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!

I'm so sorry to hear your experiences. The 'attention seeking' trope needs to die a death. It is quite normal for humans to seek attention and especially when feeling so unwell and unsafe

Thank you, and absolutely! My therapist said it is "help seeking", not attention seeking... and there is nothing wrong with seeking help. It is just that some of us struggle how to ask for help, and it comes out in behaviours etc.

I'm sorry this has happened to you. I get where you're coming from. You felt like you finally may be getting some help, and in the end its just another failure with the health services and you're essentially left to fend by yourself again. It is well meaning by the paramedics, but actually doing more harm by giving you false hope.

Sometimes A+E do help, but I think only in extreme circumstances. A family member was taken to a+e by ambulance escorted by police (no crime had been committed, but at that time they were a real risk to themselves and anyone that came near them). They spent the night there heavily sedated, until a specialist team arrived to transport them safely to a psychiatric hospital.

When my family members mental health really took a turn for the worse, they was a minor so actually received better care than if they were an adult. A lot of help they got was from cahms when they finally returned home. When things got really bad the first option would be to get hold of the crisis team and make a quick evaluation to see if immediate hospitalisation would be necessary, and if they deemed that to be the case, quite often the parents would have to try and keep them safe until transport arrived. A+E was the last option and would only be an option if the police needed to be called for assistance. If A+E was required, usually their care would involve keep them safely sedated until transport would arrive.

@CovoidOfAllHumanity

I haven't been admitted to an MH ward I work on one and have done in various places for twenty years. Obviously I know that we have nursing and OT and that MDT input is very important but people really are not admitted to acute general adult psych wards for those alone in the current climate. Twenty years ago they were as we used to offer respite admissions but now they would get a 3 day assessment if that. Inpatient psychology isn't a given everywhere and there will not be formal 1:1 therapy on a short stay ward. You are much more likely to be offered admission with a drug treatable illness than a non drug treatable one in my personal experience because then there js a clear pathway to discharge with a fairly predictable time frame. You said yourself that your long admission was in the private sector which surely proves my point that the NHS does not really offer this kind of treatment as an inpatient as it is just too costly and long term.

To answer your other qs threshold for MHA detention is set in law so is the same in all settings. It will always require an AMHP and 2 Drs wherever the assessment takes place community, police station or A&E.

The threshold for voluntary admission is also the same in all cases. There are no separate beds that can be accessed by community services vs by A&E. In most areas the beds are gate kept by the crisis team. The liaison team in A&E have no admission rights any more than the community team do. They speak to the crisis team and they decide if a bed is needed. This makes sense that one team prioritises all admission requests so that the beds go to those most in need.

I would argue that it would neither increase nor decrease your chance of admission to go via A&E and given that waits in A&E will be long and you will have to see non specialist personnel first to get a referral to psych and tell your story a number of times then a telephone triage service is better if you have one in your area or GP referral to the crisis team. It will all come down to the same thing in the end.

One of the criteria of the MHA is that detention is a last resort and voluntary admission and community treatment need to be tried first so it is quite unlikely that admission will be the first option offered to anyone unless community treatment is completely untenable due to risk and/ or unwillingness or inability to comply.
As such they might not have been wrong to ask you to try community treatment first. For many people it might have been effective. For you it was not and you got worse so you were admitted. With the benefit of hindsight you therefore believe you should have been admitted the first time but I am not sure how anyone would know that for sure without trying. Usually people will be offered community team or crisis team at first because not everyone can be admitted and many people do benefit from community treatment. There was a success story from someone upthread who did not go to A&E but got urgent community help and avoided admission. You see it from your perspective but there are other perspectives.

I work on an inpatient ward. We do get people better. Some people find the experience helpful but in fact some people hate it even though they got better. Inpatient wards can be scary as well as therapeutic despite our best endeavours. We have to admit people with very disturbed behaviour and that is frightening.
Inpatient admission worked for you but it's not the be all and end all and I would actually much much rather that investment was made in community services to help people stay well than in more hospital beds. It's extremely depressing when people relapse due to lack of community support and it happens a lot these days.

