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!

You called 999?

Would it be better then for them to say "I'm taking you to A&E but there is no help so this is all pointless?"

@Chickenpoxtwins

Would it be better then for them to say "I'm taking you to A&E but there is no help so this is all pointless?"

And then there'd be a thread complaining about that!

@Chickenpoxtwins and @mi

Shame of you both belittling and ridiculing the OP, who’s clearly struggling with their mental health, maybe you could offer something productive or make sarcastic comments else where

I understand this completely. My best friend has been suffering really badly with her mental health. Sectioned 3 times in the last 12 months.

It’s not the paramedics I’m angry at, it’s the government for cutting services. It’s the crisis team who keep promising they will phone her on a particular day and never phoning her. I understand the MH services being underfunded and under resourced, but they have to stop making promises they dont keep. It’s so unfair and deeply distressing. We really thought they understood the severity the past two weeks as she attempted suicide, but she’s back in the same cycle of being told something will happen, feeling relief that they finally get it, then broken promise after broken promise till she’s back at rock bottom. I’m genuinely terrified she won’t make to to 2023 with the way things are going.

The issue lies with services available within front door services. I work in Scotland in a children's hospital with a mental health liaison team. We assess all children that are brought for mental health concerns to A&E. We don't have a magic wand there and then but we can direct them to services, put referrals in and even them being listened to for the 1st time is massive. We are fortune to have this service as not all hospitals do

[quote OnceuponaRainbow18]@Chickenpoxtwins and @mi

Shame of you both belittling and ridiculing the OP, who’s clearly struggling with their mental health, maybe you could offer something productive or make sarcastic comments else where[/quote]
What's 'belittling and ridiculing'? Sadly what @Chickenpoxtwins and I have both said is relevant, what else could they say, and are you saying that if the crew had said this, that someone wouldn't post a thread or complain that they had called 999 and where told that?

@Chickenpoxtwins

Would it be better then for them to say "I'm taking you to A&E but there is no help so this is all pointless?"

No, it doesn't have to be either extreme. Tell them you are taking them to A&E and someone will talk to them. No need to be nasty, no need to make false promises.

@Chickenpoxtwins

Would it be better then for them to say "I'm taking you to A&E but there is no help so this is all pointless?"

That’s essentially what my GP/paramedic said to me but in a kind manner -

‘You can go to A&E, but you’ll be in a cubicle for three hours, very unlikely to see anyone beyond a junior doctor - and then discharged home - at which point you’ll need to make your way home alone and tired; or you can stay at home and I’ll do my absolute damdnest to get an urgent mental health referral through asap’ .

I appreciate the latter probably isn’t always possible at all though and probably a bit of a postcode lottery . And relied on GP trusting me to not actually go through with my plan .

The trouble with mental health is it’s so much directed towards mild anxiety/depression - it’s always ‘let’s talk’ but nobody wants to hear it if it’s not mild, run off the mill stuff !

@CovoidOfAllHumanity

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.

That sounds great 👍 I wish we had similar. I think what you describe is definitely a brilliant exception rather than the norm. In my area we also have fuck all for people with a diagnosis of personality disorder. It's such a glaring gap in service provision and its so unfair and shit for people who have that diagnosis.

@TiredSloth

Mental health services are severely lacking, what do you think paramedics should do?

That's because nobody wants to do the job.

People with psychosis or who have made a genuine attempt to take their life will usually be admitted for further evaluation on a psychiatric ward.

People with personality disorders, suicidal ideation with no plan (and the capacity and ability to safety plan) will usually be sent home with a referral to community mental health services. Or signposted to appropriate services if no mental health laision team is available.

Obviously if someone has physical injuries from self harm or overdose they’ll be treated for these, and their mental state assessed discreetly as well.

What sort of help did you want?

About eight years ago my then bf took himself to A&E and told them he was suicidal. They sent him immediately to the local psychiatric hospital where he was assessed for three days and visited at home for about a week afterwards.

A couple of years later in a different area, he wasn’t offered any help at all.

Even the GP counselling service is now a complete joke. They seem to be quickly training people who aren’t at all suited to the role….when the ‘therapist’ phoned me I thought she was the admin person doing a preliminary assessment. I wasn’t in too bad a state at that time but it could have tipped someone over the edge if they were feeling desperate.

The threshold is a danger to others rather than a danger to yourself. It's very hard to get help now.

