Exploring Mental Health Emergencies Attended by Ambulances in Rural England During the COVID-19 Pandemic

Ambulance data offer novel insight into the mental health impacts of the pandemic in rural areas, which are typically underrepresented in health service use data. This research involved a retrospective observational study of all records of patients experiencing mental health emergencies attended by ambulances in the East Midlands of the United Kingdom between March 11 and December 31, 2020, and patients in regions classified as “rural towns” and “rural villages” in the same period in 2019. Measures included the demographic and clinical details of 38,266 mental health emergencies attended by ambulances in 2020 and 11,475 emergencies occurring in rural areas in 2019, the rural and urban category classification, and relative deprivation of the areas where emergencies occurred. Regression analysis explored the factors that predicted emergencies occurring in different rural and urban areas, and differences between emergencies occurring in rural areas during compared to before the pandemic. Multinominal regression analysis found that mental health emergencies occurring in rural areas are more likely to involve behavioral disturbance, suicidality, and anxiety compared to urban cities and towns. Binary regression analysis suggests that some differences between rural and urban areas are likely to be related to the pandemic, while others may reflect more stable characteristics of regions. Increased behavioral disturbance in rural areas is likely to be related to the pandemic, while higher rates of suicidality may reflect more persistent inequalities. Challenges for clinicians in rural areas include supporting dispersed populations to prevent the escalation of behavioral problems.