Outcome Health: Providing Emergency Mental Health Services
Outcome Health, in the state of Victoria, Australia is a team of senior Credentialed Mental Health Nurses (CMHNs) who work alongside the emergency call centre staff providing specialised mental health support.
Ambulance Victoria provides emergency response to medical emergencies and life-threatening illness and provides transport to emergency departments across the state, which has a population of approximately 5.8 million people.
Approximately 25% of the calls received for emergency help are related to mental health. While the call centre staff have some mental health training, they lack the complex mental health skills required to confidently determine which calls represent an emergency. Outcome Health fills the need for specialised mental health support within emergency services to ensure appropriate support is delivered to where it is most needed in the community.
The CMHNs triage mental health callers to either upgrade or downgrade the dispatch of an emergency vehicle allowing the most appropriate services to be allocated. They keep the caller on the line until an emergency vehicle arrives and provide de-escalation and crisis management. Developing an alternative course of action with the caller keeps callers with severe mental health emergencies safe until emergency support arrives. It also reduces the number of emergency vehicles dispatched to non-emergency situations, thus making more vehicles available for medical emergencies, decluttering emergency departments. The CMHNs’ knowledge required in this role includes an understanding of medications, side effects, dosages and reasons for prescribing. This complements their strong body of knowledge regarding diagnostics, processes within public and private mental health sectors and understanding of alternate service provision.
The service considers the appropriateness of emergency ambulances and supporting police services. When needed, psychiatric triage services are informed and alternate service providers are engaged in care plans for frequent callers.
During telephone assessment, risk assessment is paramount. This complex task is done quickly and decisions are negotiated with the caller. Through the engagement of the caller, the CMHN will consider risk to attending emergency service crews and are able to disarm callers who are threatening to use weapons. This information is transferred live to other services to ensure their safety when entering a scene. Through interaction with the CMHNs, callers and their families learn how and when to seek appropriate mental health help. Whilst the urgency of cases may not change, this role has enabled families and significant others to support and assist their loved ones. The CMHNs also provide support to ambulance clinicians and call centre staff. The seeming chaotic nature of a mental health crisis can lead to medically focused clinicians doubting their responses in emergency services. Staff receive education regarding communication, stress and risk management as well as debriefing opportunities. The presence of the CMHN staff has encouraged discussion and educational opportunities leading to an increased sense of confidence in clinical decision making for those working with them.
The success of the programme has led to an expansion of the service to provide community-based emergency appointments by established providers to develop ongoing care plans and support.
This important service ensures the appropriate level of emergency care is delivered where it is most needed during critical life-threatening events, saving time and money. The service is the first of its kind around the globe.