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!

@saraclara

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.

No, that isn't all they meant. And no I didn"t get help to keep me safe beyond the short time I was in A&E. Then it was back to my DC even more suicidal. And no, no acute meds either. You presume wrong.

OP I get what you’re saying but what else can the paramedics say? They want to reassure the person. Brutal honesty isn’t going to be very nice. I mean if they are dealing with someone with severe blood loss from an injury, they’ll say ‘you’ll be ok, come on, stay with me, it’s ok’ not ‘shot, you’re doomed mate, no Band-Aid big enough to cover that hole! I’m going to get a cuppa, no point in staying with you’.

They want to think their patient will get help (otherwise what’s the point of having an ambulance service) and it’s not up to them to tell you that there’s no point and you’ll just be sent home again. It’s not their job to deliver that message. They go to their jobs with hope and the aim to do their very best for the person. They need to keep that hope.

I get that it’s horrible having your hopes up, but I don’t think outcomes would be better if they answered a call just to turn up and say ‘no point, you won’t get help’. That’s not going to lead to a good outcome either. With an actively suicidal person it’s often important to break the moment. The person is still depressed, but hopefully no longer actively suicidal. I’m so sorry that wasn’t the case with your friend. It’s truly tragic she was let down. But what else could they say? Humans make reassuring sounds to a person in distress. You’d have to be a sociopath to be able to deal with someone in such a state and not say anything at all. Paramedics do their part in the chain of people who will hopefully get a person well. They shouldn’t have to do that differently just because the rest of the services can’t cope.

There’s no good outcome here. The government need to totally re prioritise funding. It’s just appalling how stretched services are now. And this is the outcome.

@ZealAndArdour

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.

Yes, thanks for that. As you say they don't know so best not get hopes up. Demand treatment? If only I was well enough to do just that. It nearly cost me my life. Self refer to talking therapy...you must be joking?! And yes eventually I was assessed. I was sectioned and in hospital for a long time. Luckily I wasn't dead before this happened. Many others weren't so lucky.

I don’t understand how you can be a nurse and have so little insight into how fucked and broken the system is. There is a vast gaping chasm between how everything should work and how it does work in reality, I don’t know a HCP alive who doesn’t know that.

I’m struggling to understand what you want out of the thread? You’re griping at paramedics for doing they only possible thing they can do in the situation they’re presented with. Would you rather they just told you “don’t bother going to A&E, they can’t help you, you might as well just stay here and kill yourself”. Like realistically, what else could the possibly say to you other than “please come to hospital, you’ll get help”.

My faith in the system is pretty low too, in fact I’ve paid to go privately three times in the last year, once for a gastroenterologist, once for a cardiologist and I’m still seeing a private psychiatrist and paying private prescription charges for my meds. I know the system is broken, I know that timely help isn’t there, but this thread moaning about your supposed HCP colleagues is absolutely redundant,

@tcjotm

OP I get what you’re saying but what else can the paramedics say? They want to reassure the person. Brutal honesty isn’t going to be very nice. I mean if they are dealing with someone with severe blood loss from an injury, they’ll say ‘you’ll be ok, come on, stay with me, it’s ok’ not ‘shot, you’re doomed mate, no Band-Aid big enough to cover that hole! I’m going to get a cuppa, no point in staying with you’.

They want to think their patient will get help (otherwise what’s the point of having an ambulance service) and it’s not up to them to tell you that there’s no point and you’ll just be sent home again. It’s not their job to deliver that message. They go to their jobs with hope and the aim to do their very best for the person. They need to keep that hope.

I get that it’s horrible having your hopes up, but I don’t think outcomes would be better if they answered a call just to turn up and say ‘no point, you won’t get help’. That’s not going to lead to a good outcome either. With an actively suicidal person it’s often important to break the moment. The person is still depressed, but hopefully no longer actively suicidal. I’m so sorry that wasn’t the case with your friend. It’s truly tragic she was let down. But what else could they say? Humans make reassuring sounds to a person in distress. You’d have to be a sociopath to be able to deal with someone in such a state and not say anything at all. Paramedics do their part in the chain of people who will hopefully get a person well. They shouldn’t have to do that differently just because the rest of the services can’t cope.

There’s no good outcome here. The government need to totally re prioritise funding. It’s just appalling how stretched services are now. And this is the outcome.

