Is a Mental Health the hardest call to attend?

[Redcell19512]

Mental health calls are incredibly easy for ems providers. Identify a chief complaint, try to determine if the patient has harmed themselves (OD or other self inflicted damage), and run them to the hospital. We have no real mental health training so our involvement should be limited to a pleasant ride to the hospital. I have no tolerance for providers that make fun of psychotic patients or treat them like garbage.

Mental health patients seem to fall through the cracks. I once thought that every intentional suicide attempt winds up admitted to the hospital for treatment. Nope. Doesn't happen. Know it for a fact. Even when they do end up in the hospital there is no real treatment. In patient psych care, in my experience, is a joke. The real action happens on a weekly basis when the patient see's a counselor. Unfortunalty many patient's don't do the necessary long term treament that they need. Family doctor's prescribe meds for depression and anxiety and don't require the patient to follow up with a psych provider. The patient relies on medications instead of learning proper coping mechanisms (when that's possible).

How do we help EMS deal with mental health patients? Education. Contact your local county/state mental health agency and ask them to send someone out to your service to give an EMS targeted lecture. Heck, just having a dialouge between your ambulance company and a social services agency would be a step in the right direction.

[AnthonyM83]

MY hardest issue on mental health calls is when patient decides to fight. I hate to physically engage a mental health patient, even in self-defense, especially since many of them are in their teens and going through a lot of life problems (way worse than anything I've had to deal with).

[JPINFV]

We have no real mental health training so our involvement should be limited to a pleasant ride to the hospital.

Herein lies the problem. It's like calling every single non-arrest medical call easy for a basic. Let's see here, put patient on 15 liters O2 and, umm, what else can I do? Umm, transport? We shouldn't be content on calling it easy because we can't do anything. Are we going to be able to make major breakthroughs with the patient? Nope, but it seems that are treatment is either observe peacefully or observe with the patient in restraints. We need to be trained and educated on ways to calm patients down that is based on how the patient is being presented.

I once thought that every intentional suicide attempt winds up admitted to the hospital for treatment. Nope. Doesn't happen. Know it for a fact. Even when they do end up in the hospital there is no real treatment. In patient psych care, in my experience, is a joke. The real action happens on a weekly basis when the patient see's a counselor. Unfortunalty many patient's don't do the necessary long term treament that they need. Family doctor's prescribe meds for depression and anxiety and don't require the patient to follow up with a psych provider. The patient relies on medications instead of learning proper coping mechanisms (when that's possible).

That might be a good thing. Non-psychotic suicide patients are a different brand then, for example, your patient with schizophrenia. I wounder if we are doing any harm when we group the non-psychotic patients with the psychotic patients in a hospital. The problem is how many of these patients are suffering from a psychological problem (poor coping skills, destructive relationships, etc) and how many patients are suffering from a psychiatric disorder (disorder with how the brain works). One needs psychoactive drugs, the other doesn't. Most of these patients suffer from both psychological and psychiatric problems.

[Eydawn]

Mental health is as complex an issue as you can get. To begin with we don't even really know the basis for a lot of mental disorders; it is extremely difficult to tease out what is physiological, what is biological, what is situational, what is psychological etc. and all of them interplay in the realm of mental health. This makes treatment very difficult for any provider of any level, much less the prehospital care provider with 15 weeks of EMT-B training, or the paramedic with 1.5 years of education.

The deeper I get into biology and medicine, the more firmly I believe that medicine is much more important than A+B = I do C, or even critical thinking about proper treatment and interventions... It has to do with how you interact with your patient. This goes for medical, trauma, and mental health patients. If you are working with a medical patient, and you manage to establish the right connection with that patient, you can improve the outcome of your interventions. This is an idea that has been researched a few times; I'll see what I can dig up in the way of references (exam week is kind of prohibitive of that at the moment).

I think this idea is even more important to keep in mind with a mental health patient; whether it's a chronic depressive frequent flyer, a newly diagnosed paranoid schizophrenic, or someone with multiply personality syndrome, the way you interact with them will have an impact on them. Perhaps there is not a great deal that can be done prehospital, especially if you don't know what their problem is; but you can still do something for them. Talk to them. Establish a connection (albeit professionally) with them. Even though all you can do is take vitals, try to get a history and administer oxygen or sedatives (dependent on certification level) as necessary, you can still make some difference with this patient.

Mental health patients can be really difficult to deal with. They might disturb you emotionally, they might be physically combative, and you might not have the faintest idea what to do with them, but they are still YOUR patient, and need you to try your best for them. After all... many of them are suffering from an illness that they cannot control or that makes it difficult for them to mentally comply with their treatment. You don't just look at a diabetic and go "ok, shoot 'em full of d50, hi-flow O2, I'm not going to talk to them now that they're not acutely dying."

And you may never make a difference; but it is worth a shot.

My 2 pence.

Wendy

CO EMT-B

MI EMT-B

[hammerpcp]

Mental health calls are incredibly easy for ems providers. Identify a chief complaint, try to determine if the patient has harmed themselves (OD or other self inflicted damage), and run them to the hospital. We have no real mental health training so our involvement should be limited to a pleasant ride to the hospital. I have no tolerance for providers that make fun of psychotic patients or treat them like garbage.

