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Mental health in the care of paramedics: part 1

04 April 2011
Features
02 April 2011
Volume 3 · Issue 5

Abstract

Mental health disorders are common, presenting frequently in emergency and prehospital settings. Patients suffering from psychotic disorders, mood and anxiety disorders, substance misuse disorders, maternal psychiatric disorders, personality disorders and parasuicidal behaviours commonly present to the emergency services. Although the advanced management of such conditions requires considerable therapeutic sophistication, emergency health care services can contribute greatly to the initial management of patients. In the first of a two-part series, this article will provide an overview of mental health services and provide guidance on the early management of personality disorders, depression, anxiety and psychotic conditions.

Mental health disorders are common. One in six adults has a neurotic disorder (anxiety and/or depression), while one in two hundred has a psychotic disorder. One in seven people have considered suicide at some point in life (Singleton et al, 2001). Most people who receive care from the health services for mental health, do so in primary care. Mental health problems alone are now implicated in one in four primary care consultations, making mental health consultations second only to those for respiratory infections (McCormick et al. 1995; Ustun and Sartorius, 1995). Depression is the third most common reason for consultation in UK general practice (NHS Centre for Reviews and Dissemination, 2002).

While most people suffer from mild conditions and recover quickly, a significant proportion suffers from chronic conditions (Mann et al. 1981) that cause moderate or high disability (Meltzer et al, 1995). The economic cost of mental illness has been estimated at £77 billion per year which includes £5 billion from the NHS as well as money lost as a result of people being unable to work, loss of life and reduced quality of life (Sainsbury Centre for Mental Health, 2003). Mental health problems appear in all areas of health care practice and often first present in prehospital and emergency care settings.

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Assessment
Crisis
Emergency
Mental health
Psychiatric