‘Call Before You Walk’ for A&E – how will this impact treatment for self-harm?

As an experience-led self-harm support organisation, the issue of how people are treated in A&E for self-harm has been an ever present issue throughout the 30+ years we have been running. Needing urgent treatment for self-harm is one the key areas where physical and mental health care needs really cannot be separated out and sent down different pathways or to different services.

A&E is, ultimately, a service that anyone can access, anytime – easy to find, all of which are essential in moment of crisis, even if the understanding of self-harm can vary amongst departments and staff.

A few months ago we were contacted by several people concerned about a suggested scheme to manage the numbers of people coming into A&E over the winter. There were very few details available about the plan, but in the few news articles we could find, there seemed to be strong backing from the Royal College of Emergency Medicine for a ‘call before you walk’ system, which would ask anyone who was not brought by ambulance or sent to A&E by a GP to call 111 to be triaged and given an appointment before going to A&E or being sent to a different type of service such as a minor injuries unit.

In principle, this makes sense: fewer people in waiting rooms reduces the risk of infections being spread and appointments mean you don’t have to wait so long, but the people who had contacted us were concerned that additional steps like making phone calls might mean people who had self-harmed might not feel able to access treatment.

In response we set up a survey asking people their views about this approach and so far we have had over 150 responses, with the majority of people saying they have personal experience of self-harm.

Some people have said that they think a ‘call before you walk’ system could work well if staff on the phone are well trained and understand the complexities of self-harm. However, far more people have raised a range of concerns about this approach for people seeking mental health support and more specifically around self-harm.

Some of the most common themes are:

  • People who find it very hard to communicate on the phone for a range of reasons including anxiety, dissociation and autism, who say they would not seek treatment if they needed to phone first
  • Concerns about trying to convey what you need on the phone and being assessed purely on the ‘severity’ of an injury rather than why you came to self-harm and what other treatment might be needed
  • Worries about the level of training and understanding of self-harm for call handlers, and that already feeling shame and like a burden would be added to by having to justify yourself to a triage service

Overall the response so far add up to huge concerns about people not seeking treatment due to this new system, which will result in people not receiving timely treatment and support to access other mental health services and in the worst cases potentially permanent injury or even death.

Since we began this survey, there have been several pilots of this approach in England and last week the government announced it would be implemented across England from October.

We have serious concerns about how this will work. None of the frontline A&E staff we work with regularly had heard of this plan until it was announced in the news; 111 is already running at high capacity, and one month is a very short time to train and upskill many new call handlers.

We can’t stop this approach going ahead, but we do plan to keep on collecting views and with the results of our survey this is what we aim to do next:

  • Feedback to the Royal College of Emergency Medicine and ask them what work has been done around mitigating risks and supporting access for people who are unable to use the phone
  • Asking CCGs what work they have done around Equality Impact Assessments in this area and what training 111 staff will have around self-harm
  • Once we know how this system is supposed to work, trying to create an easy read information sheet about the different ways you can seek urgent help for self-harm

We welcome any other suggestions about what we could do and all views on how helpful you think ‘call before you walk’ will be for people who need self-harm treatment here: https://www.surveymonkey.co.uk/r/D25BK9S
For more information about the support we can provide please go to our website here: