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  There are three main reasons for these difficulties. One is staff shortages. Late one night last year I was in a busy A&E department seeing an acutely mentally ill patient. I needed a casualty officer to check over my patient before I transferred her. I was told by the nurse in charge that there was likely to be a wait as there were only two on duty. Two doctors, in the entire department covering central London! Meanwhile, in the waiting room, the walking wounded were piling up. Neither of the doctors had taken a break, and they were working flat-out on a 12-hour shift.