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!

@CovoidOfAllHumanity

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.

My situation was not as described - there are many reasons you may be taken in. Now, if nothing has changed since you being brought in and discharged except you now feel even more let down and even more hopeless and even more suicidal - how is that helping? I'm sorry but I find your 'magic shortcut' comment patronising. Noone with SMI (or a close relative) thinks there are any shortcuts. We spend years banging our heads against a brick wall - metaphorically and literally at times!

Yanbu. I tried to commit suicide last year. Ambulance crew couldnt have cared less, not one of them spoke to me on route to hospital.
While in hospital I was assured my the mh team I would get a cpn and access to counselling. Upon discharge told by cpn I didnt meet requirements. Asked gp and told its not up to them who cpn see. The social worker and school nurse put forward the case that I have a severe trauma history and were still told I didnt need a cpn.
There is no help.

@CovoidOfAllHumanity

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.

Sorry didn't reply to the rest.

Admission is not only for conditions that can be cured by drugs. Tbh, most people who are at threshold to be admitted can not be cured by drugs. Helped yes, but not cured. There is so much more to admission than drugs! I find that rather insulting of the amazing mental health wards- the psychs, nurses, SWs and OTs etc that you think it is only about drugs! Have you been on a psych ward? Perhaps that was your experience but it is certainly not mine.

In my personal situation I needed a bed. There is more available to a psych nurse/SW etc in A&E than just discharge once they deem safe. They can prescribe (or get a Dr to), they can show compassion, kindness. Communicate to a patient next steps, provide information as to help while waiting for community services. But also they can find beds. As far as I am aware in the same way the community services can. People keep saying the threshold is high but it is higher in A&E?

@cptartapp

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.

Yes, there could be something in that but these things were said once I was in the ambulance so already cooperating.

@MrsTophamHat

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.

That sounds brilliant. I am always all for multi-disciplinary working.

@LakieLady

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.

I mean they were stretched pre-pandemic so I totally take your point. My personal experiences were pre-Covid. But yes, community services are dire now. My CPN is actually seeing me in person in a couple of weeks but it has been awful with only phone contact. All OT services have stopped, all volunteer services. There has literally been hardly any support in the community. So I do empathise with your ex-client and I really hope he can get some help before it is too late.

Your point about noone having told the paramedics the real situation is exactly what I'm asking. I'm always amazed at the way different departments just do not communicate properly within the NHS.

@FranklyMyBeer

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.

I'm so glad it worked for you. Just seeing the right person at the right time can make the world of difference. Crisis team is purely phone calls now.

And yes, you do get seen by the MH team here. But so common to be discharged in a worse state than you went in. Luckily soon after my A&E incidents I saw someone incredible. I was sectioned and in hospital for a long time. It was what I really needed. And if the team in A&E had really listened and not been so quick just to get rid of me (or if indeed they had spoken to the HCP who phoned the ambulance in the first incident) maybe they could have helped too.

@Allelbowsandtoes - thank you so much. You sound lovely and I'm sure your patients are lucky to have you. And I think you are so right re: secondary services. It has swung too much the other way. If course it is a fine line and we don't want to hospitalise people unnecessarily but there comes a time when it is necessary. And cuts to these services are explained by way of helping people avoid unnecessary admission. I mean home treatment team - is described as the benefits of hospitalisation in the community. It is really, really not beneficial like hospital!!

@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.

God forbid suicide is considered an emergency

@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.

No paramedics absolutely do not need to say this, of course not! My point is hopes should not be raised. Paramedics should be given a realistic idea of what is happening in A&E so they don't raise hopes. This is something that can be done immediately and with little cost and would help many people enormously. Unfortunately that can't be said for changing the system so people do get help. They aren't mutually exclusive, though of course!

@londonrach

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

No, they are not. A section 135/6 is a police power. A person will be taken to the 136 suite at a mental health hospital/unit (around here anyway). It is a type of section where the person can be kept against their will. That is not the same as being taken to A&E by ambulance. The point of that is to get help/treatment just like any other patient in A&E.

@OnceuponaRainbow18

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

It really can be beyond exhausting. Would they tell someone with an emergency physical health issue to come back tomorrow? I'm so sorry.

What would help? This is a genuine question. I've been taken to A&E completely unnecessarily when I'd taken a handful of pills and was made to feel like an inconvenience. I was treated with no sympathy or even kindness at all. Cursory chat with a psychiatrist to make sure I wasn't acutely suicidal and sent on my way with no money to get the bus over an hour home.

I'm not sure what mental health services can do to help people. I won't go near them now. I feel shit at the moment but I seriously only think it's me that can make my life better. I have no idea how but I'm trying as best I can.

* God forbid suicide is considered an emergency *

The idea that my relative involved In a serious car crash or suffering a heart attack or stroke would be delayed medical treatment because a&e was dealing with someone who was saying they were considering suicide

Makes me both angry and nauseous

@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.

