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!

In my experience no- they are covering their own backs to keep their registration

@JustUseTheDoorSanta

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.

I sadly have so many complaints to make now I am feeling strong enough to do so. Don't get me wrong I also have so much praise and I do that much more than complain.

Tbh, I don't really feel angry for myself but others. I'm not sure what you mean about 'doing it several times while really unwell'. But thank you for your concern.

@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.

Don't get me started on IAPT. It may have a place for minor illness. But I know so many therapists that would never work in IAPT as they know how traumatising it can be to just get to the point of being ready to talk 6/8/10 weeks in, unpacking everything and then therapy is over and you are left retraumatised and with everything unpacked but now having to deal with it alone.

IAPT is good for what it's good for ie mild depression and anxiety. For complex trauma or any risk usually they don't go there as they know their limits.

@EgonSpengler2020

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.

As has been discussed you can care for your patient without raising false hope. It is taught as best practice within nursing that you don't promise something you can't provide. Again as discussed the trouble with raising false hope is ultimately you do fail in your duty of care as you cause that patient to feel even more hopeless, more suicidal etc. Of course I am not suggesting any paramedic would do this on purpose. But I think this is something really important for paramedics to understand.

@CovoidOfAllHumanity

IAPT is good for what it's good for ie mild depression and anxiety. For complex trauma or any risk usually they don't go there as they know their limits.

Yeah, I have found that from my own experience. I am not unwell enough for CMHT, but am too risky for IAPT. There is a huge gap in between the services that are on offer, and many people fall down it.

@Mirrorball2022 - I find it so strange that hcps don't understand you can comfort someone without giving false hope. It is nursing 101, tbh.

* As has been discussed you can care for your patient without raising false hope. *

What would this have looked like in your scenario?

They couldn’t say “someone will speak to you” as you said upthread
Because they couldn’t be sure someone would

So what could they have done?

@CovoidOfAllHumanity

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.

I think this is great and I'm sure having MH nurses there means it is less 'the blind leading the blind'.

@RosesAndHellebores

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.

I'm so glad your DD got help eventually. Unfortunately many of us can't afford to pay. I was very lucky to eventually get the right help too.

Thank you for your perspective - very good points.

@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?"

I'm sure you understand not raising false hope can be done in a much more nuanced way than that! Have you read the thread? There was a good post by a paramedic who explained how they did it. Do you think it is ok for patients to be let down and then when alone think 'this is all pointless' and complete suicide? Because that is what can happen when false hope is dashed.

Something about this thread is really pissing me off

Ah I know what it is
The thought that those paramedics were be taken away from potentially saving the life of a choking child, a man suffering a heart attack, a women injured in a car crash

And the op whining on about the paramedics not comforting her

So I will bow out

I think you will succeed more in changing the system than in changing every individuals practice

In our area as part of the Covid A&E avoidance response they got paramedics to ring the telephone triage service on a professionals line with the patient as another option rather than A&E and if the person could keep safe for maximum of 4hrs to see a MH worker at home then they saved an A&E trip and Covid exposure
At the Maudsley I know they used to have a psych A&E that they could take people to instead of the general hospital.
As I said all the same outcomes up to and including admission are available to the triage service and the crisis team as via A&E. The 4h wait is probably about the same too. So all in all I think this is a good system
We also have a MH emergency car with MH nurse, police and paramedics that goes out to people who are suicidal so as to do the MH assessment at home not A&E.
This also breaks down stigma and is an opportunity for training (I am afraid that some people in the police, ambulance service and A&E regard mental health staff as a useless waste of time as much as they do our patients- you have seen such attitudes on this very thread from some posters)
I personally think these are the kind of good ideas that we need but we need to get past people thinking that going to A&E will always result in admission as it won't any more than any other assessment route.

@MichelleScarn - and quite rightly! Hcps are able to comfort patients without false hope. This happens all the time. Just because someone has a mental illness - they should still be treated in a way that doesn't increase their risk of death. Imagine if it was a physical illness. I suspect your response would be very different.

@Bonkerz - I'm sorry to hear that. How is he doing now?

@Amijustagrump

In my experience no- they are covering their own backs to keep their registration

In what way?

This is the thing with medicine generally. People seem to think there’s literally a fix for everything. Paramedics are there (as are A&E) to make you safe/patch you up. Mental health services should then intervene and continue treatment because most of the time it’s ongoing and lengthy. MH services have been decimated and I think people totally underestimate how many people now need or would like access to MH assistance. I’ve never seen anything like it.

The problem isn’t the paramedics, the problem is the massive shortage and quality of NHS mental health services.

@CovoidOfAllHumanity

IAPT is good for what it's good for ie mild depression and anxiety. For complex trauma or any risk usually they don't go there as they know their limits.

They went there with me! It was awful the first time but the second luckily the therapist saw me deteriorate almost immediately. She was amazing but she felt she was banging her head on a brick wall often. The problem is IAPT is the only option often so people get referred there completely inappropriately. Therapists have told me that the rigid length of sessions is so unhelpful to many, many patients.

@XenoBitch - absolutely. IAPT is useful for a small group of people but is the only thing on offer outside CMHT. And then under them the wait for therapy is ridiculous. And they won't even refer until you are out of hospital and several other criteria when the hospital psychologist wants you to be under a therapist on discharge.

Again it is a resource thing though isn't it? They can only meet demand by having fewer sessions and less qualified therapists
Long term therapy with a qualified and experienced clinical psychologist is like gold dust. It's hugely costly and not everyone who could benefit can have it only what are deemed to be the most pressing cases.

@Toanewstart23

* As has been discussed you can care for your patient without raising false hope. *

What would this have looked like in your scenario?

They couldn’t say “someone will speak to you” as you said upthread
Because they couldn’t be sure someone would

So what could they have done?

Well, I think they could be much more sure someone would speak to their patient than that they would finally get the help they needed or get a bed etc. In my situation they could indeed have said (if they had known) that someone would speak to me as that is what happens here.

Lots and lots of people want to train in clinical psychology and have the ability to do it but the NHS doesn't train many of them because it can't afford to employ them. No

Depends where you are. My dd has had excellent emergency care at a&e but the hospital has a specialist mental health suite staffed by mental health nurses who made her feel like they had all the time in the world to talk, so important. The drs too were good eg when she needed a drip (not eating is one of her issues.) they were also good dealing with me, her parent and the emergency in home team were good

@Toanewstart23

Something about this thread is really pissing me off

Ah I know what it is
The thought that those paramedics were be taken away from potentially saving the life of a choking child, a man suffering a heart attack, a women injured in a car crash

And the op whining on about the paramedics not comforting her

So I will bow out

@Toanewstart23 Wow, glad you're not a hcp. Whining on! Awful that I'm whining on about people losing their lives! I mean it would be fine if they were dying from a heart attack, just not mental illness - that pisses me off! I've said very specifically that the paramedics did comfort me. But clearly you've not RTFT!