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!

@FranklyMyBeer

You are really hanging on to this thing about false hope. Paramedics are reassuring, that is their job as they take the medical emergency to the doctors who can assess and treat as they are able to/see fit. What if they told someone they would be looked after and they later go on to die from injuries sustained, for example? I really agree with a poster up thread who said you could talk to your therapist about why your are so fixated on what the Paramedics said to you and how feeling pet down by them can have such an impact on your MH

Just because someone dies does not mean we haven't looked after them, I can assure you.

The reason I am talking about this very specific thing is because it happens so often. And it has a very real impact. I am probably feeling quite emotional about it right now due to my friend dying. This is what I'm saying it is not just me but so many others I have had contact with and so many on this thread. I really don't understand how people don't get you can be reassuring without putting hopes up. We do it all the time in nursing. It is part of our training.

Yes I would say, to a certain extent, paramedics do believe this

A&E is a "place of safety" for a person having a mental health crisis

The duty psychiatric doctor/nurse can be asked to come to A&E and assess, as deemed necessary by initial assessment

Whether that turns into long term solution, is yp for debate and actually, not that realistic

A&E is essentially to keep a person safe, who is having a mental health crisis

@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

A mental health crisis can also end in tragedy, just like the other things you mention.

The main problem is space in a 136 suite, I’ve worked with people who spent a whole shift with someone as there were no beds available in London or surrounding counties. The bed managers response was to take them to custody or a&e as they could do no more. Neither option is great, a police cell is not the place for someone who is suicidal and neither is a&e as most only have on call out of hours whose final recommendation is generally they need a bed and when no bed send them home for community team to contact them. Mental health services were very poor before the pandemic since it they have deteriorated further

@TurquoiseDress

Yes I would say, to a certain extent, paramedics do believe this

A&E is a "place of safety" for a person having a mental health crisis

The duty psychiatric doctor/nurse can be asked to come to A&E and assess, as deemed necessary by initial assessment

Whether that turns into long term solution, is yp for debate and actually, not that realistic

A&E is essentially to keep a person safe, who is having a mental health crisis

Last year, I was '136d' from A&E, which was confusing as I thought A&E would be classed as a Place of Safety. Ended up 40 odd miles away.

If it was physical health and paramedics were doing something (unintentionally) that was causing death you'd be saying something very different

The paramedics trying to help someone in a crisis are not causing death. The cause of death would be a mental illness which hasn't been treated sufficiently or at all. Not a well meaning paramedic trying to give comfort. You're really focusing on the wrong things here.

@TurquoiseDress

Yes I would say, to a certain extent, paramedics do believe this

A&E is a "place of safety" for a person having a mental health crisis

The duty psychiatric doctor/nurse can be asked to come to A&E and assess, as deemed necessary by initial assessment

Whether that turns into long term solution, is yp for debate and actually, not that realistic

A&E is essentially to keep a person safe, who is having a mental health crisis

Thank you for answering the question, unlike so many!

I definitely felt at least the first time (was too ill last time to know) that the paramedics really felt I would get help and a bed. This tbh is an issue all over the NHS that different departments have no idea what is happening with each other.

Here once physical issues have been dealt with the mental health team take over. I really don't believe A&E is just to keep someone safe. It should be about treating them too (obviously in the very short term). The mental health suite nurses can prescribe (or get a Dr to), they can counsel and give advice. Sadly there is a lot of pressure to discharge as rapidly as possible, with no time to properly assess and treat. If this was physical health people would not be happy. But with mental health we should apparently just be grateful if someone is kind to us.

@Merrymumoftwo

The main problem is space in a 136 suite, I’ve worked with people who spent a whole shift with someone as there were no beds available in London or surrounding counties. The bed managers response was to take them to custody or a&e as they could do no more. Neither option is great, a police cell is not the place for someone who is suicidal and neither is a&e as most only have on call out of hours whose final recommendation is generally they need a bed and when no bed send them home for community team to contact them. Mental health services were very poor before the pandemic since it they have deteriorated further

Yes and it has got much worse as many 136 suites have been closed since Covid.

