Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study

Objective: In the context of increasing demand for ambulance services, emergency mental health cases are among themost difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services.We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. Weexplore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attendingemergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patientcare and ambulance service delivery.Methods: We conducted a retrospective observational study of records of all patients experiencing mental healthemergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801‘999’ calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and theoutcomes of ambulance attendance for patients (Outcome).Results: A multinomial regression analysis found that model fit with Outcome data was improved with the addition ofDispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept andOutcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinicalimpression. The most common predictors of Outcome care pathways other than ‘Treated and transported’ were recordsof respiratory conditions at Dispatch and anxiety reported by clinicians on-scene.Conclusions: Drawing on the expertise of mental health specialists may help ‘999’ dispatchers distinguish betweenphysical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Furtherinvestigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriatelymanaged without compromising patient safety.