Everything that is wrong with mental healthcare

Last year, the Journal of Paramedic Practice posted a news article via social media on screening for mental health and the impact this has on length of stay in the emergency department in order to stimulate discussion. The article referred controversially to mental health as ‘behavioural’ health. There are dangerous implications of this terminology for patients with mental health conditions, as well as for health professionals, and the provision of care in general.

Primary mental health presentations make up at least 10% of the prehospital workload (Duncan et al. 2019)—and this does not take into account secondary presentations. Globally, there have been substantial cuts to already-stretched mental health services, meaning that many patients feel they have no other choice than to access emergency care (Wolf et al, 2015; Roggenkamp et al, 2018). Despite national guidelines outlining the importance of all clinicians involved in mental healthcare having sufficient education and support (National Institute for Health and Care Excellence (NICE) 2004; World Health Organization (WHO) 2013), prehospital clinicians often have poor confidence and limited education regarding care for this patient group (Rees et al, 2018; Emond et al, 2019). Alongside this, a lack of alternative care pathways to refer those in need to services in the community mean that a large number of these patients are taken to accident and emergency (A&E) departments as a place of safety (Rees et al, 2018).