A lot of the issue is that MH services are very siloed in the health service

General and mental health nursing training diverge very quickly. Most A&E Drs would not do any mental health training beyond 6 weeks at medical school. Whereas mental health Drs do at least 2 yrs post qualification in medicine and surgery. The Hospitals and Trusts are wholly separate. Most have no idea what services we have, what treatment we may offer etc. Its just admit them to a bed out of sight out of mind. I would think the paramedics suggested admission out of ignorance of what the likelihood of that was and of what else there might be to offer

I would say that I have a whole lot better understanding of physical health problems and services than most physical health people have of mental health. Most of them do not care or see it as important as we are such a poor relation. When training is offered most don't actually even want it they see it as someone else's problem and not part of their own job at all. Again this attitude is clearly on display in this thread.

This is not an accident. It's a result of stigma. The public still want people with mental health problems to go off somewhere else like in the old asylums and not darken the door of 'their' police, ambulance and A&E services. They largely fail to see that 'people with mental health problems' are just people until they or someone they love is in need of such help and then they are often surprised by how good we can be and how little resources we have.

Until no health without mental health is more than just a slogan nothing will really change

@Ramalamadingdongs

If it was physical health and paramedics were doing something (unintentionally) that was causing death you'd be saying something very different

The paramedics trying to help someone in a crisis are not causing death. The cause of death would be a mental illness which hasn't been treated sufficiently or at all. Not a well meaning paramedic trying to give comfort. You're really focusing on the wrong things here.

Ok, not causing death but contributing to it. I don't understand why if something relatively simple could be done to really help people with SMI - why are people so against it?

It definitely has, people now end up miles away from family and isolated. Providing they have been lucky enough to get a bed in the first place.

It’s extremely difficult for everyone involved

@CovoidOfAllHumanity

A lot of the issue is that MH services are very siloed in the health service

General and mental health nursing training diverge very quickly. Most A&E Drs would not do any mental health training beyond 6 weeks at medical school. Whereas mental health Drs do at least 2 yrs post qualification in medicine and surgery. The Hospitals and Trusts are wholly separate. Most have no idea what services we have, what treatment we may offer etc. Its just admit them to a bed out of sight out of mind. I would think the paramedics suggested admission out of ignorance of what the likelihood of that was and of what else there might be to offer

I would say that I have a whole lot better understanding of physical health problems and services than most physical health people have of mental health. Most of them do not care or see it as important as we are such a poor relation. When training is offered most don't actually even want it they see it as someone else's problem and not part of their own job at all. Again this attitude is clearly on display in this thread.

This is not an accident. It's a result of stigma. The public still want people with mental health problems to go off somewhere else like in the old asylums and not darken the door of 'their' police, ambulance and A&E services. They largely fail to see that 'people with mental health problems' are just people until they or someone they love is in need of such help and then they are often surprised by how good we can be and how little resources we have.

Until no health without mental health is more than just a slogan nothing will really change

I completely agree with all that. No health without mental health is so important as is the other one no mental health without physical health. Those of us with SMI die on average 10 years earlier than those without. But sadly the don't care attitude is plain to see on this thread.

Incidentally, I find it interesting people keep refering to 'my therapist'. I've not said anything about having a therapist!

A&E is rubbish for MH. Paramedics tell me that, and A&E staff too.
A&E staff are there to fix things in an accident or emergency. MH is not something that can be fixed by waiting for a few hours in A&E. That is what frustrates the staff too.. they can't fix you and send you on your way. You need long term help.
At best, you see the MH liaison team, who will most likely tell you to call your GP the next day, or they promise crisis team involvement, which often never comes.
People in crisis who post on MN are often told to go to A&E... just to be sat waiting for ages then sent home with some leaflets.

Not all paramedics are sympathetic either. I have met some awful ones, including one who I pursued a case against for assault after he dug his nail so far into my hand, it bled... whilst saying I was attention seeking.

@FateHasRedesignedMost

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?

In all honesty, anything! I was too ill to think beyond that. The other hcps I saw wanted me to be given a bed as I was psychotic and actively suicidal and in hindsight they were quite right. I had had insomnia for 3 months only sleeping 2 hours a night no wonder was psychotic! Even something to help me sleep would have helped. I was in an awful state to be honest. I gave up hope after that experience. I thought as the paramedics had said I would get help there and I didn't that I obviously didn't deserve help. I tried to take my own life. Thank god I was found.

