Today marks one-year since West Midlands Ambulance Service (WMAS) launched their Mental Health Response Vehicle (MHRV) service. In their press release, WMAS tell us their five vehicles have supported over 7,200 patients “to access specialist mental health paramedics, improving the quality and experience of care.” The MHRVs are staffed by specialist “mental health paramedics” who have received additional training in mental health practice and either a student paramedic or technician who have the opportunity to enhance their understanding and knowledge of managing mental health presentations by supporting the MH-paramedics.
We’ve seen these ideas emerging in more than one area, including London. The Chief Executive of the London Ambulance Service in evidence at the London Assembly – a part of the answer to how ambulance services may deal with some of the increase in demand caused by the Right Care, Right Person programme. The PR from WMAS is interesting enough to be worth a short post, because I remember it being announced these vehicles would be introduced and I had some thoughts then.
Before I do, it’s worth noting: WMAS covers four police force area: Staffordshire, Warwickshire, West Mercia and West Midlands. They base the five vehicles in Coventry, south Birmingham, Shrewsbury, Stoke-on-Trent and Worcester – and the PR doesn’t help us understand whether the cover the whole WMAS footprint or whether any areas, such as the Black Country, Herefordshire and Warwickshire, are uncovered (by virtue of no MHRVs being based there).
STATISTICS
So, let’s do numbers –
7,200 people helped by 5 vehicles in 1 year: that means an average of 1,440 calls per vehicle, so 4 people per car per day (average) helped and we’re told “there has been a significant reduction in the number of patients conveyed to Emergency Departments, with around 85% avoiding the need to be taken to an Emergency Department.” Of course, this means 85% of those patients encountered by the MHRV service, not 85% of those calling WMAS for MH related reasons. It would have been especially helpful if we could have known how many of those calls would not have been conveyed to ED under the previous system of a traditional 999 ambulance response because in my experience, the traditional response to a MH call does not always lead to ED anyway so stating 85% isn’t fully helping us understand its impact.
So how many of the 85% MHRV responses are different outcomes to what we would have seen without MHRVs? … and if we’re being really picky, there is no obvious control group here because there could be other factors in play which are affecting conveyance rates. This is the peril of before-and-after snapshots where we do “research” by counting things after an intervention without having properly counted them before and without having a control group which helps us see the impact of confounding factors. If, for example, the MHRVs do not operate in the Black Country area, there would have been opportunity for such a control group to help us understand the impact MHRVs are having in those parts of WMAS they do cover.
Perhaps they could let us know that in due course?
STREET TRIAGE
There’s some discussions still to be had about this sort of service, nationally – whilst WMAS are busy doing this, I was hearing of another ambulance service who are doubling down on RCRP ideas and simply preparing to deflect what is sent to them by the police on the same legal basis: that the ambulance service is not the appropriate agency either. It’s a view with which I have some sympathy and we know paramedics have been seeing an upturn in mental health related demand for years. Over the last decade we’ve seen some ambulance trusts placing mental health nurses in control rooms – either seconded from a MH trust or directly employed. We’ve seen ambulance services like LAS and WMAS doing this – a mental health response vehicle service which, at least in part, can help deal with the demand increasingly being deflected from the police to the ambulance service under the Right Care, Right Person programme.
The LAS told the London Assembly in February 2024 they were seeing around 250 calls per day sent to them by the police after applying RCRP criteria to calls received but the LAS observed that most of those did not need an ambulance. In London, LAS also runs the NHS’s 111 telephone service and they would direct police-demand to 111 and then either have that service manage the patient or consider deploying the MHRV services. All of this seems part of the ongoing experiment for us to work out how we provide crisis and sub-crisis responses to those who are struggling to access relevant mental health support in a timely way and it comes after we tried (and in many places stopped) doing ‘street triage’ schemes in various forms and now in a climate where the police are pulling away from demand they have now decided to interrogate in terms of legal obligation and the risk officers could make things worse.
But the obvious point to make – regardless of what we think about this before-and-after snapshot press release – is five vehicles for an area like the West Midlands is a drop in the ocean. I’d love to know, for example, how many calls did WMAS receive to which they would have deployed this MHRV service but for the fact the cars were already committed with calls. I’d also like to see some criteria for what they actually deal with and, by implication, what they won’t.
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, 2024
I am not a police officer.
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Government legislation website – www.legislation.gov.uk
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