Sweden has unveiled a dedicated mental health ambulance
Bright yellow in colour, with flashing blue lights. From the outside, it looks like any other Swedish ambulance. Even as it races down the highway, you'd never notice anything different about it. However, a quick peek inside reveals that this particular emergency vehicle is anything but ordinary. Gone are the stretcher and first aid kits, in their place are big chairs, relaxed lighting and a desk. That's because this ambulance isn't designed to respond to broken legs or heart attacks, but to mental health emergencies.
Despite Sweden being consistently voted one of the happiest countries on earth, its suicide rate is slightly above the European average. According to the World Health Organisation, there are approximately 15 suicides for every 100,000 people, compared to the regional average of approximately 14. In 2011, the Organisation for Economic Co-operation and Development (OECD) praised the country's efforts to lower this, but critiqued its response to mental health situations stating that: “Unfortunately, mild and moderate disorders are not a priority area in Sweden's mental health strategy.”
Determined to tackle the issue and keen to reduce the burden placed on other emergency services, Stockholm's Psychiatric Emergency Response Team (PAM) was initially launched in March 2015 as part of a trial scheme. More akin to a mobile counsellor’s room than an ambulance, the vehicle is staffed by two mental health nurses and a paramedic and able to provide immediate and specialised frontline help for people experiencing mental health emergencies, including those who are in imminent danger of self-harm, experiencing distress, psychotic or suffering from schizophrenia but may have missed medication.
Just as with a regular ambulance, it's up to the crew to make decisions about whether to bring the patient in for further treatment or simply to give them someone to talk to and a lift home. During its first year, the ambulance responded to an average of 135 callouts per month, helping 1036 individuals in need of urgent care. Of these people, only a quarter went on to receive inpatient care and just 96 required repeated contact. There is no age limit for patients, and in the scheme's first year the youngest patient was just five years old, while the oldest was 100 years old.
The scheme has proven popular with both healthcare professionals and with the police who - despite having only minimal training in mental health care - are often left to pick up the slack when mental health professionals are not available. This can not only create distress and stigma for the individuals involved, but with police inherently trained to respond to and minimise threat, can also lead to the misinterpretation of situations and unnecessary use of force against vulnerable individuals.
It's situation that has been criticised time and time again by both mental health professionals and police themselves, yet is replicated across Europe and America: "It should never be the case that someone who requires treatment for any condition should become the responsibility of the police simply because other agencies do not have the resources to act", said Sir Tom Winsor, the UK's HM Chief Inspector of Constabulary, in his 2017 State of Policing report, adding that police involvement was a "profoundly improper way to treat vulnerable people who need care and help." Under the PAM system, police will stay with the ambulance crew if requested, for example if, a patient becomes agitated or violent.
So with many other countries now facing their own mental health burdens, could the scheme be replicated elsewhere? The UK is certainly one potential candidate for the introduction of mental health ambulances, with 999 call-outs to patients dealing with mental health emergencies jumping by almost a quarter in the year 2016-2017 and paramedics responding to over 172,000 patients in crisis situations. In the period 2015-2016, 2100 people were held under Section 136 of the Mental Health Act, which allows police to take individuals to a "place of safety" for their own protection, which could be a hospital or, when no hospital beds are available, a police cell. The US could also benefit from the introduction of mental health ambulances, with a high number of EMS call-outs and police call-outs believed to be connected to some sort of mental health issue. Laura Usher, Criminal Justice Senior Manager at the National Alliance on Mental Illness (NAMI), the US's largest grassroots mental health organization, told VT that they would advocate such a scheme: “Today, if you call 911 in a mental health crisis in the US, police often respond because many communities lack adequate mental health crisis services. No one would accept a police response to health attack or stroke. We would outraged if a diabetic crisis lead to jail. A dedicated mental health ambulance—and alternatives, such as mobile crisis teams—are a much more humane way to respond to people in mental health crisis and help people get connected to the care they need.”
Some areas of the country are already moving towards such a system, albeit slowly, with Los Angeles, Seattle and Denver all providing trained psychiatric nurses to accompany police to certain calls; so far, experts say that both arrests and violent interactions with law enforcement are already down. While some states, such as Oregon, have begun implementing Mental Health Emergency Rooms, facilities designed to offer short-term and specialised treatment to those in danger of harming themselves, the ability to treat these cases in-situ would reduce the dependence on emergency rooms, psychiatric or otherwise.
In this, there is also the potential for medical services all over the world to reduce the impact of "frequent callers" on medical first responders who can divert valuable emergency resources away from other calls. Speaking to Mental Health First Aid, a US project aimed at educating communities about how to deal with mental health emergencies, one paramedic from the San Diego Fire-Rescue Department’s Emergency Medical Services noted the necessity of specialised mental health practitioners, estimating that of their frequent 911 caller group: "60 percent […] have underlying psychiatric problems or mental illness, and when we get to our very high utilisers, people who are calling, you know, 50 times a year or so, it’s about 80 percent psychiatric issues."
With the potential to provide specialised and immediate treatment, protect patients from stigmatisation, reduce the reliance on other emergency services and most importantly, to save lives, it's hard to see why this scheme wouldn't be extended to different countries. So as attitudes towards mental health slowly change to give it the recognition it deserves, and more people are willing to talk about their own experiences than ever before, let's hope that the emergency response approach to it does too - because as Stockholm's? response shows, there is always more we could be doing.
Featured illustration by Egarcigu