References
Clinical decision making and the challenges of responding to mental health needs
Abstract
The paramedic service responds to emergency calls for a variety of reasons, many relating to mental health concerns. This qualitative study aims to explore the views and experiences of student paramedics in relation to clinical decision making for mental health calls. Focus groups were used to investigate the participants' perspectives. Thematic analysis was used to organise data and identify key issues. Findings suggested some disparity between what paramedic students were prepared for and the reality of public need. Clinical decision making in relation to those with mental health problems was significantly influenced by the current provision of mental health services and the lack of mental health-specific education for student paramedics. Current changes to the paramedic programme make this an opportune time for a review of curriculum content.
Over recent years, NHS England has increasingly focused on improving the outcomes and experiences of those with mental health problems. People can experience poor mental health at any time of life, as it affects all age groups. The Five Year Forward View for Mental Health (Mental Health Taskforce, 2016) acknowledges that, to improve the experiences and outcomes for those needing support, a wide-ranging approach is necessary, which includes better assessment and access to appropriate services in a timely manner.
Calls to emergency services because of mental health crises are increasing, with literature suggesting that at least 40% of calls are related to mental health (Ford-Jones and Chaufan, 2017). Indeed, Rees et al (2015) suggest that the UK has one of the highest incidences of self-harm in Europe, leading to a reason for hospitalisation. This presents significant challenges for prehospital staff, including paramedics, who are often faced with ambiguous patient presentations and a scarcity of any medical history for that person (Parsons and O'Brien, 2011). Despite Department of Health and Social Care (2014) recommendations for paramedics to be adequately equipped to carry out assessments and facilitate a joined-up approach to mental health care, gaps remain in their skills and knowledge. As this is compounded by deficiencies in community mental health services, providing high-quality care remains challenging (Rees et al, 2015; Ford-Jones and Chaufan, 2017).
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