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!

@Talkwhilstyouwalk

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.

Not in my experience. It appears to be less likely. But of course I'm talking about my area and surrounds. If only it was the start of help. I've been there as a relative, patient and HCP.

I hope if you have experienced this that you managed to get help. For me it was the first response team in the community that got me a bed.

@Somebodylikeyew

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.

Have you read the thread? I don't believe I specifically stated that. If I did I retract it. I have said it was a contributing factor. I'm sorry if that is hard to hear but unfortunately as I said it comes up time and again. The devestating effect on someone's mental health when they are promised help that never materialised.

My Dd15 has suffered from some serious mental health problems as well as anorexia. We have had to call an ambulance on several occasions for her when she has been in crisis - the paramedics were absolutely brilliant each time- patient, kind and knowing exactly how best to talk to her. So much more help than the useless Camhs Crisis team. And she was admitted twice from A and E to paediatric ward and from there on to a specialist unit.

@Schmoozer

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

Yes, absolutely. And it happens everywhere in the NHS in my experience. But this really is an issue that affects so many with SMI. I'm not sure why so many on this thread can't accept the lived experience of those with SMI. I guess it is a difficult truth that so many with SMI are let down.

@Marv1nGay3

My Dd15 has suffered from some serious mental health problems as well as anorexia. We have had to call an ambulance on several occasions for her when she has been in crisis - the paramedics were absolutely brilliant each time- patient, kind and knowing exactly how best to talk to her. So much more help than the useless Camhs Crisis team. And she was admitted twice from A and E to paediatric ward and from there on to a specialist unit.

Oh, the paramedics I had were wonderful too. Crisis team not much help here either. That's great A&E worked for her. I was lucky enough to be admitted to an acute and then onto specialist too. I hope her inpatient stay helped?

[quote SpringTime2020]@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?[/quote]
Your specific example of a paramedic telling a patient they’ll get help and admission to a ward is a contributing factor? I find that incredibly narrow and unlikely. Do I think the systematic failures of the system are a contributing factor? 100 percent! But you’re specifically talking about paramedics reassuring people by saying they’ll get help and/or admission. I’m sorry but that’s not my experience at all and I’m certainly far from singing the praises of the system!

^ just to add, not that it’s never a contributing factor. I just am astounded that it’s such a big issue. I am certain there are other significant and common contributing factors.

@Mickarooni - yes unfortunately it is very common. I mean you could reframe it and say of course the issue is people should be getting the help they need and they don't. Of course that is true. But unfortunately that is unlikely to change anytime soon. So expectations should be managed. And paramedics are part of that.

Again, you’re still extrapolating your own experiences. As I’m sure you know, there is a vast range of mental illnesses and how they present and how they should be approached. One size does not fit all.

In my (too many!) years in the system, it’s never been a problem of “managing expectations”. Complaints have rarely been about nice paramedics, for example! Many patients don’t wish to be admitted, many patients want to be seen urgent for a medical review, many patients would be horrified at being made to talk. You cannot presume your experience is universal.

But yes, as explained in my own situation it was devestating to be reassured I would get a bed and help to get better and I got nothing. I'm not blaming anyone. I think the paramedics genuinely believed what they told me and the mental health team are under a lot of pressure to discharge people quickly. Now the lack of help would have been hard anyway. But I have explained why specifically being told to expect things that didn't happen messed with my head. And I have spoken to many others who say similar. I am surprised you find it so unlikely. Managing expectations is often talked about in healthcare - around both physical and mental health.

@JustUseTheDoorSanta

If you write to your CCG with a detailed complaint, then you can ask them to identify why you weren't given support by A&E that was needed and to fix processes. Here are the details of the complaints process: www.nhs.uk/using-the-nhs/about-the-nhs/how-to-complain-to-the-nhs/.

It's good that you are feeling a bit better, but threads here where you go over and over the same thing repetitively are not productive; the risk is that constant repetition of anger about not getting help will make you spiral back into depression. You should discuss with your current therapist that you've been writing threads getting upset about not being helped in the way you feel you need, and that you did it many times whilst extremely unwell, because it may be an early sign that things are getting worse again.

Thankyou.

I hope OP takes your advice

I’ve been both a patient and a professional (although I’m currently neither), so I like to think I have a fairly balanced view of the system. Managing a 16 year old young woman with anorexia nervosa in the A&E setting is a whole different ballgame to managing a 66 year old man with schizophrenia who is intoxicated and hallucinating. It’a comparing apples and oranges. It’s impossible for any one to be able to manage their expectations.

@Mickarooni

Again, you’re still extrapolating your own experiences. As I’m sure you know, there is a vast range of mental illnesses and how they present and how they should be approached. One size does not fit all.

In my (too many!) years in the system, it’s never been a problem of “managing expectations”. Complaints have rarely been about nice paramedics, for example! Many patients don’t wish to be admitted, many patients want to be seen urgent for a medical review, many patients would be horrified at being made to talk. You cannot presume your experience is universal.