Sorry I missed this and thank you for taking time for all your helpful responses. Around here if you go in voluntarily you will go to an assessment unit for around 7 days. It is a notoriously awful place so is a last resort. Therefore it actually means people are sectioned more as they will then go to a n acute ward. In A&E you can bypass the main area and go straight to the mental health suite if there are no physical health needs. I'm not keen on telephone calls Vs face to face as a preference. I have had 1:1 time with a therapist on an acute ward but I was there 7 months. It wasn't formal therapy of course. I take your point about community treatment but I wasn't offered anything by A&E, they didn't even speak to my therapist who had called the ambulance the first time. You know, in all honesty I do need to admit these are my recollections when I was very unwell. It might not be entirely accurate. But a lot of it does just stick in my head as trauma can. Oh and yes, I am not denying community treatment works in many cases, but unfortunately I was beyond that. Luckily my therapist managed to get me seen by First response who sectioned me. It was all in a very short time frame. There had been community involvement prior that did nothing. I don't believe in those days I got significantly worse. Anyway, that's by the by.

The private hospital I went to was NHS funded so there are places for long term inpatient. Only for a quite specific subset though - although they get it wrong at times - but again another conversation!

I have nothing but praise for the acute wards I was on they helped me enormously. I was very compliant (too tired not to be) which helped. I didn't find it frightening but the second ward I went to I'd actually worked on before!

The problem with community support when discharged from inpatient is there is no joined up thinking. Noone will communicate with each other!

@XenoBitch

I'm so sorry to hear your experiences. The 'attention seeking' trope needs to die a death. It is quite normal for humans to seek attention and especially when feeling so unwell and unsafe

Thank you, and absolutely! My therapist said it is "help seeking", not attention seeking... and there is nothing wrong with seeking help. It is just that some of us struggle how to ask for help, and it comes out in behaviours etc.

That is such a useful idea, thank you for sharing.

@Xmassprout

I'm sorry this has happened to you. I get where you're coming from. You felt like you finally may be getting some help, and in the end its just another failure with the health services and you're essentially left to fend by yourself again. It is well meaning by the paramedics, but actually doing more harm by giving you false hope.

Sometimes A+E do help, but I think only in extreme circumstances. A family member was taken to a+e by ambulance escorted by police (no crime had been committed, but at that time they were a real risk to themselves and anyone that came near them). They spent the night there heavily sedated, until a specialist team arrived to transport them safely to a psychiatric hospital.

When my family members mental health really took a turn for the worse, they was a minor so actually received better care than if they were an adult. A lot of help they got was from cahms when they finally returned home. When things got really bad the first option would be to get hold of the crisis team and make a quick evaluation to see if immediate hospitalisation would be necessary, and if they deemed that to be the case, quite often the parents would have to try and keep them safe until transport arrived. A+E was the last option and would only be an option if the police needed to be called for assistance. If A+E was required, usually their care would involve keep them safely sedated until transport would arrive.

Yes, exactly that. I am happy to hear your relative got good care. How are they doing now?

Don't get me started on IAPT. It may have a place for minor illness. But I know so many therapists that would never work in IAPT as they know how traumatising it can be to just get to the point of being ready to talk 6/8/10 weeks in, unpacking everything and then therapy is over and you are left retraumatised and with everything unpacked but now having to deal with it alone.

I work in welfare rights, but all my referrals are for from clients under IAPT schemes, and I totally agree with this. Very often, clients deteriorate within a few weeks of a course of IAPT work ending. It's as useless and pointless as the 6 sessions of bereavement counselling that you get from my NHS trust.

Dementia care has very specific reasons for avoiding the truth. It can also be the same with delusions. We need to be able differentiate. And I agree sadly, nothing will change under the Tories I wasn't saying they were the same? I was saying they were doing the best they could. Also, they possibly genuinely believed you would get support. As stated by myself and others, they have very little training in MH. But you've chosen to make out like I don't know the difference. Just as you chose a title which comes across as bashing paramedics but then denied that's what you were doing. Maybe ask MNHQ to change the title to something more appropriate if you didn't mean it to come across as though it's the paramedics fault for providing reassurance to someone who was not in a rational state of mind.

