Journal Of Paramedic Practice - College of Paramedics evidence into mental health care and policing

Earlier this year the College of Paramedics undertook a survey to support our submission in response to a Home Affairs Committee inquiry into Mental Health Policing. This was a wide-scoping review engaging with multiple stakeholder organisations. It is widely recognised and understood that historically and currently, paramedics are the first contact point for patients with mental health episodes, and therefore it was important to us that the role of the paramedic was understood and was part of this inquiry. There are various emerging developments around the country seeing paramedics working collaboratively with mental health services and police in some areas providing street triage teams. Elsewhere, paramedics are working alongside mental health practitioners, and jointly providing enabled care in the system.

A survey of the membership of the College of Paramedics indicated that paramedics across the country do not feel that they currently have the necessary skills and knowledge to meet the needs of mental health patients and that the services set up to help them (both patients and service providers) are not effective. The survey results are summarised in Box 1.

Box 1.

Results of survey on mental health patients sent to College of Paramedics members

Of 723 respondents, 86% (622) stated they were familiar with sections 135 and 136 of the Mental Health Act 1983

Of 613 respondents, 67% (414) stated they understand sections 135 and 136 of the Mental Health Act 1983

Of 609 respondents, only 37% (229) believe there is a good level of understanding among police officers in regards sections 135 and 136 of the Mental Health Act 1983

Of 623 respondents, almost 98% (609) believe there should be more education and training for paramedics in mental health conditions—the highest component of which was for training in how to manage mental health patients safely (581)

Out of 457 respondents, there was no clear support for additional powers for paramedics through legislation with 58% (267) in favour of being able to detain; 56% (255) in favour of being able to restrain; and 70% (322) in favour of being able to treat patients with mental health illnesses and conditions

While 83% (456) of 546 respondents stated that paramedics are put at risk when dealing with mental health illnesses and conditions, there were a number of comments emphasising that the risk is no higher than the general level of risk encountered across all types of cases paramedics deal with

Of the 546 respondents, 94% (513) believe that the numbers of mental cases are increasing

Comments on survey

The survey represents only a snapshot of views from a relatively small number of the UK's 20 000 paramedics. However, it is felt that this is a fair representation of the general view of paramedics, though there would need to be structured research to ensure academic rigour and scientific validity. It is suggested that the survey provides the following insights:

There is a higher level of awareness of sections 135 and 136 of the Mental Health Act 1983 than there is of understanding amongst paramedics responding to the survey

The paramedics respondents believe the level of understanding of sections 135 and 136 of the Mental Health Act 1983 among the police is fairly low

There is a resounding call among the respondents for further education and training in mental health for paramedics

There was a small majority of paramedics who felt there was a need for additional powers through legislation for paramedics, but there was clear evidence to have further treatments available for paramedics to provide this group of patients (however, more research would be need to specify what those treatments could be)

There is both perceived and actual risk to paramedics when dealing with some patients with mental health illnesses

Mental health cases are increasing as a proportion of the workload for paramedics.

Recommendations

While the problems are complex, there are a number of practical steps that should be considered in more detail and which would help to address the issue and raise the quality of care for patients. The College of Paramedics calls for increased awareness of the systematic and system-wide failings in terms of crisis and in particular out-of-hours access to specialist mental health services that it believes contribute to the increased prevalence of crisis and unnecessary deterioration in patients' health. There also should be a continued focus on greater understanding and education for paramedics in relation to mental health, legislation and treating patients with respect and dignity, thus reframing perceptions of mental health emergencies. We believe such an approach would limit the inappropriate use of legislation, and give greater confidence to both the police and paramedics in caring for people in such crisis situations.

The College of Paramedics believes that the current powers in terms of deprivation of liberties afforded under the Mental Capacity Act (2005) are sufficient, but neither well understood nor, in general, sufficiently enabled in terms of paramedic and police joint working. There should be detailed research into the effectiveness of increased powers in ambulance services overseas where such legislation has been enacted and there should be provision made to opening access to appropriately competent specialist paramedics for access to the Approved Mental Health Practitioner status to enable paramedics to operate within the full scope of the Mental Health Act (1983).