Mental Health: Intervention Skills for the Emergency Services

Description:

This book addresses the practical management of mental health scenarios in the emergency setting and offers first-hand reflections on how emergency nurses, practitioners and allied mental health professionals handle these situations. Responding to mental health needs in emergency situations can be profoundly complex. Frequently emergency nurses and other personnel express their feelings of powerlessness, as they do not know what to say or do in order to achieve the best outcome, and have concerns that their intervention may make the situation worse for those in their care. How a practitioner confronts the mental health encounter and takes the essential steps in managing the event can have a critical impact on how that person copes in the future. This book helps readers understand what is involved in mental health work in emergency situations, and the practical, psychosocial and spiritual tensions that arise from managing the event and the sequelae. Moreover, it shows that it may be possible to provide a more effective emergency mental health service.

This unique edited book presents critical reflections on aspects of mental health work gathered from the ‘hands-on’ experiences of the personnel. Mental health encounters in the emergency context are described in detail, illustrating not only what emergency nurses and mental health workers ‘do’ when mental health crises occur, but also what they feel about what they ‘do’. Written by a diverse team of emergency and mental health nurses and allied professionals currently engaged in emergency care both in hospital and pre-hospital settings, this book will appeal to emergency nurses and allied health professionals alike.

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Foreword

This teaching text has brought together a range of expertise to address issues central to the mental health and welfare of patients and emergency care fields. The work is thoughtful, and every attempt is made to centre the patient in each chapter to provide the golden thread which galvanises the book. People who experience the emergency pathway during mental health crisis may experience heightened emotion, feel out of control, become isolated, sometimes fearing judgemental opinion due to negative attitudes from others. This means that emergency care practitioners and allied emergency services personnel who support them need to understand their own attitudes toward mental ill-health and to develop skills which enable them to recognise deep pain and vulnerability in another person and to willingly provide supportive measures.

Dr Scott rightly begins the book by honouring those people who truly bear the risk of poor services, the patients, people and their families with lived experience of a mental health condition, many of whom bear the real and metaphorical scars of distress and lack of support. There is no doubt, people with lived experience of mental illness have not always received the most appropriate help to meet their needs, especially at the time they needed it the most, i.e. when they were in crisis. There are a number of factors that contribute to this, as is very well mapped in this book, and ultimately, patients and staff often come away from urgent and emergency response scenarios feeling like it has been a challenge which has not necessarily produced the most beneficial of outcomes for the patient or their family.

The book then takes us through a range of scenarios and considerations using an allage approach and so you will learn about the children and young people’s experiences alongside adults and older adults. These pages discuss the incidence and nature of mental health presentations, legislation, policy and contemporary research; it also incorporates case studies and provides bullet points for reflection and inspires the reader with a real sense of what could be possible if best practice could be applied across the urgent and emergency care system. Chapter authors provide both an understanding of the difficulties and complexities involved in caring for people in crisis within the emergency pathway whilst also offering hope and ideas for what could be handled better. This book will challenge emergency care practitioners and allied emergency services to do better by developing contemporary and well-researched evidence-based interventions.