Shame of you both belittling and ridiculing the OP, who’s clearly struggling with their mental health, maybe you could offer something productive or make sarcastic comments else where

I'm not belittling anyone and i wasnt being sarcastic. I genuinely want to know what the op thinks the paramedics should have said if trying to give her hope was the wrong thing to do, should they have been honest with her and told her the services aren't there to help her? How would that have helped her in the short term?

I think they're damned if they do and damned if they don't. They're overworked and underpaid, understaffed and underappreciated. They're doing their best in a failing system. Their job is to take her to hospital, which they did. They seem to be copping the blame for the fact that there is little to no mental health provision in this country and that they tried to give a distressed person some hope.

@hurtingandworried

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 .

I’m so glad they they helped you like that. Really practical and compassionate and effective. Someone helped and in that moment it’s what you needed. So glad you called. I hope things have been better since.

I know if people being kept in A&E or on the assessment ward for 48 hours or more while they wait for someone from mental health services to show up. And of people who have made serious attempts at ending their own life - as in only being found in time because someone else came home unexpectedly - being told it wasn't and therefore not being referred.

The system is at risk of collapse, despite the best efforts of many of those within it.

@HoppingPavlova

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.

Oh for goodness sake - how many times - I am not blaming paramedics! Has noone RTFT?

Mental health beds are hard to come by no doubt. But they aren't harder for the mental health team in A&E to come by than for a psych and AMPH.
No need to stay in an A&E bed - there is a mental health suite. I realise that is not everywhere but it is here and in other hospitals. Where there is no separate mental health people do indeed stay in A&E beds at times. And the mental health team in A&E do have capacity for assessment.

I have said exactly that about government. I have no anger towards paramedics.

@ThreeFeetTall

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.

The trouble is often it doesn't save a life but ends it. The crushing feeling of being let down yet again when you were told there really would be help this time sent me into such despair it made me attempt to take my life. And that is an all too common story. Often by the time you get to A&E you have already been let down repeatedly by crisis team, by the assessment unit, home treatment team etc.

@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.

I completely agree with you about MH ambulances. I have often thought this would be a great idea. Re: sectioning - is the threshold higher in A&E than in the community? The problem with A&E is they often just treat you like you are wasting their time. There are brilliant parts of our mental health facilities in this area (and beyond according to others) but A&E (and assessment units) seem to let people down so much. I mean I have been told a reason why but trying to explore it more. Is it harder for A&E to find beds than care cos and AMHPs? It doesn't make sense that it would do.

No need to stay in an A&E bed - there is a mental health suite. I realise that is not everywhere but it is here and in other hospitals. Where there is no separate mental health people do indeed stay in A&E beds at times. And the mental health team in A&E do have capacity for assessment.

It’s great saying there are suites and all will be fine but you are missing so many things. Chronic staff shortages in the mental health units for instance, that often affects diverting people for assessment in suites/units, or their resource for MH consults in A&E. If the suites are understaffed or none can come it makes things difficult.

Not every A&E is crawling with a mental health team twiddling their thumbs waiting for someone to turn up. It just doesn’t work like that. You do know that you can request a consult for a patient and …. nada. Again, a service that’s been stripped down, combine that with staff shortages and it’s not really a guaranteed service.

You are not really understanding that at the acute point, sometimes there are just no options. No immediate resources, units either overfill or staff shortages meaning can’t run at capacity, no beds for those that do need them. We used to shunt to any old ward once upon a time to wait it out for a bed if people were deemed to need one but that’s stopped as it was too problematic all round. It’s a disgrace but sometimes there are truly no options other than for a person to be sent home in an unfit state and you cross your fingers and hope to hell the system doesn’t break down and community reaches them as soon as possible and get the ball rolling and there is not a tragedy meanwhile. That’s the reality at times.

@Polyanthus2

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.

Are you for real? Have you ever seen someone having an acute psychotic episode? Someone passed out from overdose? You really can't understand why an ambulance would be called apart from a heart attack? And everyone really does not get lifts to the supermarket every week!! Most people get there themselves! What a strange comment!

@pinkstripeycat

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

It is so sad. I know that feeling of being desperate for help. And sadly when you have a large network of people with SMI you hear too often of no help being given and suicide being completed. All these young lives being wasted.

@Prinnny

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.

As I have already said of course they aren't to blame. Here we have a mental health team in A&E. Is their threshold higher than in the community?