The alarm

Emergency rooms understaffed, but youth distress and pink codes are booming

Psychiatric pathologies and violence against women are the new emergencies, with the alarm over self-harm and substance abuse among minors, while the outlook for 2026 sees the workforce suffering further with the farewell to the tokenists

by Barbara Gobbi

21 November 2025

5' min read

Translated by AI

Versione italiana

5' min read

Translated by AI

Versione italiana

Psychiatric emergency care for 350,000 patients a year, with as many as 10 per cent of consultations required for minors, and a total of about 250,000 pink codes landing in Italian emergency rooms. Where it is expected that even in 2026 staff will continue to be scarce or even rare commodities, so much so that only a third of the facilities will be able from January onwards - with the discontinuation, among other things, of contracts with token cooperatives provided for by law - to cover more than 75 per cent of the staff, while another third will have less than half of the staff expected.

The Simeu survey

The picture of Italian emergency rooms taken by the latest survey carried out by the Italian Society of Emergency Medicine (Simeu), which met in Rome for the Academy of Directors, is dramatic. Where we talk about technicalities, of course, but also about everyday life, because it is in these structures that most of the malaise, not only medical, of society lands. Including the galloping psychiatric malaise and the escaped victims of domestic violence.

A 'snapshot' of shortcomings and emergencies is provided by the flash-survey conducted on a sample of Emergency-Urgency Medicine facilities of the National Health Service: about 50 selected Emergency Departments responded, corresponding in terms of number of centres and number of accesses in 2024 (over 2.3 million) to 12% of the national total, including level I Dea, level I and simple Emergency Departments.

Organic underwater

The data will have to be further refined, but what emerges is a picture that is already very significant: according to the facility directors, from January 2026 there could be yet another 'freeze' on staffing, not only because of the gradual farewell to tokenists, but also because of the possible expiry of contracts still standing from Covid. It is then predicted that only 31 per cent of the facilities will see a staffing level of over 75 per cent, but 100 per cent will be a chimera, and this is in any case the rosiest projection. Much heavier are the estimates of a 26% of centres that will have to cope with the most varied assistance and needs of citizens with less than 50% of the staff, which in one 4% of cases will be even less than 25% of what is needed. A quarter, barely. 39% of the centres - and the figure given the current distressed condition is paradoxically considered almost 'good' - will have between 50% and 75% of doctors on duty.

"These data," emphasises Simeu National President Alessandro Riccardi, "although slightly better than in previous years, confirm how the medical personnel crisis continues to represent a highly problematic element in the emergency emergency system. In the absence of the implementation of other solutions for the near future, it is confirmed that it is necessary to resort to buffer solutions, such as additional services and recruitment of professionals with contractual modalities outside the dependence on the SSN'.

The Psyche in Code Red

The number of psychiatric consultations required in A&E is growing: in the sample surveyed by Simeu it stands at 40,000 by 2024, which is almost 2% of all A&E accesses. Projecting the survey-spot on the national data we obtain a need for psychiatric interventions in emergencies equal to about 350,000 per year.
According to Fabio De Iaco, Head of the Simeu Directors' Academy, "as far as psychiatric emergencies are concerned, the first datum to underline is that in 54% of the facilities there is a specialist active guard, able to intervene promptly, while in 33% there is a specialist on-call and in 13% there is no psychiatric intervention. The figure re-proposes a known but unresolved issue, concerning the evident growing burden of psychiatric distress and pathology, which is confronted with an insufficiency of specialist resources'.

Adolescent alarm

De Iaco turns the spotlight on adolescents in particular: 'An issue within an issue and one that is becoming dramatic for us. 61% of the facilities have no possibility of admitting a teenager, and this percentage accounts on the one hand for the shortage of beds that has been denounced for years by child psychiatrists, and on the other hand for the fact that we are increasingly faced with acts of self-harm involving substances, cutting weapons and tranquillisers. These boys then do not find, once discharged, a response on the territory and the emergency grows. It has to be said that the picture that emerges from the data is then decidedly underestimated in relation to reality: very often the boys do not seek psychiatric counselling or leave in some other way. It is an iceberg that comes to us, and after all, as the world literature tells us, the emergency room is the main gateway to the National Health Service for adolescents".
The general data that emerges from the survey shows that while 67% of the facilities that participated in the survey have a psychiatric in-patient ward within the hospital, the possibility of admitting a patient under the age of 18 with behavioural problems drops to 39%.

Pink Codes

The number of patients registered in 2024 with a pink code is just over 3,000: a stable figure in recent years, from 2022 onwards, and the projection for 2025 confirms the same trend. Projected onto the national total, this gives a number of around 250,000 pink codes in emergency rooms: 'A dramatic index,' comments De Iaco. 'The issue is not so much the ascertainment of the injury as the social-health care that we cannot cope with, all the more so with these staffing levels,' he continues. 'When in the middle of the night a battered lady arrives with three small children who cannot go home, you have no one to help you for the first 24-36 hours. We find ourselves, in the urgency, having to look for a place to provide safe shelter for these people. The emergency room is unfortunately not in a position to cope with these situations, while waiting for the social services to take action. We can't accommodate a whole family, but that's what we do especially at weekends or at night".

Confirmation of this scenario comes from Antonella Cocorocchio, Head of the Simeu Nursing Area. "Violence against women is a datum that will also have to be confirmed through other surveys: however, it is important," she explains, "to emphasise that the Code Pink in the Emergency Room constitutes an eventuality for which the clinical part represents only a part of the necessary commitment, often not even prevalent. The care implications that Code Pink codes impose, for example with the need to identify shelters for victims who need to be removed from dangerous contexts, frequently also in the presence of children, impose tasks on emergency rooms for which, despite the maximum availability of operators, the planned resources are often insufficient'.