And as I have said over and over. I am talking at 10s if not more people's experience. Yes, I am talking about my experience as an example as of course I am most familiar with it. And complaints rarely come from those who are very unwell, precisely because they are too unwell to complain! However, as I said it is not a blame game. You've really never had to manage expectations? Not sure what your role is but I find that odd. One size doesn't fit all but honestly paramedics have little MH training and little time with patients. For them to be expected to know how to approach different mental illnesses is not feasible. I can't see that comforting and calming a patient without promising things you can't provide is such a bad approach. It is how nurses work.

Their job is to get you to assess you and transport you to hospital as safely as possible. They are usually very skilled in calming people down and de-escalation. They help a lot of people in a state of panic because of a medical emergency, and a lot of medical emergencies which are mental health based (psychotic breaks, panic attacks, etc). But they have very limited options at their disposal. They would be negligent to leave somebody without further care if they were very distressed, and they only have the hospital to take them to. It's a broken system, and so many Working within that can see it. I think for some paramedics that will upset them enough to leave the job, others are not so emotionally attached and just 'doing a job' and others still care deeply, worry about those people but believe they helped for that piece of time at least.

@2bazookas - I have no therapist, and I'm not just a bit better, I'm fully recovered and back at work. And what does 'did it many times while extremely unwell' mean? I mean I know you didn't write it but you endorsed it so presumably know what it means?

@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.

This - a million times

Well I’ve come across many patients and families and rarely has “the paramedics didn’t manage my expectations properly” has ever been a repeated theme. That’s not to say all paramedics are angels and that there isn’t a need - as you say - for further MH training.

Have I never had to manage expectations? You’ve missed my point. My point is that there isn’t one size fits all with expectations. I don’t know if you’ve come across a subgroup but I am talking about all people of all ages with all variations and severities of mental illnesses.

Comforting and calming is of course good for some people but again, many people don’t want that. They just want to be taken to hospital. It depends on the nature of the illness and how urgent it is.

@Mickarooni

I’ve been both a patient and a professional (although I’m currently neither), so I like to think I have a fairly balanced view of the system. Managing a 16 year old young woman with anorexia nervosa in the A&E setting is a whole different ballgame to managing a 66 year old man with schizophrenia who is intoxicated and hallucinating. It’a comparing apples and oranges. It’s impossible for any one to be able to manage their expectations.

We'll have to agree to disagree then. In my experience it is not impossible.

Look, you asked if YABU. In answer to your extremely specific query, yes I think you are. Your more general points e.g. about training for all medical professionals are obviously completely understandable and reasonable.

@rubyjam - you do realise that being actively suicidal is an emergency? If A&E is not the place, why are there mental health teams working in A&E? How do these teams manage to treat their patients if it is not possible? Why are hcps like therapists told to ring 999 in an emergency? Why do paramedics attend these calls?

@Mickarooni

Look, you asked if YABU. In answer to your extremely specific query, yes I think you are. Your more general points e.g. about training for all medical professionals are obviously completely understandable and reasonable.

Well, it wasn't actually an AIBU it was a question. I was just trying to understand why this is an issue. I know it's an issue as I talk to people week in week out about it. Actually, a few did answer the question and it was an interesting discussion. I mean of course other discussions have been too. I'm glad to have heard your perspective

But someone did point out I didn't go about asking the question the right way and that my title was inflammatory. I didn't intend that atall. It has been really upsetting to hear some of the more nasty comments against those with SMI but unfortunately not surprising.

@Mickarooni

Well I’ve come across many patients and families and rarely has “the paramedics didn’t manage my expectations properly” has ever been a repeated theme. That’s not to say all paramedics are angels and that there isn’t a need - as you say - for further MH training.

Have I never had to manage expectations? You’ve missed my point. My point is that there isn’t one size fits all with expectations. I don’t know if you’ve come across a subgroup but I am talking about all people of all ages with all variations and severities of mental illnesses.

Comforting and calming is of course good for some people but again, many people don’t want that. They just want to be taken to hospital. It depends on the nature of the illness and how urgent it is.

Haha no of course patients and families don't talk about managing expectations! It's usually managers! And this is not about calling paramedics bad. It is precisely about training etc.

Maybe if there were specialised paramedics for MH they could be expected to give a nuanced approach to different mental illness. As it stands I don't think that is a reasonable expectation of paramedics.

The point about comforting and calming was that many asserted that was the paramedics job and as part of that it was reasonable or even preferable that the paramedic made promises to a patient that may be completely unfounded.

@SpringTime2020

But someone did point out I didn't go about asking the question the right way and that my title was inflammatory. I didn't intend that atall. It has been really upsetting to hear some of the more nasty comments against those with SMI but unfortunately not surprising.

The nasty comments are par the course on MN but I really don’t think most people are that unpleasant. I like to think most people are good and kind people. :)

Interesting point about specialised paramedics. Some areas have paramedics and MH practitioners working together in one vehicle. As you can imagine, demand for this service is high, so it can’t help everyone but it’s had positive outcomes for some people that gives me hope for the future.