The Guardian reported at the start of September that “people with mental illness in England face ‘horrifically long’ wait for an ambulance” — and off we go in to the world of ambulance and mental health. This article instantly brought a number of memories and flashbacks, notably including the senior paramedics who once asked me “Why do you think it’s appropriate to send an intensive care unit on wheels to something that’s just a mental health incident.” Yes – just a mental health incident, without apparent insight in to mental health incidents being quite capable of being serious, if not fatal. I hadn’t actually suggested a “rolling intensive care unit” was needed, in fairness – merely pointed out the Code of Practice to the Mental Health Act said conveyance should not occur by a police vehicle!
I was also struck by the remark at the start of the article which said the delays were worst of all for those cases requiring a seven minute response time. Well regardless of whether it’s “just” a mental health call or not, if the triage system has determined something requires a seven-minute response time, it’s a potentially life-threatening emergency so it doesn’t really matter whether it’s about mental health or not. An immediate risk to life (as defined by law) is an immediate risk to life whether it’s due to a potential heart-attack or a potential overdose and until a clinician attends to start untangling it all, there may be no way to know whether it was what we fear it may be.
But back to mental health issues:
MENTAL HEALTH AMBULANCES
After it became known that the Right Care, Right Person scheme would be rolled out nationally in policing, questions arose about whether the NHS had the right resources to pick up the demand that may now not be picked up by the police. The most commonly repeated response to that question, deployed to reassure us that they would, was about mental health ambulances. The government have announced £150m in funding for the creation of a new service within the ambulance service. By way of example, it was announced within the West Midlands this would involve such a service at five bases, bearing in mind WMAS cover four police force areas, inc Staffordshire, Warwickshire, West Mercia and West Midlands. I’ll have to assume the service is 24/7, as I’ve not heard anything to the contrary.
It seems quite likely to me that five vehicles on duty at any given time, will be very easily consumed by current demand. I should imagine I’d have said the same if I’d be told the number would be ten vehicles, not five. So how much of an effect these new resources will have on overall levels of demand facing the ambulance service, given ‘horrifically long’ waits during 2022, I’m not quite sure, especially if any of the RCRP demand being pushed back by the police is deflected from Team Blue to Team Green.
It seems likely it will be – I’ve heard that ambulance services in areas where RCRP is running are noticing an uplift in demand, whilst sometimes wondering whether they – the ambulance service – is any more appropriate for that patient than the police? Of course, police officers will always point out they are not healthcare professionals and paramedics are; paramedics could point out they do not have powers under the Mental Health Act 1983 and police officers do (as well as other legal powers which may be relevant to ensuring safe outcomes from mental health situations, inc those which may not necessarily meet the so-called ‘threshold’ which RCRP operates).
There can be no winner to that argument in many cases, because many patients need neither service – they just need something they cannot otherwise access in a timely, relevant way.
NO MENTAL HEALTH SYSTEM
Some of this stuff comes back to an observation I’ve made in another post: we don’t really have a ‘mental health system’. We have confederation of different NHS agencies from GP surgeries, to minor injury units, emergency departments, crisis teams, mental health trusts, ambulance trusts, etc., and the NHS itself often doesn’t seem to know where mental health sits. In recent days as the temperatures rose, we saw ambulance trusts and others reminding us of the #ChooseWell initiative, which encourages the public to make the ‘correct’ choice about where to present.
The problem is, those social media memes don’t mention mental health AT ALL even though it represents almost a quarter of all NHS demand.
The bigger problem, of which these latest ambulance statistics is just one symptom, is we don’t have a functioning mental health system and the NHS itself doesn’t seem to know what the ‘right’ service is for patients across the range of predictable situations. In that context, is it any wonder we’ve come to over-rely on policing and the wider emergency system, including the ambulance service.
It will only become more worth discussing this, in coming months, not least because I’m yet to see or hear of people talking specific details on all of this.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2023
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 