Mental Health Nurses on Emergency Calls Reduce ED Admissions

A recently launched pilot initiative, which involves mental health nurses responding to 999 calls, has resulted in a 40% decrease in emergency department (ED) admissions for individuals experiencing a mental health crisis. This program, situated within the South Eastern Health Trust area and financially supported by the Public Health Agency (PHA), deploys 12 mental health practitioners from the trust to collaborate with the Northern Ireland Ambulance Service (NIAS) in their Belfast control room during weekends. Its focus is on individuals contacting 999 due to mental health distress. Under this initiative, a mental health practitioner conducts an assessment to help de-escalate individuals, thereby preventing their attendance at EDs and stopping ambulances from being dispatched to those in a mental health crisis. Stephanie Patten, who leads the project for the trust, stated that the pilot has demonstrated success to date. Speaking to BBC News NI, she reported, “From April to September, there were 190 [mental health] calls,” adding that “40% of those calls were de-escalated which meant they did not require an emergency ambulance.” Ms Patten explained that this approach ensures individuals “have the right care and the right response at the right time” during a crisis, eliminating the need for them to await an ambulance or spend time in a crowded ED. She further commented, “An emergency department is not an appropriate place for someone who is depressed, anxious or distressed to be sitting waiting.” Anne-Marie Scott, a mental health nurse practitioner who handles patient 999 calls, noted that the majority of callers are familiar to them, with some individuals expressing suicidal or self-harm thoughts and frequently experiencing significant distress. “We listen to what they say,” she stated. “We give them time to vent and then try, with them, to rationalise how they are feeling and try to break everything down.” She added, “Then we can, with their consent, refer on to statutory or voluntary services for additional support.” The initiative is active on Fridays and Saturdays from 19:00 to 03:00, and on Sundays from 15:00 to 23:00. Should an individual within the South Eastern Trust area dial 999 during a mental health crisis, they are directed to a mental health nurse practitioner for a comprehensive mental health assessment. A subsequent referral to either a voluntary or statutory service is then arranged, provided it is deemed suitable. This mechanism avoids patients needing to wait for an ambulance or present at a crowded emergency department. Ms Scott commented, “In these antisocial hours, the patients that are not involved with the mental health team, they have nobody to turn to.” Ms Scott further explained that individuals experiencing a mental health crisis typically depend on emergency services to access an emergency department; however, due to the high demand, some patients might endure lengthy waits to be assessed by the mental health team. Karl Bloomer, a consultant paramedic with NIAS, indicated that the “peak” demand period falls within these specific hours. He stated, “We’ve seen an increase in our demand for mental health calls, and quite often 999 ambulance response, and ED isn’t the most appropriate or best care for this patient cohort.” Mr Bloomer noted that the service has observed several advantages from the pilot to date, such as more effectively directing emergency ambulance responses. The pilot has also yielded an additional, unforeseen advantage. Mr Bloomer elaborated, “Our control room colleagues also get support from the mental health practitioners when they have a difficult mental health presenting call.” He further explained, “They can lend their expertise to reassure, encourage and educate our staff, so that is a benefit we did not anticipate initially.” Although the project is primarily situated within the South Eastern Health Trust, the implementation of Encompass, a digital health records system, has enabled mental health nurse practitioners to access patient information from the Belfast Trust, thereby expanding their operational scope. There is an aspiration for its further expansion in the future. Mr Bloomer expressed, “Ideally we would love to see the service rolled out seven days a week and regionally.” Copyright 2024 BBC. All rights reserved. The BBC bears no responsibility for the content found on external websites. Information regarding our policy on external linking is available.