Paramedic practice is known to be a vulnerable line of work, in part because it is common for patients to have some form of mental illness (SA Health, 2015). This can of course make their behaviour and reactions unpredictable at times, and their care will require additional skills that health professionals may or may not always be equipped with. The unnecessary variation in access and quality of care that exists across England for people with mental health problems is an issue that has been highlighted before, and that needs urgent attention.
Earlier this year, NHS England recognised this and launched an independent taskforce whose role was to develop a 5-year national strategy to improve mental health outcomes across the NHS (Mental Health Taskforce, 2015). The strategy interim report called, The Five Year Forward View Mental Health Taskforce: public engagement findings, was published in September and delves into the unmet needs of people with mental health conditions of all ages.
It has taken into account relevant clinical and economic evidence, as well as the views of relevant organisations and health professionals. However, importantly, it has also been led in large part by the views of people with experience of mental health problems, including services users, families and their carers. It sets out the key priorities and major themes identified, as well as ‘new solutions to tackle old problems’ in the care and support of people within this population (Mental Health Taskforce, 2015: 3). Health professionals working in ambulance services should be aware of this as they will play an important role in the equation, particularly given the commonality of their care of this patient group.
Prevention and stigma
There were three major themes highlighted in the Taskforce's findings. Prevention of mental health problems and tackling the stigma associated with them featured highly in the priorities of both individuals and organisations. Prevention was highlighted as being equally important to those with and without lived experience of mental health problems, whereas tackling stigma was more of a priority for those with experience of it, as people with mental health problems, families or carers.
Several crucial priorities associated with these themes were raised including:
Ambulance services will come into contact with patients in different areas and with different social situations. Unlike many other health professionals who will work from the security of a clinic or hospital, ambulance workers will actually go out to underprivileged neighbourhoods. They may witness a patient's debt, poverty, and lack of access to important determinants of mental health, as well as learn about a person's culture, sexual orientation or involvement with substance use. They should be aware of factors that can cause mental health problems, as well as factors which make their patients vulnerable to additional stigma.
Importantly, ambulance workers may witness, or even experience, abuse, bullying and bereavement while on the job. They may also experience trauma as a result of what they see, or if they experience abuse or violence. It can be argued that this places them among those at risk of mental health problems, and an awareness of this and appropriate management strategies for themselves and colleagues is vital. Employers will also have a role to play, as they were cited in the report as having a crucial role in preventing and supporting mental health problems.
Access and choice
The second theme identified was timely access to effective, good-quality evidence-based mental health treatment and therapy, in the least restrictive setting, and choice of treatment in response to their individual needs. People with the worst access and outcomes include Black, Asian and Minority Ethnic communities (BAME), children and young people, older people, carers, lesbian gay bisexual and transgender people (LGBT), and people living with multiple needs such as those with long-term conditions, substance use issues, etc.
There is a need for 24-hour access to high-quality care, available locally, and a greater overall consistency of availability and quality of services across the country. There are also concerns about the support available within primary care, as well as its lack of integration with specialist mental health services. The top five areas people prioritised were:
Quality and experience
The final theme related to quality and experience of care raised several priorities. The top five aspects of service delivery ranked in order of their perceived importance for bringing about change related mostly to the NHS workforce:
With regards to the attitudes of staff working in non-mental health settings, professionals in paramedic practice are in a unique position. They will sometimes see into the personal and intimate lives of their patients in a way that health professionals working in hospitals will not. They therefore bear additional responsibility for an awareness of their own personal beliefs, attitudes and prejudices, and ensuring these do not hinder their ability to provide equitable, sensitive and high-quality care to their patients.
Other issues related to a need for a greater skill mix of staff, the need for the right information to make meaningful decisions about treatment including side effects and long-term research into these, the importance of care planning in collaboration with the patient, information sharing between services, involvement of carers and patients, including control of their care, and in research, as well as recognition of the contribution they make to services.
‘Despite ongoing stigma, it appears that people are passionate about helping people to have good mental health and achieving better care and access to treatment for those who do not’
Following through
Despite ongoing stigma, it appears that people are passionate about helping people to have good mental health and achieving better care and access to treatment for those who do not. This is particularly apparent in the fact that more than 20 000 people provided their views to the taskforce—an unprecedented level according to NHS England (2015).
This is, of course, not the first time efforts have been made to gain such insights, and the Taskforce wrote in their report of their painful awareness of this fact. They realise that such issues have consistently gone unaddressed, and have acknowledged both the ‘underdeveloped’ mental health system and the ‘chronic under-investment’ in mental health services (Mental Health Taskforce, 2015: 4). They appear to be serious about making this initiative different, with plans to tackle current disparities in care and, ultimately, to ensure that physical and mental health are valued equally.
This is a noble objective, and may well be one that professionals working within ambulance services feel they do not have the luxury to worry about when they are so focused on simply keeping people alive. This is fair and understandable, but every small effort aimed at a person's mental health will count for patients receiving that care, and in such a vulnerable line of work, ambulance workers are at high risk of forming part of this population themselves. This is everyone's problem—to ensure this strategy does not become yet another archived Government document of broken promises to the people who rely on NHS care—everyone must become part of the solution.