To improve care for people who present to healthcare as psychiatric emergencies in Scotland, our researchers have used record linkage techniques through multiple studies to better understand these psychiatric emergencies (including those at risk of suicide) and improve their care pathways.
One study linked data relating to Scottish Ambulance Service (SAS) psychiatric emergencies and self-harm with Emergency Department (ED) data, and Acute & Mental Health episode and deaths data, following individuals for at least 12 months.
It found more than half of the people (62%) attended by the SAS were either left at home (11%) or discharged from ED with no known follow-up (51%). Within 12 months of their emergency call, 279 of the 6,802 callers had died – with 35% recorded as suicide.
Our research included a stakeholder workshop which revealed that 93% perceived the study findings to be ‘very useful’ or ‘quite useful’ in understanding the patient population – and nine out of ten found the data to useful in developing evidence-informed alternative care pathways.
Building on this, our team were invited by the Scottish Government to join a working group to further apply this data to the ‘Enhanced Mental Health Pathways’ project. Further analysis went on to reveal that mental health related journeys in the out-of-hours period represented four times as many journeys through NHS 24 than indicated by standard analyses and were responsible for 27% of all ambulance journeys. These journeys also resulted in longer waiting times in A&E – and according to our research, could have ultimately been resolved by telephone contact in around 60% of cases.
This analysis led to Government investment of £2 million for the ‘Enhanced Mental Health Pathways’ project to support dedicated mental health nurses being recruited to staff NHS24’s 111 service to provide front line patient care. Calls to the 111 service made by people in distress are now diverted to these dedicated staff, where calls are triaged, care provided or escalated as necessary.
This mental health service is therefore dealing with an estimated approximate 100,000 calls per year benefitting many thousands of people across Scotland.