If you are a frontline clinician within an ambulance service, you will be fully aware that mental health incidents are commonplace, complex, time consuming and, at times, frustrating for both patient and clinician. The traditional training that paramedics and technicians undergo will include mental health conditions; however, the proportion of incidents attended compared to the time afforded to this topic do not equate. I can confidently say that a Paramedic BSc programme will spend considerably more time covering trauma management and cardiac arrest than how to take a comprehensive mental health history, formulate a safe plan and accept a refusal from a patient that has self-harmed and will not go to hospital.
This message is put much more eloquently and backed with a catalogue of evidence in the introduction of Mental Health Care in Paramedic Practice by Ursula Rolfe and David Partlow. For example, in 2019, the London Ambulance Service (LAS) received 168 000 mental health-related calls (LAS, 2020). The authors present a very strong argument for why you should continue reading this book given the link between mental health and physical health. The lack of training you will likely have received while working towards your current clinical qualification, and the inevitability that you will be called to a mental health patient who is statistically more likely to die from their complaint than many of your other patients, should be enough for you to take mental health as seriously as every other medical and physical presentation.
I have experienced the challenges when trying to manage a patient presenting with an acute mental health problem. Having a patient in crisis at 3 am and trying to avoid taking them to a busy, noisy and chaotic emergency department, yet every number I call to make a referral either goes to answer phone or responds with ‘we don't have capacity to deal with that at present’, is where the frustration comes in.
The first chapter clarifies the interprofessional working which we often attempt with limited success. The author explains the role of GPs, police, social workers, approved mental health professionals (AMHPs) and a number of other professionals. We are presented with a useful ‘myths versus facts’ table, which covers several common ‘sections’ that are often used. If you are going to make a successful referral, you must know what other professionals can and cannot do. This chapter summarises this in a clear and concise manner and is priceless. If, unlike me, you have a good enough memory, you need to store every word. I will ensure I have access to this information on every mental health incident I attend or provide advice on. Having this knowledge will offer a huge advantage in gaining the right care for your patient. It will avoid lengthy discussions with other professionals that do not culminate in the outcome you are seeking for your patient. It will allow you to access the right person at the right time and, ultimately, the right care (that sounds familiar doesn't it!).
The second chapter changes author; however, the text flows in a similar way. We are presented with a detailed case study with three options at the end for the reader to consider. Following this, the author discusses in detail the decision-making process, and the laws and acts that would support this. The case study is complex; however, the use of bullet points, short sub-headed sections, tables and highlighted ‘remember!’ boxes make the content manageable.
This format is continued in the following chapters, each one dedicated to a number of common mental health conditions such as depression, postpartum depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), psychosis and schizophrenia, bipolar disorder, self-harm, delirium and dementia, and acute behavioural disturbance (ABD). The chapters all start with a realistic and detailed case study which the author refers to throughout, allowing the reader to understand the condition and how best to manage the patient in a safe and effective manner. As clinicians, we must understand the presentation we may be dealing with in order to access the correct treatment and management. The authors really delve into the detail of each condition and the wider implications of management without confusing the subject. I especially like the ‘patient voice’ section, which is just a sentence or two from someone who suffers from the condition. There are a few mnemonics used to remember such things as alternative reasons for delirium, for instance, ‘I WATCH DEATH’ and ‘PINCH ME’. I am not a huge fan of mnemonics as it takes me back to my basic training where exams would require you to list signs and symptoms—not really that useful without the background knowledge to support it. Luckily, in the book, this is provided. However, if mnemonics work for you, get them into your memory bank.
The chapter covering anxiety challenges one of my ‘pet hate’ statements I hear all too often, that the patient is ‘attention seeking’. If you genuinely think this is the primary reason that many mental health patients call 999, you need to read this book and challenge your bias through education. Your patients will undoubtedly receive more compassionate care through your wider knowledge.
The third section of the book moves onto wider topics around mental health covering ‘special considerations’, beginning with a chapter on ‘older people’. Again, a detailed and well thought out case study is presented, which mirrors a very common incident you will have no doubt attended in the past. The author then provides a well-researched evidence base around the increased risks that older people face due to frailty, the risks of falls and isolation. The detail provided around history-taking is excellent and will ensure you significantly increase the chance of finding the right pathway for your patient while reducing further risk in the future. The author provides an overview of both mental capacity and safeguarding; albeit briefly, they cover the pertinent points related to this category of patient. As the topic changes for the next chapter, so does the author. Helpfully, the format stays the same which makes navigation of the chapter effortless. The chapter dedicated to children and young people is lengthy, and it needs to be as this can be an even more challenging area for clinicians. We are provided with a wealth of information which is specifically focused on the prehospital setting, with a section dedicated to ‘assessment within an ambulance setting’. This is good to see as this environment is so unique within healthcare, bringing with it its own unique challenges.
The final chapter tackles the complication that drugs and alcohol bring when managing a patient presenting with an acute mental health condition. It is acknowledged that there is often a relationship between mental health and drugs/alcohol. However substance abuse is a real problem in its own right and this topic is covered towards the end of the chapter.
In summary, the knowledge in this book will be a massive help when you find yourself dealing with a complex mental health patient. It will provide you with the information you may have previously had to seek from a senior clinician. Like many of the Class Publishing books, it can be read cover to cover but also serves as an excellent point of reference when dealing with specific cases. The nature of mental health presentations often allows the clinician time to consider different options. This book will very likely provide the solution and information you require. It will arm you with the rationale for your referrals and allow you to work with other professionals in a constructive manner. After all, knowledge is power.