They can not make false promises. I'm a nurse and know how important that is. You can reassure someone without telling them things that may or may not happen. That is different to brutal honesty. If someone is in danger of death I would reassure them we are doing all we can for them and there is pain relief available - I would not promise them they would not die.

The trouble is raising false hope is making the situation worse for the patient. By being reassuring but realistic you prevent the horrendous feeling of hopes being dashed again. That is what paramedics should be doing, imvho. It was part of my nurse training.

@ZealAndArdour

I don’t understand how you can be a nurse and have so little insight into how fucked and broken the system is. There is a vast gaping chasm between how everything should work and how it does work in reality, I don’t know a HCP alive who doesn’t know that.

I’m struggling to understand what you want out of the thread? You’re griping at paramedics for doing they only possible thing they can do in the situation they’re presented with. Would you rather they just told you “don’t bother going to A&E, they can’t help you, you might as well just stay here and kill yourself”. Like realistically, what else could the possibly say to you other than “please come to hospital, you’ll get help”.

My faith in the system is pretty low too, in fact I’ve paid to go privately three times in the last year, once for a gastroenterologist, once for a cardiologist and I’m still seeing a private psychiatrist and paying private prescription charges for my meds. I know the system is broken, I know that timely help isn’t there, but this thread moaning about your supposed HCP colleagues is absolutely redundant,

I'm more than aware of it as I have referred to in many of my posts.

Again as I have said I am not griping at paramedics atall. They are free not to raise false hopes (if they are aware help is unlikely). As I have said in my nurse training this was very important - how to reassure a patient and manage expectations. It isn't something that is impossible for ambulance crew to do.

And no it's not redundant. Not when people's lives could be saved if people understood the point I am making. Luckily the ambulance crew on this thread did understand and we have been able to have a useful conversation. Communication is so important and we've been able to have it here. If the thread is not of interest to you - no need to post.

But maybe some people did find A&E helpful, perhaps some of them just needed to be heard, and felt better after a listening ear and a cup of tea, some people might have even signposted to other mental health services or referred for CBT or simile, others might have been sectioned, and another person might have had a dose of diazepam and their breathing coached to help them out of a panic attack, and some of them might have had a reversible physical problem causing their mental health issue I.e. an elderly person with delirium, and there’s a lot of others who feel a lot, lot better after the drink or drugs have worn up and their loved on has come to comfort the and collect them to go home.

You’re talking specifically about your situation, like it’s a universal experience for everyone attending A&E for a mental health issue and it’s not the case. If you feel your care was misleading or substandard, it is within your rights to complain about that and have it addressed. But also consider that maybe you assessed very differently on the day you were taken to A&E, than you did on the day you were finally sectioned. Perhaps the person performing the first assessment has a higher threshold of risk that they’re comfortable working to and if a different person assessed you the first time you might have been sectioned.

There are so many nuances and variables, but you’re taking in absolutes.

What precisely did they say to her and what would you have preferred they say? I mean, if you were training paramedics, what exact words would you like them to say to a suicidal patents?

Not being arsey, I’m trying to get my head around where you see the line is between being reassuring and giving false hope. I personally think it’s very much in the eye of the beholder and unfair to put on paramedics. For example how “we’re going to get you help” is interpreted will vary. For paramedics it means “we’re going to get you to the hospital”. Not their fault if the next step in the chain doesn’t give the person help.

What precisely should they say that’s comforting but doesn’t give false hope? I’ve been suicidal. Never called an ambulance but I would have liked them saying I’d get help. At least I’d feel they cared. But I appreciate your perspective is different and I’d like to understand what you would want to hear.

I mean in the example I gave above about a person dying, I said they’d say things like ‘you’ll be ok’. That’s not saying that the person isn’t going to die, you aren’t giving false hope but comfort. It’s what I’d want to hear if I were scared I was dying. ‘there’s pain relief available’ would be no comfort to someone scared who is feeling their life ebb away and probably beyond pain. Likewise when I was so depressed I wanted to die, I wanted comfort. What would you have had them tell me? Just a very precise ‘we are transporting you to hospital, they will assess you”. To me that’s like being told ‘your call is important to us, please hold’.