Their job is to ensure the patient is taken to hospital if they feel they need immediate treatment. They can’t guarantee that happens as their job ends when they hand the patient over to A&E. A friends husband was taken by ambulance last year and spent 8wks in hospital due to mental health breakdown

@EllaVaNight

Dementia care has very specific reasons for avoiding the truth. It can also be the same with delusions. We need to be able differentiate. And I agree sadly, nothing will change under the Tories I wasn't saying they were the same? I was saying they were doing the best they could. Also, they possibly genuinely believed you would get support. As stated by myself and others, they have very little training in MH. But you've chosen to make out like I don't know the difference. Just as you chose a title which comes across as bashing paramedics but then denied that's what you were doing. Maybe ask MNHQ to change the title to something more appropriate if you didn't mean it to come across as though it's the paramedics fault for providing reassurance to someone who was not in a rational state of mind.

I know I have made all those points myself. I'm sorry if I made you feel I thought you didn't know the difference. I was just responding to your comment. I don't know if my title came across as sarcastic - it was actually a genuine question. And no I really do not like the blame game atall. I didn't realise it would come over like that. What could I get it changed to?

@Darbs76

Their job is to ensure the patient is taken to hospital if they feel they need immediate treatment. They can’t guarantee that happens as their job ends when they hand the patient over to A&E. A friends husband was taken by ambulance last year and spent 8wks in hospital due to mental health breakdown

But that's the point. Of course they can't guarantee beyond, as someone has suggested that you will be spoken to, so just say that. Don't tell the patients things will happen that may not happen. I'm glad your friend's husband got help and only needed to be in hospital for 8 weeks. Did it help him recover?

I am trying to understand why ambulance crew reassure you that you will get the help you need

Because it's their job to reassure and calm ALL their 999 emergency patients, for obvious medical reasons.

The 999 patient is in acute distress from some emergency; injury, pain, shock, fear, or symptoms of mental illness. Acute stress and shock can cause additional medical emergencies (stroke, heart failure, breathing problems). To reduce stress, the paramedic reassures the patient ( regardless of the presenting problem, or its severity). You're safe, we're looking after you.

You got the same verbal comforting and calming paramedics provide to all acute emergency patients. For the same reason.

” I thought as the paramedics had said I would get help there and I didn't that I obviously didn't deserve help. I tried to take my own life.”

It is incredibly sad and difficult to read that you felt unworthy and like you didn’t matter. However, I think that’s a reflection on your mental state and the systemic failures of the MH system, rather than a well meaning paramedic who genuinely believed you would get help. “Get help” clearly means different things to different people, as this thread clearly shows.

It takes committed self centredness not to see that what might be best for them might not be best for everyone. A 'one size fits all' approach might not be appropriate in these circumstances.

A kindly 'false hope' or even just kindly hope might actually help others in crisis. It's not all about you!

A fair few posters have tried to point this out.

@2bazookas

I am trying to understand why ambulance crew reassure you that you will get the help you need

Because it's their job to reassure and calm ALL their 999 emergency patients, for obvious medical reasons.

The 999 patient is in acute distress from some emergency; injury, pain, shock, fear, or symptoms of mental illness. Acute stress and shock can cause additional medical emergencies (stroke, heart failure, breathing problems). To reduce stress, the paramedic reassures the patient ( regardless of the presenting problem, or its severity). You're safe, we're looking after you.

You got the same verbal comforting and calming paramedics provide to all acute emergency patients. For the same reason.

But that isn't what happened as I have explained. The first time for me they told me I would get the help I needed and would get a bed. I reassure and calm my patients too. I do not promise things I have no control over. Assume you haven't read the thread. A paramedic posted about how they deal with their patients without giving them false hope. I raised this issue as I wasn't sure the reason this often happens with serious mental illness.

