This post was first published on ' The Ramblings of a Graduate Paramedic ' Blog by Saul Gaunt. You can follow him on Twitter @saulie10
Ah, mental health, those two words that make health professionals cringe. Although, I really enjoy the effect you can have on people during these types of calls. Throughout my placements my interest in mental health has become greater and greater. I kinda enjoy the challenge. There isn’t just one answer to mental health and you have to use your brain. Mental Health services unfortunately in the area I work (and from what I hear across the country) during out of hours (when the majority of calls occur) is practically non-existent. This makes the situation somewhat frustrating as our only choice is to take the patient to hospital.
With my interest in mental health growing, i decided to write one of university essays on the subject. What I found was shocking, and led me to want to keep as many mental health patients away from Accident and Emergency and instead keep them at home with the correct pathways and support in their own environment.
On placement recently, in the early hours of Saturday night I attended a young lady who was feeling suicidal. I was “excited” to treat this patient as the previous day we were informed of some new pathways for mental health patients, and I wanted to try them out.
I spent about 2 hours on scene with this patient, asking her all the relevant questions so I could assess her suicide risk and gain a comprehensive history. The patient scored a relatively low risk on the scale, meaning with the correct pathways, we could have left this patient. Fantastic i thought, perfect opportunity to try out these new services. I get out the list. Based on the time and day we had very limited choice. I telephoned the one which was meant to running that evening.
15 attempts later, i gave up.
This frustrated me to no end. Yes they are probably very busy, but they weren’t there when I needed them. So unfortunately I had to take this patient into hospital. On the way to hospital, we chatted about films, music. She was my age, and we had a lot in common which actually made it more difficult to comprehend.
Now you may be thinking this is fine, she will be treated there. However, as the patient is not sectioned, she would be able to leave at any point, with a standard long wait at hospital there was the potential for her to leave.
I felt I had failed this patient. I felt the system failed her, I felt helpless as I wheeled her into the waiting room and left her there. Now of course I did the best for her, I tried everything that I could. But this didn’t change my impression of what I had done.
Getting home was not easy, I was tired, hungry, and pissed off. This led to some admittedly self-destructive thoughts to creep into my head:
1. “She is going to leave and jump off a cliff”
2. “All mental health leads to this and people who I love are going to end up doing that”
3. “I have failed in my duty of care”
I had to tackle each individual one in my own mind before I was going to get to sleep that night.
1. I told myself that this wasn’t going to happen. Why would she? I reached out to her. When I left her she was happier and she would get seen and all would be fine.
2. This one struck a chord. Some of the people I truly love are suffering with mental health problems - or have done so in the past - and this led me to imagine their faces on hers. Will all those people end up like that went through my head. This one has stuck with me...
3. This is an interesting one, and is in my view completely subjective. Legally, no. I had done everything in my scope of practice to assist this patient and had left them in a place of relative safety (a whole other debate). But in my eyes, I had. What more could i have done though? It annoyed me more that i didn’t have an answer to that question. Why wasn’t there more that i could have done for that patient?
Eventually I got to sleep realising that it was late and actually I couldn’t deal with the situation at the time and now all I needed to do was sleep. In the morning I rang, texted everyone who I knew would be able to help me. Essentially convincing myself that she and me would be fine.
And I really hope she will be…