Mental Health Response Vehicles partnership
Mark Jones, Head of Mental Health, Welsh Ambulance Services University NHS Trust
Introduction
Mental health calls make up about 10% of Welsh Ambulance (WAST) workload, often requiring more time and resulting in patients being taken to Emergency Departments (ED), where they typically wait five hours for support and are twice as likely to stay over 12 hours compared to the general public.
Recognising that EDs are not ideal for mentally distressed patients, WAST implemented mental health practitioners in call centres in 2022 for remote triage. Through a Mental Health Response Vehicle (MHRV) pilot; the aim was to reduce the burden on A&E and ambulances by treating 75% at the scene within two months.
Methods
A business case for the MHRV pilot was presented to the WAST executive board, in collaboration with Aneurin Bevan University Health Board (ABUHB) for a winter pressures pilot in their area. Using Kotter’s change model, initial discussions showcased data and evidence from other regions to gain stakeholder support from WAST and ABUHB. Regular weekly meetings were established to discuss plans, address barriers, and ensure progress.
Plan Do Study Act principles were employed for setting up the pilot. Initially, we explored various transport options, ultimately using a car from WAST. Defining a mental health pathway involved numerous discussions to ensure appropriate patient referrals. Staffing was challenging; while the ABUHB initially required its own staff, WAST used its own mental health practitioners on overtime and bank shifts. This approach leveraged experienced staff but was not sustainable long-term due to added pressure on personnel.
Outcomes
- MHRV pilot treated and closed 74% of mental health cases at the scene.
- 7% of patients were conveyed to a mental health facility.
- 19% were conveyed to an Emergency Department for appropriate physical issues (e.g., overdose, deep wounds, ligature damage).
- The pilot team reported a positive experience and perceived significant benefits for service users.
- Mental health practitioners noted increased confidence among control room and road staff.
- Zero serious incidents reported during the pilot.
Learnings
- Implementing MHRV requires adequate funding and dedicated staffing.
- Staff should not be expected to work overtime for MHRV implementation.
- Ensuring correct patient pathways is crucial for maximising patient benefit.
- Pathways must be robust to maintain partner confidence and prevent breakdowns.
What next?
A business case is being written to further expand, test and rollout MHRV’s across Wales. We also intend to publish our findings.
