A review of best practice for managing patients with mental health crisis in the prehospital environment: are we doing enough?

Traditionally seen as ambulance personnel who stabilise patients, and transport to Accident and Emergency (A&E), the introduction of state registered paramedics in 1999 (Collage of Paramedics, 2015) has developed a shift towards treating patients within their own surroundings, rather than A&E. Conversely this is more likely to happen with physical health (PH) as opposed to Mental Health (MH) and a disparity of esteem exists (Panday, 2016). With this disparity of treatment highlighted, the aim is to move away from this ‘scoop and run’ attitude that exists for MH patients and deliver a more patient centred and evidence based approach. The National Audit Office (2017) report a 5.2% year on year increase in MH patients to ambulance services, with a 4.9% increase on patients attending A&E. Training and care delivery to these patients should be appropriate to this increased need, therefore it is necessary to introduce changes to meet this increased demand. Nevertheless with MH services and funding being cut, training is not being delivered (Kings Fund, 2015), resulting in patients not having the appropriate assessment and treatment options that are set out by the Crisis Care Concordat (CCC, Department of Health, DOH, 2014). Working as a paramedic team leader based on an emergency ambulance in the North West of England, the author encounters MH patients regularly. This project will apply changes to the current methods of assessment by way of a more robust assessment tool, providing adequate MH assessment, allowing for further referral to Crisis Resolution Home Teams (CRHT). This will decrease the need for MH patients to be taken directly to A&E, where they potentially have long waits to access CRHT. 4 out of 139 hospitals in the United Kingdom (UK) currently meet the 4 hour standard of 95% of MH patients seen within a 4 hours (Kings Fund, 2017). This change will not only provide better patient care for MH patients by bypassing A&E, but is also advantageous to paramedics as it could reduce the amount of time spent in A&E with patients. This time could be better utilised developing training needs, and applying the knowledge gained from this training to both PH and MH patients. The change will also ensure that patients are treated in the most appropriate setting; using best available evidence based care, and treated within a timely manner, in line with the Bradley Report (DOH, 2005) of taking healthcare to the patient