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!

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

And those who voted for them, who plainly don't give a damn about MH provision, until it actually affects them in some way.

You're more likely to get admitted to a psych unit from police custody than from A&E. A couple of clients have gone down this route in the last few months, thankfully only by causing some sort of disturbance or committing criminal damage.

MH services are so stretched that they can't possibly meet the need, which has increased since the pandemic. They're losing really good staff, because they are utterly demoralised by not being able to give people the help they need.

I have an ex-client who struggles with paranoid schizophrenia. They're supposed to have a fortnightly visit from a CPN. That all stopped in the first lockdown, they've had a phone call every few months, and 2 telephone reviews with a consultant in nearly 2 years. When they asked when visits or F2F appointments were going to resume, he was told that there were no plans to do that yet, because of cuts. He is really unwell.

MH services here are in crisis. I doubt if anyone has bothered to tell paramedics that the chances of anyone with MH issues getting meaningful help via A&E are, at best, slim.

A&E can help. I drove myself there - actually to see them about another imagined condition I thought was happening to me.
I was having a breakdown with pnd. Luckily a social worker came in to chat to me in my cubicle and I heard her telling the doctor that he couldn’t let me go.
I spent about 8 hours there that day, dh collected me and I was under the community mental health team for weeks - they visited me twice a day and I had psychiatrist appointments regularly.
I've always had mh problems my whole life. This was the first time I ever went to a&e (although I have been in a private mh hospital before too).
They did help me - thanks to the social worker. Perhaps the ambulance crew thought you'd get seen by one. Also, it's probably their policy and the drivers themselves can either decide to leave you or take you to a and e. Perhaps they knew you would be sent home again.

@Pandoh

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.

In most places in the UK there are street triage teams, made up of mental health professionals who can go out with police or paramedics to mental health calls. So it is a thing. OP - I'm sorry you've felt dismissed and struggled to get the help you needed. I'm a mental health nurse and I have found it increasingly difficult over the seven years I've been qualified, due to services being constantly cut and understaffed. But I can't imagine how hard it is when you're the person using those services and feeling that you're not getting the help or empathy you need. I think there has increasingly become a culture within MH services of making it difficult for people to get into secondary services or get the care they need, all under the guise of "encouraging independence " or not making people dependent on services. I hope that things start to get better for you

It is surely more important to focus energy on how to change the system so that people DO get the help they need and are not turned away feeling even more suicidal and without good support.

Do the paramedics need to say "I hope you get the care you need today but please be aware that this might not be possible" ? I'm not sure that everyone would find that helpful to hear, true or not.

I spent 8 hours getting a seriously mentally ill friend to a&e, police helped searched for her all day, she got told to come back tomo to a&e, was horrific. She didn’t go back

No they don't but they taking the person to a place a safety. Yabu

Some myths in this thread

Lack of beds
Well it depends. It's not the whole truth
If you were ravingly manic or psychotic a bed would be found somehow somewhere and you would get dosed up with some meds. You would clearly meet a threshold for admission and effective treatment would be available.
Beds for people with personality disorder, emotional trauma and other long term issues that require months and years of therapy and management more than meds are what is not available. It's obvious why not because the person would be occupying the bed for many months or even years so they won't come up often.
If the public want more people to be treated as inpatients for conditions such as these then it would require huge investment
Many people would argue that an admission to a short term general mental health bed for such a condition is not a whole lot more helpful than A&E because those treatments are not available in a general acute ward where most patients have psychotic mental illness.
In most areas 3 day crisis assessment beds exist and then the majority of the long term work is carried out by community services.
That is the real reason why people don't on the whole get admitted from A&E.
Not that there are no beds at all but there are none of the kinds of bed that would be helpful to someone with a non drug responsive condition

'Sectioning'
No one would be detained under the MHA if they were actually wanting or accepting treatment as the entire purpose of it is to enforce treatment. Being detained is not a fail safe marker of the severity of a persons mental illness. Many people with serious mental illness are never detained or haven't been for years as they learn how to avoid it. It is pretty aversive as you lose nearly all autonomy
You do not need to be 'sectioned' to be admitted if you agree to it and most people are not. You cannot be 'voluntarily sectioned' that is a total oxymoron. You can be voluntarily admitted and if you withdrew your consent and the MHA criteria were met then you could still later on be detained so it is never a one time decision.

Underfunding of MH services vs physical health is not a myth though.
Parity of funding and esteem is a pipe dream. I heard an oncologist on the radio once complaining about how shit MH services are vs cancer services and he did not once appear to realise that the funding differential and the stigma are the cause of that. If we had all the money and public goodwill that cancer services have things would be very different. As it is we have to cut our cloth to fit and for some people we pretty much cannot offer a service or not one that is any good as we don't have the money or the staff to do it. Hence why OP eventually went to a private unit I guess.
We do offer a good service for what we are good at which is largely schizophrenia, bipolar I and major depression.

