Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

Abstract

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

“…Previous studies indicate that patients who have self-harmed themselves might benefit from alternative pathways of care [ 25 ], and patients with psychiatric complaints can be directed to specialty care after evaluation from an advanced level paramedic [ 26 ]. However, it has also been shown that patients with a history of mental illness are more likely to recontact emergency care if non-conveyed by EMS [ 32 ].…”

“…As paramedics are capable of performing out-of-hospital triage [ 17 – 21 ], it would be beneficial for patients and the healthcare system to identify non-urgent patient groups that could be treated at home [ 5 ] or directed to alternative points of care instead of conveyance to the ED [ 21 – 24 ]. Previous study results have reflected that, for example, patients who have self-harmed themselves might benefit from alternative pathways of care [ 25 ], and patients with psychiatric complaints could be directed to specialty care after evaluation from an advanced level paramedic [ 26 ].…”

Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

“…A recent review13 of interagency collaboration models found that there is a wide range, with different kinds of agencies and services involved at various levels. Co-responder interventions are not routine practice and the majority not evaluated,13 and high costs, logistics13 14 and limited access to local mental health services15 make such models difficult to implement.…”

Understanding prehospital care for self-harm: views and experiences of Yorkshire Ambulance Service clinicians

“…Ambulance clinicians are often the first professionals involved in their care. This encounter affects immediate actions and long-term outcomes by influencing future help-seeking behaviour 2. Little is known about prehospital care for people who self-harm,3 although assessing and managing this group represents a unique challenge for ambulance clinicians 4.…”