be used to self-harm, and doing it with your child involved in the decision rather than as a raid on their bedroom.

Before you leave, and the 48 hours after

Discharge is the point at which things most often go quiet, so it is the point to slow down. NG225 says that before a young person is discharged from a general hospital after self-harm, a psychosocial assessment should have taken place, a plan for further management should have been drawn up with all the appropriate people and agencies, a discharge planning meeting should have happened, and arrangements for aftercare should be specified, including clear written communication with the primary care team. You and your child should have a copy of the plan and contact details for whoever is providing the aftercare. Where there are ongoing safety concerns, initial aftercare should be provided within 48 hours of the psychosocial assessment (National Institute for Health and Care Excellence, 2022). Three questions cover most of it on the way out. Who is contacting us, and by when. What do we do tonight if it happens again. And what has been written to the GP. If nobody has an answer to the second one, that is the gap to name before you leave the building.

The visit is not the treatment

An emergency department can keep a child alive, treat an injury, and start an assessment. It cannot deliver therapy, and it was never designed to. That is the RCPCH's own point in publishing the figures: alongside them the college called for children's mental health to be prioritised in the forthcoming Mental Health Strategy, for prevention and early intervention pathways to be strengthened, for community services to expand, and for dedicated crisis pathways that reduce the need to attend A&E at all. Dr Ronny Cheung, the college's Officer for Health Services, put the argument in one line: without urgent action to provide support earlier, we risk storing up serious problems for the future (Royal College of Paediatrics and Child Health, 2026). For a family, the practical version of that is simpler. The work that changes the trajectory happens in the weeks after, and it has to be booked by somebody.

If tonight is an emergency, use it: 999 or your nearest emergency department, or 111 and the mental health option if you are unsure. Samaritans are on 116 123 at any hour, Shout takes texts on 85258, Papyrus HOPELINE247 is on 0800 068 4141 for anyone under 35 with thoughts of suicide, and Childline is on 0800 1111. Blip is a specialist mental health service for children and young people aged 7 to 25, and we are not a crisis service. What we do is the part that comes after, and ideally well before: assessment by a named clinician, a treatment plan you can follow, and appointments that happen. If your child has been to A&E recently, or if you can see where this is heading and want to get ahead of it, get in touch and one of our clinicians will talk it through with you.