@ZealAndArdour - I'm not talking just about me. I wish I was! Did you not see my friend died a few days ago! I don't think you understand what I mean by serious mental illness. A cup of tea?! You must live in a very different place to me! Noone is being made cups of tea and when you have a SMI a cup of tea really doesn't cut it! When you have been in psych hospitals a long time you get a very large network of people with SMI. You hear their stories everyday. It's nice to imagine all those scenarios you suggest. And of course they happen. But a much larger proportion of people are let down in A&E. And all I'm saying is managing expectations is preferable.

And regarding myself I have complained and they were upheld (not just A&E situation). But speculating on how I presented is not likely to lead to any useful discussion.

@tcjotm

What precisely did they say to her and what would you have preferred they say? I mean, if you were training paramedics, what exact words would you like them to say to a suicidal patents?

Not being arsey, I’m trying to get my head around where you see the line is between being reassuring and giving false hope. I personally think it’s very much in the eye of the beholder and unfair to put on paramedics. For example how “we’re going to get you help” is interpreted will vary. For paramedics it means “we’re going to get you to the hospital”. Not their fault if the next step in the chain doesn’t give the person help.

What precisely should they say that’s comforting but doesn’t give false hope? I’ve been suicidal. Never called an ambulance but I would have liked them saying I’d get help. At least I’d feel they cared. But I appreciate your perspective is different and I’d like to understand what you would want to hear.

I mean in the example I gave above about a person dying, I said they’d say things like ‘you’ll be ok’. That’s not saying that the person isn’t going to die, you aren’t giving false hope but comfort. It’s what I’d want to hear if I were scared I was dying. ‘there’s pain relief available’ would be no comfort to someone scared who is feeling their life ebb away and probably beyond pain. Likewise when I was so depressed I wanted to die, I wanted comfort. What would you have had them tell me? Just a very precise ‘we are transporting you to hospital, they will assess you”. To me that’s like being told ‘your call is important to us, please hold’.

When you are told that 'you are going to get the help you need now'. Suggestions that they'll get you a bed etc. This was one of my situations. A hcp had called the ambulance and had passed on to the paramedics how serious things were. I think they genuinely thought I would get help. They really thought I would be found a bed. Now, when I was treated with contempt and discharged with no help there is the crushing disappointment which if hopes have been raised is much worse. Then there is the fear...they said I would get help here but there wasn't any help but if this is the place people get help then I will never be helped. Life is pointless, I might as well give up.

What can paramedics say/do? They can be with their patient in that moment. Supporting them with breathing etc, grounding and reorienting. I mean there are many things our wonderful talented paramedics could do if mental health training happened. They can show kindness and compassion for their patient. 'I know things feel awful right now and I'm truly sorry you are experiencing this' The thing is being told you will get help might make you feel better at the time but if you don't get that help you will be left feeling much worse. You may have experienced that yourself if you had been taken to A&E. Paramedics have always shown they care so much aside from refering to help.

Actually pain is one of the thing many patients are afraid of. Letting them know there is pain relief can be a huge comfort.

Thank you @SpringTime2020that does really help. I agree, being told you’ll get a bed is a step too far, they can’t promise that at all. That must’ve been a crushing experience.

I acknowledge too that my experience is probably coloured by being in a better funded health system. What I read about the UK here is horrific. Mental health treatment still isn’t great, but overall the health system is much better resourced. But even here I wouldn’t assume I’d get admitted/get a bed. That shouldn’t be promised, though I’m sure the paramedics really hoped you would. “You’re going to get the help you need now” really should be a promise they can keep (at least some level of help” but sounds like things are beyond broken. A&E is less cutthroat where I am, I’ve always gotten some kind of help.

Again, really sorry for your loss. It must be so hard having had similar experiences yourself. It’s somehow worse to understand and still lose someone to it.

@tcjotm - thank you for your understanding. I ended up one of the lucky ones. I was sectioned and given lots of help in hospital. The long stay one was a private hospital so I got lots of wonderful extras not available in the NHS.

Just to clarify this is not a dig atall at our amazing paramedics. This is not a dig at any hcps. We all know the real answer is adequate funding.

Just for some reason so many people in crisis are let down at A&E.

Easy answer. There are generally no beds to send you to and services are at capacity so the mandate is to refer to outpatient services who will get to you when they can (although this part seems to break down often and not everyone is contacted). Mental health beds don’t grow on trees and for one to be free while you are in A&E the stars and planets would have to be in alignment and that’s so rare. It’s not that A&E don’t care, there is literally nowhere to send you that had capacity at the time.

