How paramedics manage and respond to patients experiencing mental health issues

Introduction Mental ill-health is the largest single source of disability in the UK and approximately one in 4 of the UK adult population (some 7 million people) will have a significant mental health problem at any one time (McManus et al, cited in Mental Health Foundation, 2015). The ambulance service is often called upon to respond to people experiencing mental health issues. Statistical figures support the increasing demand for paramedics to manage mental health patients. Ambulance trusts dealt with an average of 16.1 emergency calls to the 999 ambulance service per minute (23 216 calls on average per day) in 2013 / 14 (NHS Digital, 2016). Between 2013 / 14, over 1.7 million adults accessed NHS services for severe or enduring mental health problems (NHS Digital, 2015). Simply put, the ambulance service is being inundated with calls and struggling to meet the demand and some of these demands concern mental health. Aim To observe and explain how paramedics respond to and manage patients experiencing mental health issues. Methods This study adopts an ethnographic approach, using qualitative methods of participant observation and semi-structured interviews. Twenty-one paramedics were observed over 240 hours during their frontline shifts on an ambulance within a single English Ambulance Trust. This was followed by 11semi­ structured interviews. Results Thematic analysis revealed that paramedics see mental health patients as being "Iike a black hole". Paramedics say they only have "about 20 minutes of 'there, there'" in them when managing these patients. Ironically, these quotes speak to the state of mind of paramedics and not their management of mental health patients. Paramedics managed their fee-lings by making use of humour, stereotyping and nostalgia. These behaviours were then analysed using Coffman's ideas of presentation of self (1959), which uncovered that paramedics used humour to de-escalate- emotional tension that arose during a mental health call and also used humour among themselves as a form of resilience. Paramedics also used stereotyping as a triage tool which served as a coping mechanism when managing mental health patients. These behaviours, which manifested through shared emotions, knowledge and tips, created a supportive mechanism in the form of a paramedic Community of Practice, where the ties of this paramedic community were strengthened. Conclusion This study has provided rich and detailed material to evidence how and why paramedics manage mental patients in the way they do and could therefore provide a platform for relevant future role players, such as ambulance trusts and higher education institutions, to initiate support and consider the future of paramedic practice in terms of managing mental health patients.