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!

@gamerchick

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?

Well, in my situation I didn't ring the ambulances - they were rung for me. Help looks like seeing a psych/psych nurse and getting treatment.

@BlanketsBanned

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

Well, that's what I wondered. Do they think that is what happens? Mostly that doesn't happen. No treatment is given atall. You are often treated with contempt and are in a worse state when they discharge you.

@TiredSloth

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.

It would be good if paramedics were aware though that rarely is any help given. It is awful to have your hopes raised like that. If they aren't sure what will happen saying nothing is better

@AlphaAlpha

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'

I know you are in a difficult position. I totally understand services are cut to the bone. All I will ask - please don't get our hopes up - it makes it all so much worse.

@NoSquirrels

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

Thank you. This was a while ago for me and things are much better.

I understand paramedics care for the immediate danger. That really wasn't what they were refering to when they were reassuring me I would get the help I needed. And yes, you can get help from A&E. They can find you a bed on a psych ward for example or make a referral to first response. But they don't seem to. This is my experience and many others. They just make you feel you are wasting their time and discharge you. Then if you weren't feeling suicidal before you really do then.

Please don't misunderstand me. Paramedics are heroes! I really think they are amazing. I just wondered how much communication is there between teams. Do they genuinely think we will get help? Or are they trying to be nice?

@SockFluffInTheBath

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?

I think they shouldn't get people's hopes up as it makes you feel worse.

@RoomOfRequirement

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

I'm not complaining. Just exploring the reasons this happens. Having you hopes put up then dashed leads to many committing suicide. It's important.

@owlinnahat

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.

You're lucky if you get diazepam!! It's just promethazine round here - which I'm allergic to!

Not long after the 2 situations I was sectioned. And total turning point for me too. But I nearly didn't get there as each time they let me down in A&E I tried to take my life.

@Flexitarian

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?

No it isn't. Taking to a place of safety is something else. This is just being taken to be reviewed by MH team at A&E.

Actually A&E depts often do have access to Crisis team nurses who can come and do an assessment and if they deem it necessary can get the patient admitted to a psychiatry bed/seen by a psychiatrist if they’re very sick. But it’s a very high threshold of mental health issue that would necessitate psychiatry admission these days. Unless you’re actively suicidal with a credible plan and the means to carry it out, or psychotic or have already made a credible attempt on your life then you’re unlikely to be deemed in need of sectioning, and these days they prefer to get a lot of people in on a voluntary “section” which comes with its own pitfalls for the likely care you’ll get, the follow up you’d have and other procedural things, but essentially, when you calm down from the crisis and things settle, you can ask to leave and they won’t stop you, thus absolving themselves as you’re there voluntarily.

It’s a rubbish underfunded system, but neither 999 or A&E places for depressed or anxious people who have no active intent to kill themselves or harm others. Some liaison psychiatry teams won’t even leave their office to see a patient unless that threshold is met.

@ToastieCrumbs

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.

Thank you - someone who understands the point I am making! All the paramedics I have ever been cared for by have been amazing. I know they meant know harm. But I wondered if they really know what happens when you get to hospital? Talked to like you are wasting their time and discharged with nothing.

@elenacampana

Everybody is desperate OP, staff and patients.

Yes, I agree.

@Christienne

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.

Really? And did it work? Here the psychs and AMHPs do it.

I mean in theory A&E can do it but it is very rare.

@BankersBonus - I'm so sorry to hear that. It is very common. They patch you up and send you on your way feeling even worse. I hope your brother is doing better?

@Oblomov22

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?

Criticised by who? Certainly not me. I am trying to understand why ambulance crew reassure you that you will get the help you need when in most cases you will not.

@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.

No they have a mental health team. Can't believe people don't realise that. And it is an emergency when you are actively suicidal.

@HowToStopThinking

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!

I'm not angry with paramedics!!! You have completely missed the point. When seriously mentally ill patients keep having their hopes raised (by ambulance crew) and then dashed (by the mental health team) it makes them even more likely to take their own life. This was the situation for a friend of mine a few days ago and she passed away. This is important!! Who is telling ambulance crew they will get help? Why are patient's hopes being raised like this? Because it leads to another young women completing suicide. And if anyone thinks that is not worth discussing please think again.

@ZealAndArdour

Actually A&E depts often do have access to Crisis team nurses who can come and do an assessment and if they deem it necessary can get the patient admitted to a psychiatry bed/seen by a psychiatrist if they’re very sick. But it’s a very high threshold of mental health issue that would necessitate psychiatry admission these days. Unless you’re actively suicidal with a credible plan and the means to carry it out, or psychotic or have already made a credible attempt on your life then you’re unlikely to be deemed in need of sectioning, and these days they prefer to get a lot of people in on a voluntary “section” which comes with its own pitfalls for the likely care you’ll get, the follow up you’d have and other procedural things, but essentially, when you calm down from the crisis and things settle, you can ask to leave and they won’t stop you, thus absolving themselves as you’re there voluntarily.

It’s a rubbish underfunded system, but neither 999 or A&E places for depressed or anxious people who have no active intent to kill themselves or harm others. Some liaison psychiatry teams won’t even leave their office to see a patient unless that threshold is met.

Well in my situation I was actively suicidal and made even more so by the mental health team at A&E. Having hopes raised and then dashed and being treated with contempt by A&E lead to further attempts. I needed a bed. And luckily I was soon sectioned and in hospital for a long time. So yes I did meet the threshold. Just for some reason so many people in crisis are let down at A&E.

I am trying to understand why ambulance crew reassure you that you will get the help you need when in most cases you will not.

Because they aren’t mental health professionals capable of taking a full psychiatry history, risk assessing your mental state, suggesting differential diagnoses and identifying a treatment plan for your mental health needs.

They only have access to/knowledge of some initial brief screening tools that likely suggested A&E based on what you told them. They probably believed you would get help. Help comes in many forms and it’s different for everyone.

Usually the mental health team in the department will give you details to self refer to talking therapy at the very least, if not access to the crisis team for a defined period of time or they might write to your GP to recommend a referral to outpatient psychiatry.

Nobody with a physical or mental health need gets to go to hospital and demand what treatment they think they need, it is based on a skilled assessment and an evidence base of information which informs what treatment your particular presentation is most likely to benefit from.

@caranations

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.

Well, I was soon back at home with my DC. Just because you are in A&E for a few hours coming back home even more suicidal is even worse. I'm glad your DM got help. She most likely wouldn't have done if taken to A&E.

But A&E aren’t letting you down on purpose, nobody works in A&E to make anyones life worse. There is no funding.

Write to your MP? Stand in your next local election? Try and discourage people you know from voting for the tories? Train to be a mental health nurse? Or psychiatrist?

@BettyBag - it is often the ambulance service that takes you to your psych hospital but private ambulances are used to.

It is disappointing that some people don't understand MH crisis can be an emergency.

@SleepyRich

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.

Thank you for your post. And admire you so much. It is absolutely awful the lack of MH training you get. It's great that you never promise things that might not happen. I think it is so important. And yes, you lot are wonderful to talk to and it helps a lot to have a friendly ear to listen.

@ZealAndArdour

But A&E aren’t letting you down on purpose, nobody works in A&E to make anyones life worse. There is no funding.

Write to your MP? Stand in your next local election? Try and discourage people you know from voting for the tories? Train to be a mental health nurse? Or psychiatrist?

I'm already a nurse.

They may not be letting us down on purpose but they are and people are dying. As has been discussed a small thing paramedics can do is not raise people's hopes. That can be done much quicker and will affect many more people than me standing for election or training to be a psych!!! And how you think I can afford to do that anyway!