@XenoBitch

A&E is rubbish for MH. Paramedics tell me that, and A&E staff too. A&E staff are there to fix things in an accident or emergency. MH is not something that can be fixed by waiting for a few hours in A&E. That is what frustrates the staff too.. they can't fix you and send you on your way. You need long term help. At best, you see the MH liaison team, who will most likely tell you to call your GP the next day, or they promise crisis team involvement, which often never comes. People in crisis who post on MN are often told to go to A&E... just to be sat waiting for ages then sent home with some leaflets.

Not all paramedics are sympathetic either. I have met some awful ones, including one who I pursued a case against for assault after he dug his nail so far into my hand, it bled... whilst saying I was attention seeking.

I'm so sorry to hear your experiences. The 'attention seeking' trope needs to die a death. It is quite normal for humans to seek attention and especially when feeling so unwell and unsafe.

Thanks spring! I really hope something is done soon
Police have told me they are seeing a lot of this in kids/teens now since lockdown
It's so difficult if you don't know the system and then thrown in the deep end and trying to juggle it all

I'm certainly not against mental health provision being improved. I've had ptsd and been suicidal. But no one thing caused me to be that way. It was a combination of a great many factors. I wouldn't have even considered blaming someone who had tried to help me in a crisis for me being suicidal.

I've read the whole thread and it's still not clear what you think the paramedic should have said because it seems that you're placing a great deal of importance on this one interaction out of all the many interactions you must have had with health professionals.

I would have thought that a paramedic doing a very difficult job and trying to get you to someone that could help you was at the bottom of a long list of things to blame.

@HoppingPavlova

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.

I think you may have misunderstood me. I am aware of all of that only too well.

@Ramalamadingdongs

I'm certainly not against mental health provision being improved. I've had ptsd and been suicidal. But no one thing caused me to be that way. It was a combination of a great many factors. I wouldn't have even considered blaming someone who had tried to help me in a crisis for me being suicidal.

I've read the whole thread and it's still not clear what you think the paramedic should have said because it seems that you're placing a great deal of importance on this one interaction out of all the many interactions you must have had with health professionals.

I would have thought that a paramedic doing a very difficult job and trying to get you to someone that could help you was at the bottom of a long list of things to blame.

If you really have read you'll see I and others have answered that over and over. Also it is not about blame. If we want to change a practice within healthcare it is never useful to blame. It is about developing best practice. When you are very ill one thing (that may seem insignificant to others) can tip you over the edge. This is such a common one that comes up time and again.

Sorry and just to say within my work people are mostly always keen to develop best practice. If every comment was taken as 'blame' I think we'd be buried under it!

@MrsBerthaRochester

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.

I'm so sorry to hear that. I had a situation with my ex-DH where the psychiatrist wanted him to have a cpn but that team didn't take the situation seriously and I think it took 2 years before he finally got one.

How are things now? Is there a First response team your GP can refer you to?

@Toanewstart23

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

You really don't get it. People in mental health crisis are experiencing slightly more than a mere thought about suicide. They are psychotic, disorientated, actively trying to end their lives, not sleeping, not eating, etc. That you don't realise mental health crisis is an emergency makes me extremely nauseous too. You do realise when I was discharged I had to go home and look after my DC. I was unable to do so. So they suffered too. I was discharged twice from A&E before being sectioned.

@Toanewstart23

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

What are you talking about? Yes, in health we do all sorts of things and then we move onto our next patient and give them our all too. You do realise many people with physical health problems has a knock on effect on their mental health. Even in physical health we are dealing with mental health all the time. What do you mean didn't ask questions and sat in peace. Have you had any experience of paramedics? They don't do that! Whether you like it or not part of our current system is that mental health emergencies go via normal ambulances. What do you think should happen to people with serious mental illness suffering crisis? People who are psychotic, actively suicidal (i.e high risk of completing suicide), disorientated, unable to function normally, unable to care for their kids?

@Toanewstart23

Who did?

The first time it was a therapist and the second time it was my ex-DH