View from the frontline: Dealing with mental health as a paramedic

Poor mental health doesn’t discriminate. It can affect anyone of any age or background. Our mental health training was limited, so, although I would always endeavour to provide the best possible support to a patient, I didn’t always feel equipped to do so effectively.

That is why I understand the importance of the National Record Locator project (NRL). This has been a two-year effort to help develop the sharing of mental health information with ambulance trusts for the patients they treat.

I recall the first time I was called out to a patient who had suicidal thoughts and having a sense of helplessness as the patient did not want to attend accident and emergency (A&E). We did not have access to their crisis team or crisis plan. This meant we had a real struggle to persuade them that it was in their best interests to go to A&E. If the patient had not agreed, we would have been left in a really difficult situation of having to assess their capacity to make such a decision and possibly requiring police involvement.

With experience, I learned to better manage these situations and communicate more effectively with patients, but our access to resources to support them remained minimal. Often, our only option would be to take patients to A&E as a safe place of care. This rarely seemed to be the best outcome for the patient or a busy A&E.

Many patients have access to a mental health crisis team who can help them and provide support away from A&E. If we could contact the crisis team, we could potentially provide a better outcome, but this was not an easy task.  Patients would not be able to recall the details of their crisis team. Sometimes they didn’t want to tell you. If their phone had died, it was difficult for them to access those details even if they wanted to retrieve them.

The development of the National Record Locator is crucial in allowing clinicians and other NHS staff to more easily contact the mental health crisis teams.

Ambulance clinicians can now see when a patient has a mental health crisis plan, who is responsible for the plan, and how they can be contacted for further information.

During the first phase, we worked with organisations that had a wide range of digital maturity. This meant that our delivery approach was less consistent than we had anticipated and we had to be flexible in working through the different constraints that organisations were facing. For example, the mental health trusts were trying to connect to the NRL from a variety of different platforms. We had to work with them to overcome the barriers in being able to perform all the API interactions, which help integrate application software. Another constraint was understanding the complexity of the trusts’ different admission and discharge processes.

Introducing a new clinical system into the workflows of already busy clinicians was also challenging. We had to make sure they could really understand the benefits to them to ensure uptake. We needed to help them see a longer-term view of what the National Record Locator would provide.

For instance, the first phase, which went live in November last year, solved some problems for the ambulance clinicians, but not all. The crisis team couldn’t always pick up the phone and the clinicians weren’t always able to extract the extra information they needed.

The second phase, which is about to go live imminently, enables the clinicians to instantly access the mental health crisis plans of the patient, without having to go to the crisis team to share them. This will enable crews to make better informed decisions more quickly.

This sharing of records across organisational and regional boundaries helps the organisations and their clinicians to meet their targets of providing more integrated care.

After the first phase went live a year ago, we were able to prove that the technical functionality worked in a live clinical environment.

The second phase will involve us trying to get greater uptake by working with more mental health trusts to make their mental health crisis plans available via the NRL.

We are also using new NHS digital capabilities to provide better access to the National Record Locator for ambulance clinicians. 

For example, using the NHS Identity system means ambulance clinicians can authenticate themselves using biometrics such as a fingerprint instead of using a Smartcard, which isn’t always a practical solution in a mobile setting.

We are also making a wider range of records accessible to clinicians, including child health and maternity records, plus further types of care plans in collaboration with the Local Health and Care Records (LCHR) initiative. For each record we bring on, we have to work out how it is best technically represented so that it can be easily searched for and viewed by a clinician. We also need to ensure that the correct access controls are in place so that it is only viewed appropriately. Although this can be challenging, knowing the benefits it will bring to the frontline makes it all worthwhile.

You can keep up-to-date with the progress on the second phase on the NHS Digital website.