It’s unfortunate but someone can’t stay in an A&E bed for a few days until a mental health team has capacity to make a proper assessment and then for days until a mental health bed becomes available. A&E are no more happy about this than you are, let me assure you but it is what it is and yes, unfortunately some people may not survive this and no one is blind to that but in an individual level no one can do anything otherwise.

Perhaps instead of blaming paramedics and A&E you could put the blame squarely where it belongs, Govnt funding has stripped mental health services back past the bone, and THIS is where your anger should be directed.

I work with someone now who left a paramedic job because he got totally fed up of the drain of mental health people constantly taking their call out time when he should be helping people with a life or death emergency . He felt the same people over and over were calling 999 for some attention seeking supposed suicide, preventing them getting to emergencies .
He decided to leave when he was starting to feel if they were genuinely suicidal they would bloody get on and do it and not delay everyone for hours on top of a motorway bridge they had no intention of falling from .
It's very sad all around but this explosion of 'mental health ' seems to permeate every sector and it's totally new and hard to understand for a lot of us .

I have just read 'Can you hear me' which is written by a paramedic and covers this (along with lots of other stuff)

I agree no one should be lying but I might exaggerate a bit about what will happen at A&E if I thought it might save a life.

Here anyone brought in for MH related things gets assessed by the relevant professionals that can section if needed. The trouble is that the threshold is so high and there's no beds, so for many who do require help sadly they still cannot access it. It's not even a funding thing at this point, there aren't enough staff to expand services. I do think there should be ambulances dedicated to MH calls with different equipment and mental health trained HCPs on board, it would free up ambulances as we know them and also the people would have more knowledge of the system and be able to provide more tailored care. Paramedics already have tonnes to know and learn, and to expect them to have an in depth knowledge of mental health as well is too much.

I don't understand how everyone can get a lift to the supermarket each week but suddenly need an ambulance to take them if they feel ill.
At the worst and you have no transport people get picked up from the supermarket by a taxi.
What the heck is it - unless you are dying of a heart attack - can't you just get a lift like the rest of the time.

Your frustration should be directed at the governing party who won’t fund mental health services.

Or at the public who won't pay more taxes.

@CurtainTroubles

Your frustration should be directed at the governing party who won’t fund mental health services.

They will chuck money at them but there aren't enough staff so there's no point. The nhs is beyond just chuck more money at it.

A friend was in A&E this week and was talking to a 19 year old boy. He’d tried to commit suicide and been brought in by the police. He’d sat there for 10 hrs. He said to my friend “I just want help and they’ve left me here.” So sad

Paramedics go to multiple hospitals, and what happens at one may not happen at another. Yes we can call the crisis team, they often taken hours upon hours to come, then will simply check you not actively suicidal and will say discharge and follow up in the community. The threshold for admission is extremely high, and mental health beds are few and far between! They aren’t lying to you, they are not to blame, neither are the ED staff, our hands are tied.

They take people to hospital if they feel they won't be safe at home. They have to do that obviously. If you are saying you will kill yourself if left at home then they have no choice do they? They will say what it takes to get you to go if the stakes are high.

'Get the help you need' is relative isn't it?
Surely you did not believe that A&E was a magic shortcut to being cured otherwise everyone else would also have discovered it. If the help you immediately need is to stay safe tonight then you will get that. You will usually also be seen by a MH professional but their role at that point is to ensure you are safe for discharge that night and refer you in to other services for the longer term problem. You might still have to wait though.

What is the help that you need in your view? Admission: only really helpful for conditions that can be cured by drugs. Psychotherapy? Not going to be available in A&E at any point

It's fine to go to A&E if you are in crisis as a place of safety and usually there will be a hospital liaison team or a duty psychiatrist to talk to but that's realistically all that's going to be available there. Many places have a crisis line 111 option 2 which would offer much the same if you are OK with telephone interactions and avoids the waiting around in A&E if there are no accompanying physical issues.

Nurse here too.
They're so very busy, I suspect that in good faith they just say what you want to hear to gain your cooperation, and move as quickly as possible onto their next call.

My DH works as part of a joint initiative between police and NHS to better deal with people in mental health crisis who would previously have ended up being sectioned. It's not something that happens everywhere yet but it works well and may become more widespread if other counties decide to set it up.