I absolutely agree - beds are found if necessary. I was actually psychotic in my experience as well as actively suicidal but there was no willingness to properly assess me in A&E. It was just discharge as fast as possible. Long term beds are available but you need to go through acute services first. Someone with PD may be fine to use community services once meds are sorted on an acute. Personally, I needed inpatient treatment. Acute beds are filled with many women with EUPD around here. Transient psychosis is part of this illness.

I was sectioned and I wanted help. Many of us do. You can be a danger to yourself and others and psychotic and still want help . The problem with voluntary around here is you have to go to an 'assessment unit' - like A&E they seem to be all about discharge as quick as possible and leaving people in a worse state. Being sectioned gets you to a proper acute ward.

Absolutely agree re:funding and stigma. Also for me once in an acute I was helped immensely and then onto a long term PD unit.

Sorry were you discharged or sectioned? I’m not clear

@ancientgran - thank you for understanding my point and validating my opinion. That is exactly what I mean.

@Christienne

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).

I'm glad she got help.

@Butterbegood

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.

A place of safety is a 135/6 not an ambulance crew taking you to A&E. Have you read the thread? It has been fully discussed - patients can be kept calm, cared for without giving them false hope that leads to them feeling worse than when admitted.

These paramedics would have resuscitated not breathing children in front of frantically screaming mothers
Would have given heart compressions to men in front of weeping wives
Dealt with young babies with serious scalding kettle water burns

So the fact they didn’t ask questions on the journey to the hospital
To someone conscious
No immediate physical medical need whatsoever

No I’m surprised they took the opportunity to sit there in peace

@Toanewstart23

You called 999?

Are you aiming that at me? As I have said I didn't call the ambulances.

Who did?

I haven't been admitted to an MH ward I work on one and have done in various places for twenty years. Obviously I know that we have nursing and OT and that MDT input is very important but people really are not admitted to acute general adult psych wards for those alone in the current climate. Twenty years ago they were as we used to offer respite admissions but now they would get a 3 day assessment if that. Inpatient psychology isn't a given everywhere and there will not be formal 1:1 therapy on a short stay ward. You are much more likely to be offered admission with a drug treatable illness than a non drug treatable one in my personal experience because then there js a clear pathway to discharge with a fairly predictable time frame.
You said yourself that your long admission was in the private sector which surely proves my point that the NHS does not really offer this kind of treatment as an inpatient as it is just too costly and long term.

To answer your other qs threshold for MHA detention is set in law so is the same in all settings. It will always require an AMHP and 2 Drs wherever the assessment takes place community, police station or A&E.

The threshold for voluntary admission is also the same in all cases. There are no separate beds that can be accessed by community services vs by A&E. In most areas the beds are gate kept by the crisis team. The liaison team in A&E have no admission rights any more than the community team do. They speak to the crisis team and they decide if a bed is needed. This makes sense that one team prioritises all admission requests so that the beds go to those most in need.

I would argue that it would neither increase nor decrease your chance of admission to go via A&E and given that waits in A&E will be long and you will have to see non specialist personnel first to get a referral to psych and tell your story a number of times then a telephone triage service is better if you have one in your area or GP referral to the crisis team. It will all come down to the same thing in the end.

One of the criteria of the MHA is that detention is a last resort and voluntary admission and community treatment need to be tried first so it is quite unlikely that admission will be the first option offered to anyone unless community treatment is completely untenable due to risk and/ or unwillingness or inability to comply.
As such they might not have been wrong to ask you to try community treatment first. For many people it might have been effective. For you it was not and you got worse so you were admitted. With the benefit of hindsight you therefore believe you should have been admitted the first time but I am not sure how anyone would know that for sure without trying. Usually people will be offered community team or crisis team at first because not everyone can be admitted and many people do benefit from community treatment. There was a success story from someone upthread who did not go to A&E but got urgent community help and avoided admission. You see it from your perspective but there are other perspectives.

I work on an inpatient ward. We do get people better. Some people find the experience helpful but in fact some people hate it even though they got better. Inpatient wards can be scary as well as therapeutic despite our best endeavours. We have to admit people with very disturbed behaviour and that is frightening.
Inpatient admission worked for you but it's not the be all and end all and I would actually much much rather that investment was made in community services to help people stay well than in more hospital beds. It's extremely depressing when people relapse due to lack of community support and it happens a lot these days.

@AndAsIfByMagic

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.

I don't know if you meant this but you come over very dismissive of mental illness. You do realise people die of mental illness? And that a mental health situation can be an emergency?

It's not just paramedics that want to believe in MH support though.
My son was sectioned by police and took to A&E for mental health issues and being a risk to himself and others.
24 hours he was released with no support or follow up help. In that 24 hours he spoke to staff for less than 2 hours.