@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.

I think that is all very understandable but I think the OPs point is if you promise a sick person they will get the help they need and they don't it makes things even worse for them as it is just one more let down. I don't think she expects the ambulance crew to work miracles she just wants them to be honest.

I can imagine if you are dealing with someone very distressed it must seem kind to reassure them but in the long run it might not be. It is difficult but I do think it is good to hear it from the service users point of view and it shows that you are doing the right thing when you don't make promises. Maybe it is a training need for some crew members?

@londonrach

How’s it a place of safety when they are told to go
Home? Which happened to my friend, I was begging them not to send her home

I can't help but feel support groups (like alcoholics anonymous) are teh way for a lot of mental health probs. Charity run but with trained people running it - somewhere to talk, share problems etc etc
Surely teens getting together to share things would be a good thing. Though I did go to AA for children of alcoholics and it was difficult sometimes as attention seekers just dominated the conversations and little progress was made. But this was wholly voluntary without funding so no controls.

@Snog

It is surely more important to focus energy on how to change the system so that people DO get the help they need and are not turned away feeling even more suicidal and without good support.

Do the paramedics need to say "I hope you get the care you need today but please be aware that this might not be possible" ? I'm not sure that everyone would find that helpful to hear, true or not.

Or they could just say, "We are taking you to A&E where you will be able to talk to someone." Not promising something they can't guarantee but not being negative.

Hopefully it isn't unrealistic to expect someone in A&E to actually speak to them.

I had an ambulance sent out to me ten days ago after I phoned 111 and told them I had the means and the desire to end my life and planned to do so there and then .

Paramedic (his colleague was a soldier so just stood in the hallway) sat with me, rang my GP, GP spoke to me for 25 minutes calamine me down, paramedic got me a cup of tea and talked me down and talked to GP too .

Both explained that they could take me to A&E thirty miles away but GP said I’d be in a cubicle for three hours then discharged and GP said I’d then have a new problem of trying to get a bus home when agitated anxious and alone - so said last place I was going was A&E .

GP said she would contact MH services urgently, within 72 hours I got a call telling me I’d been made an appt with a clinical psychologist for three weeks time and practice therapist is going to phone me in the meantime .

The 111 call handler even called me two hours later to make sure I was OK .

I’m aware that’s unusual and previous experiences haven’t been like that at all, In fact usually the opposite - but I’ve nothing but praise for the system just now - if it wasn’t for them I’d have done it .

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

Eventually. mum was triaged by an A&E nurse, then saw an A&E doctor, then a MN nurse and eventually a Psychiatrist. She had to explain what the problem was 4 times which she found incredibly traumatising.

But, we were told, it was absolutely to only route to getting her seen (Wales, if it makes any difference).

@Polyanthus2

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.

I'd say 'and' rather than 'or'.

You can't absolve people who happily spent millions (billions?) of taxpayer's money on services that weren't fit for purpose so they could enrich their mates. Or people who cynically encouraged people to vote for leaving the EU knowing it would seriously damage our economy and leave us with fewer people to staff the NHS, while claiming they'd actually have MORE money to fund the NHS.

It's shameful.. Really shameful. And almost sociopathic in their levels of denial.

@CovoidOfAllHumanity

Some myths in this thread

Lack of beds
Well it depends. It's not the whole truth
If you were ravingly manic or psychotic a bed would be found somehow somewhere and you would get dosed up with some meds. You would clearly meet a threshold for admission and effective treatment would be available.
Beds for people with personality disorder, emotional trauma and other long term issues that require months and years of therapy and management more than meds are what is not available. It's obvious why not because the person would be occupying the bed for many months or even years so they won't come up often.
If the public want more people to be treated as inpatients for conditions such as these then it would require huge investment
Many people would argue that an admission to a short term general mental health bed for such a condition is not a whole lot more helpful than A&E because those treatments are not available in a general acute ward where most patients have psychotic mental illness.
In most areas 3 day crisis assessment beds exist and then the majority of the long term work is carried out by community services.
That is the real reason why people don't on the whole get admitted from A&E.
Not that there are no beds at all but there are none of the kinds of bed that would be helpful to someone with a non drug responsive condition

'Sectioning'
No one would be detained under the MHA if they were actually wanting or accepting treatment as the entire purpose of it is to enforce treatment. Being detained is not a fail safe marker of the severity of a persons mental illness. Many people with serious mental illness are never detained or haven't been for years as they learn how to avoid it. It is pretty aversive as you lose nearly all autonomy
You do not need to be 'sectioned' to be admitted if you agree to it and most people are not. You cannot be 'voluntarily sectioned' that is a total oxymoron. You can be voluntarily admitted and if you withdrew your consent and the MHA criteria were met then you could still later on be detained so it is never a one time decision.