Centre for Mental Health London, UK
Sarah Hughes

Table of contents :
Foreword
Acknowledgement
Contents
Mental Health as a Societal Concept Impacting on Emergency Care
1 Introduction
2 The Emergency Care Field
3 New Approaches
4 Where to Find Help
References
Learning Disability and Autistic Spectrum Conditions
1 Background and Introduction
1.1 Learning Disability
2 Patient Factors
3 Communication
4 Diagnostic Overshadowing
5 Sensory Processing Issues
6 Autistic Meltdown
7 The Equality Act and Mandatory Training
8 Pain
9 Early Warning Scores
10 The Mental Capacity Act
11 Resuscitation Decisions and Quality of Life
12 Hospital Passports
13 Care Pathways
14 Family
15 Soft Signs
16 Learning Disability Nurses
17 Reasonable Adjustments
18 Staff Awareness
19 Conclusion
References
Paramedic
1 Introduction
2 Policy Guiding Practice
3 Providing Care to Individuals with Mental Health Needs
4 Patients Experiencing Challenging Behavioural and Emotional Crisis
5 Interventions for Mental Health Illness and Crisis
6 Integrated Care Interventions, Pathways and Referrals
7 Conclusion
References
Police Custody Officer
1 Introduction
2 Police Custody
3 Police Custody as a ‘Place of Safety’
4 Risk Factors in Police Custody
5 Healthcare Needs
6 Vulnerability and the Investigation
7 Appropriate Adult
8 The Changing Face of Policing People with Mental Ill-Health
9 Diversion from Police Custody
10 Diversion from the Broader Criminal Justice System
11 Conclusion
References
Emergency Physician
1 Introduction
1.1 Mental Health Presentations to the Emergency Department
1.2 Patient Views on the ED
2 Scenario 1 Carrie’s Experience
3 What Constitutes Good Care in the ED
4 Mental Health Triage
5 Referral to Mental Health Teams from Triage
6 Observation
7 Risk Assessment by ED Clinicians
8 Mental State Examination
9 Capacity Assessment by ED Clinicians
10 Managing an Agitated Patient
11 Attitudes and Training
12 A Safe and Calm Environment
13 Legal Frameworks Within the ED
14 Frequent Attendance to the ED
15 Conclusion
References
Mental Health Liaison Team
1 Introduction
2 King’s Liaison Psychiatry Service
3 Legislative and Ethical Issues
4 Referral Routes
5 Presentations
6 Interventions and Support Paths
7 Evaluations and the Future of the Service
8 Conclusion
Appendix 1 King’s Liaison Data, November 2020: January 2021
Appendix 2 Code 10 Pathway
Appendix 3: Section 136 Pathway
References
Approved Mental Health Professional
1 Introduction
2 AMHP Role and Responsibilities
3 Interagency Cooperation
3.1 Case Study: Julia
3.2 Case Study: David
3.3 Case Study: Brenda
4 Conclusion
References
Children and Young Peoples’ Services
1 Introduction
2 Tier 1
3 Tier 2
4 Tier 3
5 Tier 4
6 Mental Health Crisis
7 Right Care at the Right Time
8 Management of Mental Health Crises
9 Professional Attitudes
10 Care Pathways
10.1 Case Study: Ellie
10.1.1 Admission to an Emergency Department
Background
Risk Assessment
10.1.2 Post-initial Assessment at the ED
Second CAMHS Interview
Management and Discharge
11 Communication
12 Conclusion
References
Older People Mental Health
1 Introduction
2 Environment for Care
3 Why Older People Attend ED
4 Policy Impacting on Older Person Emergency Care
5 The Complexity of Older Person Presentations
5.1 Associated Multimorbidities and Polypharmacy
5.2 Co- or Multimorbidity
5.3 How Comorbidities Impact on the Older Person
5.4 Impact of Polypharmacy
5.5 The Complexity of Delirium and Dementia
6 Communication, Capacity and Consent (Mental Health Act 2005)
7 Early Assessment and Improvements in Patient Flow for the Older Person
8 The Older Person’s Emergency Care Journey
9 Involving the Family
10 Dignity, Choice and Person-Centred Care
11 End-of-Life Care
12 Interagency Collaboration
13 Conclusion
References
Toxicology in Parasuicide
1 Introduction
2 Risk Assessment
3 Clinical Assessment
4 Poisons Advice
5 Paracetamol
5.1 Mechanism
5.2 Clinical Features
5.3 Antidote
5.4 Anaphylactoid Reactions
5.5 SNAP Regimen
5.6 Management
5.6.1 0–8-h Post-ingestion
5.6.2 8–24-h Post-ingestion
5.6.3 More Than 24-h Post-ingestion
5.6.4 Staggered and Therapeutic Excess Ingestions
6 Antidepressants
7 Selective Serotonin Reuptake Inhibitors
7.1 Mechanism
7.2 Clinical Features
7.3 Serotonin Syndrome/Toxicity
7.4 Investigations
7.5 Management
7.6 Management of Serotonin Syndrome
8 Tricyclic Antidepressants (TCAs)
8.1 Mechanism
8.2 Clinical Features
8.3 Investigations
8.4 Management
9 Conclusion
References