Please ignore the poster who mentioned all the other patients the ambulance service had to deal with.

You are no less entitled to care and compassion than anyone else who uses the service.

Doesn't matter what we have heard or seen before we speak to to you, if you're in crisis enough that we think you need an ambulance.

@Mickarooni

” I thought as the paramedics had said I would get help there and I didn't that I obviously didn't deserve help. I tried to take my own life.”

It is incredibly sad and difficult to read that you felt unworthy and like you didn’t matter. However, I think that’s a reflection on your mental state and the systemic failures of the MH system, rather than a well meaning paramedic who genuinely believed you would get help. “Get help” clearly means different things to different people, as this thread clearly shows.

As I said I genuinely think they believed I would get help. I got nothing. They also told me I would get a bed. I didn't. I absolutely am not blaming them. They did the best with the information they had. What I am talking about is more communication between multi-disciplinary teams. More training around mental health or specific mental health ambulance staff.

And yes, of course it is a reflection of both those things. But that is always going to be the case for MH patients. Something that may seem so insignificant can tip someone over the edge. And this is a common one. That's all I'm saying!

What communication failed - out of interest. Your thread seems to be about the ambulance service and mental health care in A&E. It is clearly lacking but IMO, primarily due to underfunding and poor resourcing. There are, of course, some bad apples too.

@SpringTime2020

And yes, of course it is a reflection of both those things. But that is always going to be the case for MH patients. Something that may seem so insignificant can tip someone over the edge. And this is a common one. That's all I'm saying!

It is absolutely impossible to know what is going to tip someone over the edge and quite unfair to put that burden on a well meaning HCP. Being told something different may well tip someone else over. Mental illness is very unique and people rarely end their lives because of a well meaning person tried to reassure them and help them. It’s far more nuanced.

I hear ya OP
This happens across the mental health services
They are not joined up generally very well
One department will refer and discharge, referrals won’t be accepted for various reasons
And before the referral is triaged by the receiving service the patient has already been promised a service !!! Very unhelpful for patients

@Awrite

It takes committed self centredness not to see that what might be best for them might not be best for everyone. A 'one size fits all' approach might not be appropriate in these circumstances.

A kindly 'false hope' or even just kindly hope might actually help others in crisis. It's not all about you!

A fair few posters have tried to point this out.

And I have pointed out endlessly this is not just about me! Did you miss the bit about my friend who died a few days ago? Did you miss the posters giving similar stories? I have spoken to so many people who have had this issue. When you have been in hospitals for an extended time you end up with a large network of people with SMI. Many have the same experience. People I have spoken to on Mind conferences/workshops have the same experience. People I spoke to through being a peer mentor. Some of my patients too. We are not all wrong! Stop trying to shut me up! Of course there should be no one size fits all. I've never said that. I have said this is an issue for many that deserves looking at. I deeply care about what happens to people with SMI so yes, I will talk about it. I find it pretty self-centred to try to dismiss patient's lived experience because it doesn't fit your agenda.

@Mickarooni

What communication failed - out of interest. Your thread seems to be about the ambulance service and mental health care in A&E. It is clearly lacking but IMO, primarily due to underfunding and poor resourcing. There are, of course, some bad apples too.

When I am talking about communication between the mental health team at A&E and paramedics around managing expectations. This is a problem everywhere in the NHS not just here. Yes, absolutely underfunding etc is the cause. But there are ways to manage the situation. I will say again I am not blaming any one individual or team.

They are more likely to get a bed by turning up at A&E, it's sometimes the only way for desperate relatives to start the process of getting them the necessary help.

@Mickarooni - but what if time and again this was raised as a contributing factor? By patients, by family, by hcps? Would it not be worth looking into?

Your comments saying your friend killed herself because of what the paramedic said are appalling.

Your friend killed herself because she had mental illness.

If you can’t draw those basic boundaries then I am not convinced you should be a nurse at the moment.