Underfunding of MH services vs physical health is not a myth though.
Parity of funding and esteem is a pipe dream. I heard an oncologist on the radio once complaining about how shit MH services are vs cancer services and he did not once appear to realise that the funding differential and the stigma are the cause of that. If we had all the money and public goodwill that cancer services have things would be very different. As it is we have to cut our cloth to fit and for some people we pretty much cannot offer a service or not one that is any good as we don't have the money or the staff to do it. Hence why OP eventually went to a private unit I guess.
We do offer a good service for what we are good at which is largely schizophrenia, bipolar I and major depression.

Re; lack of beds, that's not true there really really is a lack of beds. People who are manic and psychotic are not "magically" found a bed somewhere. I work in a community team and we regularly have service users who are acutely psychotic and for whom home treatment isn't a viable option. We've waited for weeks, in one case up to a month, for a bed to become available.

They have to come. They have to make sure a patient is safe and taken to a place of safety, usually the hospital. What do you expect them to do? They’re medics, they keep
Patients calm and reassured because that’s what’s best and safest for the patient and the crew.

The crew are trained to treat physical injuries or events.

They aren't trained in mental health so are anxious to move people on so they can do the job they are trained to do. They are only human and it must be hard trying to deal with someone when you are not trained in MH and there may be someone dying of a heart attack who you could help.

The government are to blame for lack of funding. There should be a crisis number that actually brings a response for MH.

@Allelbowsandtoes Yep. We've had people in general hospital beds who desperately needed psychiatric inpatient beds but were stuck for weeks. When I started my career maybe three people on a ward would be detained and the rest informal, always a bed available. Now it's 10+ waiting for beds and the acuity is much higher than before.

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.

In my area we still have beds on acute wards for people who have psychotic mental illness and cannot be home treated although of course we will try to home treat first. We don't have any beds hanging around empty but we can make one for those that need them usually in a reasonable length of time
We have a 3 day assessment unit for crisis management
The gap is that we have next to no service for personality disorder or things along those lines
Very limited psychology apart from IAPT for minor stuff.

I'm a paramedic and within my profession 'good practice' is taking a patient having an acute mental health crisis to hospital. We are not mental health professionals after all.

If I then tell a patient who is in an acute mental health crisis, that they should go to a&e but realistically they won't get much help there, then that could be deemed as coercing them into declining care, and I would be failing in my duty of care. It would also be a very counterproductive thing to say in a situation where mental capacity may be questionable, as I would then have a mentally unwell patient in the community refusing care, who shouldn't really be making that decision, and this opens a massive can of worms.

@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!

Absolutely this. Mental health funding is so so bad that Health care professionals wether it’s in A&E or mental health services know it’s not what patients should receive. Absolutely blame austerity/funding over the years.This also applies to children and young peoples mental health of which seems to need more and more support since I started in the NHS 17 years ago. Yet funding is bare minimum and they are failed before even getting to adulthood in so many cases. Us HCPs frustratingly know this is not good enough but we can’t change the system when there’s no money/support/government backing to do so. We are frustrated with the systems in place too.

The paramedics job is to make the patient safe and transfer for treatment as needed in all cases. I’m sure they would much prefer to take to a place where proper help is given or a telephone triage as mentioned but this just exist for most anymore. Would it help when someone is in crisis for the paramedics to say ‘well you’ll wait in a&e all night, may get some meds and then a call in a week’ that’s hardly going to help get them to hospital and somewhere safe. As a HCP its a natural response to reassure and comfort people in need. The crew know it’s not the ‘best place’ but it’ll be a safe place for a period of time.

We have a MH emergency car in our area too with MH nurses going out with ambulance and police. This works quite well but it does not result in people being admitted to hospital necessarily. The purpose is more to stop pressure on A&E and the emergency services.

A point re funding I may. There is an overall budget from which CCGs commission services. The budget comes from tax. My tax statements now tell me the proportion of my contributions dedicated to the NHS. It does not tell me which proportion funds different illnesses. Regrettably There is a total lack of transparency.

When my dd was ill in 2015/16 There was no adequate help from CAMHS. What is concerning is that there was a review of the services in 2009, 2014/15 and 2018. There have still been few improvements re the availability of psychiatrists and diagnosis. In 2015 CAMHS was given an additional £2.3m here. The MH Trust spent it on an additional tier of bureaucracy which was such a disaster the 2018 review arose.

There is a resourcing issue but a much greater accountability issue.

My dd saw a fabulous psychiatrist after 6 months of getting nowhere. This led to the correct counselling, medication and diagnosis. We paid. I just wish the system had been more honest at the outset re what was available and the time frames. That way we wouldn't have wasted 6 months. Best £6k I ever spent.