Mark Jones and Simon Amphlett
Welsh Ambulance Services NHS Trust
Project Background:
- There are c. 100,000 crisis care episodes in Wales each year, with the Welsh Ambulance Services NHS Trust (WAST) receiving more and higher acuity calls than any other single organisation (though primary care as a whole manages more crisis demand). Around 20,000 episodes are managed within the specialist mental health crisis care system.
- Mental health crises are common, and people seek help through multiple routes. WAST is a key provider of crisis care.
- Whilst mental health presentation accounts for around 5% of ED (Emergency Department) demand, this demand has nearly doubled over the last ten years and continues to increase. These patients are twice as likely to experience 12 hour waits than others and are likely to experience an exacerbation of their distress and be supported in highly unsuitable environments.
- Mental health calls represent around 10% of total ambulance service demand in the UK. These calls are often more complex, take longer to resolve and are a significant challenge to the generalist workforce. WAST’s data shows that when an ambulance is dispatched to a mental health call, c. two thirds of these patients will be conveyed to an ED.
Project Aim:
Implement mental health response vehicles in Wales.
Project Approach:
Between 2018 and 2020, London Ambulance Trust piloted a Mental Health Joint Response Car (MHJRC) scheme that involved pairing paramedics and mental health nurses to respond to patients experiencing a mental health crisis or who required a specialist mental health response.
Findings from this pilot:
- Reduction in ED conveyance rates, with 77% of patients discharged at the scene compared to a business-as-usual non-conveyance rate of 54%.
- The combination of MHPs alongside paramedics had a positive effect on the quality and effectiveness of the care delivered to patients at the scene.
- Positive patient experience.
- MHJRC team members reported high levels of job satisfaction and believed the multidisciplinary approach to care was beneficial for patients
(NHS England et al 2020).
A similar initiative in Wales could have significant benefits for patients and staff. It would support face-to-face holistic assessment and management, improve the quality of care delivered and potentially further reduce the burden on ambulance services and EDs.
The WAST mental health team developed a local mental health response vehicle protocol and undertook a pilot with Aneurin Bevan UHB between January and March 2024:
- It was expected that the MHRV operating at peak demand times of Friday to Sunday 13:00 – 01:00 could respond to 27 patients per month; a total of 137 across the pilot period.
- Using existing data on non-conveyance rates from the London pilot, that no more than 20% would be conveyed to ED. In addition to this it is envisaged that no more than 5% will be conveyed to mental health services.
Project Impact:
Patient and staff benefits are as follows:
- 74% treat and close rate
- 7% conveyed to mental health services rate
- 19% ED conveyance rate
- Zero serious incidents
- Positive staff experience
- Staff perception that service users had benefitted from the MHRV service
- Increased confidence in control room staff and road staff when helping mental health patients
- 1 car covering two health boards could save (on average after costs) circa £250k/ year. It is estimated that national savings of over £1M.
Read about the project in RCNi Emergency Nurse: Delivering a mental health response vehicle service in Wales: a pilot initiative
Project Roll Out:
Following the pilot as part of the Bevan Exemplar Programme, mental health response vehicles are now being rolled out across South East Wales, and in other areas of Wales in 2025 following recruitment. More here: Welsh Ambulance Service launches new mental health crisis initiative – Emergency Services Times
