Do ambulance crew really believe someone with serious mental health issues will be helped at A&E?

[SpringTime2020]

The other thread about ambulances made me think about this.

I was taken to A&E by ambulance a couple of times some time ago due to my mental health. Both times the ambulance crew reassured me I'd get the help I needed but both times I got no help for my mental health at all.

Honestly, no wonder these people are making repeat calls - they are probably desperate!

Mental health services are severely lacking, what do you think paramedics should do?

Well, not get a patient's hopes up I suppose. I'm not saying they are wrong to take someone to A&E as of course that will keep the patient safe for the duration they are there. And of course they may have physical health needs (overdose, for example). But when I was assured by the ambulance I would finally get the help I needed it was another blow to find out that wasn't the case.

It's their job to make sure you're safe. At hospital you're safe until you're discharged. I'm not sure ringing ambulances can help you.

What does help look like to you?

Maybe the crew thought you would be seen by a psychiatrist a plan would be put in place

I would say that the fault lies with the lack of services in the hospital, not with the paramedics who were trying to reassure you in the moment. Paramedics aren’t to know what help you receive in hospital once you’ve left their care and obviously they are hopeful that you’ll get the assistance you need. I think your disappointment is aimed at the wrong people.

If I can speak for 'our' side, we often sincerely hope that MH pts get the help they so desperately need but seeing the same people time after time we do know that it rarely is the case.
MH services are woeful at best and I really feel for some people.
When I started in '99 we had direct access to 2 MH emergency units, located at big MH hospitals. But, as is often the case, these much needed and well used services were cut.
We had direct access via telephone triage to another MH service during all of last year - it worked and it was a godsend. And yes, you've guessed it, it's been cut. Costs too much apparently.

So whilst yes we may pay you some lip service, for us there is no other option. We try our best to refer to appropriate pathways but we are often told 'just take them to the ED'

Paramedics deal with the immediate need. Therefore they’re not wrong to say you’ll get the help you need - in an immediate sense.

But mental health problems aren’t ever going to be fixed by A&E, of course. And mental health is one of the most funding-stricken sections of the NHS.

I’m sorry OP. I hope things improve

Not really sure what you expect the paramedics to do OP. If someone calls an ambulance are they supposed to ignore it if it’s a MH call?

My DM has a significant mental health issue. Last time we needed to get her admitted, we were informed via A&E was the only way to do this.

This is not a thing I would be complaining about ambulance crews for.

Sometimes MH patients do get help via A&E. I was sectioned via A&E about ten years ago and it was a real turning point. Before A&E, the GP had been fobbing me off, I had no real support and was basically on my own. In hospital my meds actually got sorted, I was put on anti psychotics and mood stabilizers and not just SSRIs which are massively bad for me and when I got discharged, I was put under CMHT care which has been v helpful.

I know it doesn't always happen but I know other people it has worked for. It just seems like such a crap shoot as to whether you're one of them and it's gotten pretty crap since COVID from everything I can tell. Now they pretty much seem to send you home with a handful of diazepam, no matter what.

It’s about taking the patient to a place of safety, which is either hospital or police custody, and hospital is the gentler option, I think? Maybe a paramedic can confirm this?

Very soon after starting to deal with MH services on behalf of a sibling, I learnt very quickly to have basically no expectations and not to make promises to them that I couldn’t keep.

The system is appalling and ends up being cruel to unwell people and yes that is not the fault of paramedics, but I agree that they do need to be careful what they say to patients.

It doesn’t help practically, but I’m sure the paramedics that came to you OP would be devastated to know that you weren’t cared for though, and that they had raised your expectations only to have them crushed.

Everybody is desperate OP, staff and patients.

@BlanketsBanned

Maybe the crew thought you would be seen by a psychiatrist a plan would be put in place

A plan was put in place when DBro was taken to hospital after ODing.

The psychiatrists plan was to release him, after treatment to prevent organ failure, and he would be contacted a week later by the CMH team.

He wasn’t contacted.

Even when actively suicidal with family members repeatedly phoning the crisis team every hour there still wasn’t any help. He never heard from any one again. Appalling.

I was sectioned via A&E about ten years ago and it was a real turning point.