Mental health patients seem to fall through the cracks. I once thought that every intentional suicide attempt winds up admitted to the hospital for treatment. Nope. Doesn't happen. Know it for a fact. Even when they do end up in the hospital there is no real treatment. In patient psych care, in my experience, is a joke. The real action happens on a weekly basis when the patient see's a counselor. Unfortunalty many patient's don't do the necessary long term treament that they need. Family doctor's prescribe meds for depression and anxiety and don't require the patient to follow up with a psych provider. The patient relies on medications instead of learning proper coping mechanisms (when that's possible).

How do we help EMS deal with mental health patients? Education. Contact your local county/state mental health agency and ask them to send someone out to your service to give an EMS targeted lecture. Heck, just having a dialouge between your ambulance company and a social services agency would be a step in the right direction.

Yes!

[hammerpcp]

Mental health is as complex an issue as you can get. To begin with we don't even really know the basis for a lot of mental disorders; it is extremely difficult to tease out what is physiological, what is biological, what is situational, what is psychological etc. and all of them interplay in the realm of mental health. This makes treatment very difficult for any provider of any level, much less the prehospital care provider with 15 weeks of EMT-B training, or the paramedic with 1.5 years of education.

The deeper I get into biology and medicine, the more firmly I believe that medicine is much more important than A+B = I do C, or even critical thinking about proper treatment and interventions... It has to do with how you interact with your patient. This goes for medical, trauma, and mental health patients. If you are working with a medical patient, and you manage to establish the right connection with that patient, you can improve the outcome of your interventions. This is an idea that has been researched a few times; I'll see what I can dig up in the way of references (exam week is kind of prohibitive of that at the moment).

I think this idea is even more important to keep in mind with a mental health patient; whether it's a chronic depressive frequent flyer, a newly diagnosed paranoid schizophrenic, or someone with multiply personality syndrome, the way you interact with them will have an impact on them. Perhaps there is not a great deal that can be done prehospital, especially if you don't know what their problem is; but you can still do something for them. Talk to them. Establish a connection (albeit professionally) with them. Even though all you can do is take vitals, try to get a history and administer oxygen or sedatives (dependent on certification level) as necessary, you can still make some difference with this patient.

Mental health patients can be really difficult to deal with. They might disturb you emotionally, they might be physically combative, and you might not have the faintest idea what to do with them, but they are still YOUR patient, and need you to try your best for them. After all... many of them are suffering from an illness that they cannot control or that makes it difficult for them to mentally comply with their treatment. You don't just look at a diabetic and go "ok, shoot 'em full of d50, hi-flow O2, I'm not going to talk to them now that they're not acutely dying."

And you may never make a difference; but it is worth a shot.

My 2 pence.

Wendy

CO EMT-B

MI EMT-B

YES YES! At least 2 Euros.

[Asysin2leads]

Psychiatric calls aren't that tough if you keep a few things in mind.

1. Crazy does not equal stupid. Many times, its just the opposite. Talking to someone who is mentally disturbed like they are five years old or condescending to them will generally piss them off.

2. Don't let your emotions get involved. If you have a family member with mental illness, this is particularly difficult. Remember, you are going to do what is best for this patient and what is required of you, not what would have been right for your loved one in a similar situation.

3. Mental illness is just that, an illness, and the person who is afflicted needs serious professional attention. Trying to play Dr. Phil in the back of the bus will get you no where and probably make the situation worse. Empathy is a good thing and a requirement of this job, but keep it in check. By the same token, trying to go all State Trooper/drill sergeant on them isn't going to help either.

4. Scene safety, at all times, of course. Have the appropriate resources necessary, and if you don't, don't transport.

5. The big questions are "Have you had any thoughts of hurting yourself or others," and the standard ones to gauge orientation. Besides a med list and a brief history, you really don't need much else.

[Ridryder 911]

Good points Asysin2leads.. but, would it not be better to be educated more in depth at all levels of EMS since really... come to think of it .....all of our patients are mental health patients?... Even the trauma patient whom just lost their loved one or the AMI patient that is going for the CABG?....

[Asysin2leads]

Rid, you know far that it is far from me to suggest not knowing all you can about every facet of the human condition. I would say that basic human psychology should be a required course for all EMS providers, but really the only thing my introductory psychology couse ever taught me was that there are courses in college where you can not show up for half the semester and still pull a B plus.

Mental illness of course is really hard to define. What may be mentally ill in one culture can be just fine in another. Defining what constitutes mental illness and what place society has in the treatment of the individual is a question that touches on ethics, sociology, politics, neurology, and philosophy, the debate of which would start a thread that could last for years.

Yes, EMS providers should be able to identify signs and symptoms of mental illness, and should know the laws regarding involuntary treatment in there area, as well as knowing how to deal with mentally disturbed individuals. My point is that a little knowledge is a dangerous thing. Recognition and mitigation is one thing, but treating mental illness is a very serious business that can only be handled by highly trained professionals, and even they have only moderate success.