New mobile unit making in-roads into mental health care

24 Jan 2017

NSW Ambulance receives a call via Triple Zero that a Lalor Park man with a history of bipolar is behaving erratically and requires urgent assistance.

What happens next provides a snapshot of a new mental health unit operating in western Sydney – the first of its kind in NSW - that is making major inroads into the way patients are being assessed and treated. 

Mental health care 

Piloted in Western Sydney in December 2013 and transitioning to business as usual in October 2015, the Mental Health Acute Assessment Team (MHAAT) program is a joint initiative of NSW Ambulance and Western Sydney Local Health District’s Mental Health Services (WSLHD MHS)

Mental health patients requiring further care are normally transported by ambulance to the nearest hospital emergency department to await further assessment. 

On this occasion however, MHAAT, which comprises a NSW Ambulance paramedic and mental health nurse, attends the patient’s home.

The team provides a clinical assessment before deciding on the best course of care, be it contact with their GP, follow-up with a community mental health team, admission to a mental health facility or, in the case of medical issues or injury, transport to a hospital emergency department (ED).

It is determined the patient requires admission to a mental health facility. A call is placed to Bungarribee House at Blacktown and the patient is delivered immediately.

Cameron Clough, just one of the small team of paramedics rostered to staff MHAAT, said the case demonstrated the immense benefit of the unit.

“You can imagine the difference to the wellbeing of the patient who was able to bypass the hospital ED. For some patients it’s just better for them to go to a mental health facility rather than delay that by taking them to the ED to get cleared medically,” he said.

Piloted in Western Sydney in December 2013 and transitioning to business as usual in October 2015, the MHAAT program is a joint initiative of NSW Ambulance and Western Sydney Local Health District’s Mental Health Services (WSLHD MHS)

Acting Superintendent Josh Atkins, Zone Manager Western Sydney, who led the project for NSW Ambulance, said since its inception the initiative, which is based at Parramatta Ambulance Station, had shown positive results.

He said since MHAAT transitioned to business as usual, the team had attended 1261 callouts and transported 579 patients. Of these patients, 287 – or 49.6 per cent – had bypassed emergency departments, in favour of more appropriate care pathways.

“While the treatment and care of patients is uppermost, there is the added benefit of reducing the pressure on our local emergency departments,” he said.

Paramedic Clough said the MHAAT pairing of a mental health nurse and paramedic worked well. “Paramedics do a medical assessment and, where applicable, schedule the patient under the Mental Health Act. The nurses offer a lot more options for care and so much more experience and knowledge,” he said.

Shobna Chandra, WSLHD MHS Acting Clinical Nurse Consultant who also staffs the unit, said she had witnessed noticeable results, particularly for patients whose conditions did not relate to drug and alcohol abuse.

“They have a real mental health problem and sending them to emergency will not help the way they’re feeling. It’s all about not traumatising them further; making sure the journey of seeking help is a good transition,” she said.

Paramedic Clough said the unit also worked in conjunction with NSW Police. “They will also call us and we can help them make the decision. A lot of times they will call us to take a patient and we’ll determine they seem OK and we’ll look at other options,” he said.

He said the team had come to know some patients well and a level of trust had been established as a result.

“Normally these patients are vulnerable; they’ve seen us regularly so they know we’re going to help them and take them to the right place,” he said.

Inspector Kevin McSweeney, Duty Operations Manager Western Sydney, described MHAAT as a great initiative, not only for the specialist care provided to patients, but the flow-on educational affect for paramedics.

“There’s a fair bit to learn about mental health and more and more paramedics are showing an interest in working in the MHAAT car to assist their clinical knowledge, or they are speaking with the paramedics who are working it, asking their advice and getting a second opinion,” he said.

“Of course, it’s reliant on WSLHD MHS and NSW Ambulance working together and that partnership has proved extremely successful.”