I wonder what happened ten years ago to make mental health services turn to shit? Austerity has a lot to answer for.

OP the paramedics know the help isn't there, but they can't leave you if you're not safe to be alone.

I seriously can't believe I'm reading Ambulance staff being criticised for this.

Have you made an appointment with your GP since, or are you under any other MH team OP?

@GorBlimeyGG - yeah. You're right. I started typing my comment and realized how out of date it was and how badly things have gone downhill.

The paramedics job is to treat any life threatening injuries and take the patient to a place of safety.

A&E is for people who have had an accident or emergency, they can treat the issues caused by mental health problems such as injuries caused by self harm etc but they can diagnose and treat mental health problems.

Can’t believe people think paramedics and A&E are the place for mental health support, all they can do is refer you on.

Fabulous, yet another stick to bet the ambulance service with.

I say that as a person with a list of diagnosed mental health conditions and with a DH who works, on the road, as part of an ambulance crew (AAP). My DH puts his life at risk every time he has to be a part of a blue light run!

Paramedics and ambulance crew/staff have no say, absolutely no say, about what happens in the hospital. If they are told that a patient with MH concerns will get help how on earth do you expect them to know different, it's not like they always get updated on how the patients are after they have been handed over.

The people you need to be angry with are the current government, not paramedics, Nurses, Doctors or any other HCP!

*beat

@Prinnny

The paramedics job is to treat any life threatening injuries and take the patient to a place of safety.

A&E is for people who have had an accident or emergency, they can treat the issues caused by mental health problems such as injuries caused by self harm etc but they can diagnose and treat mental health problems.

Can’t believe people think paramedics and A&E are the place for mental health support, all they can do is refer you on.

They probably think that because that is correct. Or at least is in my health trust. A&E can't diagnose anything really besides trauma. Lots of people get transferred on to MH inpatient services from A&E, I'm not sure what you think they are supposed to do. They will always try to use community services if possible and safe but if they don't feel it is A and E is the right call.

FYI if somebody is detained (sectioned) in the community its the ambulance service that takes them to the psychiatric unit.

Speaking as a Paramedic I received very little clinical training in regards to mental health, we're talking just a 2-4 hour lecture on the subject, no placements. Training programmes do vary so experiences differ.

So when I'm sent to assess someone in crisis/suicidal really it's not a lot different to sending a random member of the public unfortunately. Personally I go as someone for them to speak at for an hour or so and try to just listen/be supportive. But ultimately we're not tied into any mental health services, what we learn wont be forwarded onto any mental health teams, it's very poor.

Ultimately all I'm doing is trying to identify if a patient is actively contemplating suicide, if they are do they have a plan, if they have a plan do I think they're likely to try it, if they try their plan it is it likely to work. If the answer is yes to all those things then they're the people that A&E/crisis teams there would be most appropriate for.

To my knowledge the others that are suicidal but not having a realistic plan, have a long history of these thoughts but no serious attempts, call for help themselves as opposed to being discovered are likely to be discharged from A&E without treatment as it'll be felt their not likely to end their lives imminently. We still encourage patients calling 999 to attend A&E regardless of knowing they probably wont get the help they need because we recognise that we do not have mental health training, we are not mental health professionals, it is not our place to discharge them. Personally I'd never promise to a patient that they'll get help, just that they'll be able to speak face to face with someone from the mental health team.

You got help, OP. Help to keep you safe. That's all they will have meant. The difference between leaving you at home and taking you to a&e meant that with the latter prob you'd get help in the form of safety, and presumably any acute medication.

They weren't lying to you. You just have a different definition of help.

Better the ambulance crew take them in than leave them at home, which is what they did with my late DM when I was a child. She was having a complete mental breakdown and they drove off and left her alone with me. It was only because the neighbour across the way had seen the ambulance, were worried and came across to see if we were ok that anything got done. They called the ambulance again (who refused to come, by the way), then called their own GP who came and sectioned her. The GP insisted that the ambulance returned, and they took her off to a psychiatric hospital. She was there for several months.

I just wish the ambulance had taken her in the first time, instead of fucking off and leaving me alone with her. I have never felt so abandoned in my life as I did that day.