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Taking a holistic approach to acute mental health crisis

02 October 2019
Volume 11 · Issue 10


An innovative, collaborative model implemented by a UK ambulance service allows patients presenting with a mental health condition to be promptly assisted by a specialist team comprising a paramedic, mental health nurse and police officer. Initial evidence suggests that greater collaboration between emergency services and mental health trusts benefits patients and services: leading to timely assessments, reductions in patient distress levels, and decreasing emergency department overcrowding while providing substantial savings for the NHS. This article explores existing care pathways for patients experiencing acute mental health crisis. Current research from the UK is discussed, and compared with working practices of paramedics internationally. Through reflection of a case study, common difficulties faced in paramedic practice are identified. A multi-agency response to ensure the right care is provided in the right place at the right time is proposed.

Emergency response to patients in mental health crisis is substandard and worse than that for physical health emergencies (Mental Health Taskforce, 2016). Inadequate provision and an increase in suicides continue despite government initiatives such as New Horizons: a Shared Vision for Mental Health (HM Government, 2009), No Health without Mental Health (Department of Health and Social Care (DHSC), 2011) and The Five Year Forward View for Mental Health (Mental Health Taskforce, 2016). Ambulance services respond to numerous calls related to mental health and, because alternative services are limited, the most appropriate care delivery is often not achieved (Mental Health Taskforce, 2016; Duncan et al, 2019).

The role of the paramedic has developed considerably, with increasing responsibility for providing patients with the most appropriate treatment at their first contact with a health professional (College of Paramedics, 2018). The contemporary paramedic is an autonomous practitioner who has the knowledge and skills to assess, treat, diagnose, manage, discharge and refer patients in a range of urgent and emergency settings (College of Paramedics, 2018).

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