I have been privileged to work with the London Ambulance Service (LAS) since 2015. I am the current Consultant Nurse for Mental Health and am honoured to have been named Mental Health Nurse of the Year in the BJN Awards 2024.
Mental health calls account for at least 10% of our call volume, with patients or their relatives often dialing 999 during a crisis. When I first joined the service, mental health clinicians had recently been introduced into our Emergency Operations Centre, which is where 999 calls are taken. Introducing mental health clinicians into the service enabled patients calling 999 to receive enhanced assessments from mental health specialists, and provided crew advice to staff on the scene with patients.
A specialised response
Building on this success, I was eager to explore what a specialised face-to-face response for our patients might look like. In 2017, using quality improvement (QI) methodology, I began conducting test shifts with a paramedic colleague. We responded to mental health crisis calls as deemed appropriate by the ambulance dispatcher. Using plan-do-study-act (PDSA) cycles, we completed 10 test shifts and then presented our findings to the trust. Simultaneously, the trust was developing its next 5-year strategy, and mental health was identified as a ‘pioneer service’. This led to the creation of a pilot for a mental health joint response car.
Given the need for parity of esteem and the fact that individuals living with chronic mental illness can have a 15–20-year shorter life expectancy than those who do not, it was crucial to address both the physical and mental health of our patients. By developing a joint response car with both a paramedic and a mental health professional on board, I ensured we could effectively meet the patients’ mental and physical health needs. It was certainly a busy time, and I had the support of our operations colleagues who provided us with operational resources and paramedic staffing for the pilot.
This period of change brought both excitement and anxiety. Once all the appropriate governance was in place, the pilot launched. I made sure to be present during everyone's first shift to ensure they felt as supported as possible. The team really embraced this new way of working, and there was a great buzz of enthusiasm.
Benefits of the joint response car
On the first day of the pilot, I saw the benefit the car could bring. A patient who appeared anxious was actually experiencing a cardiac event and needed urgent transport to the hospital. This incident reiterated the need for both clinicians to work together, as diagnostic overshadowing can occur within this patient group.
After 6 months of the pilot, we completed an evaluation of the mental health joint response cars and found that these cars had a significantly lower conveyance rate to the hospital compared with a doublecrewed ambulance. This demonstrated that a multidisciplinary assessment approach helps ensure patients can avoid unnecessary trips to the emergency department and access the right care in the right place, the first time.
Building on the success of the pilot, the team expanded from one car to six cars to support winter resilience in 2019/2020. This was a massive undertaking in a short amount of time. I worked with various stakeholders, from mental health trusts to NHS England, to mobilise the rapid expansion. We adopted a workforce-sharing agreement with mental health providers to quickly recruit for the mental health posts and also recruited internal paramedics.
Shortly after the expansion, the COVID-19 pandemic hit. It was a time of great uncertainty. As the country shut down, the ambulance service and the wider NHS experienced unprecedented demand, making the cars more essential than ever. This resulted in the cars being continued while a further evaluation occurred. In the summer of 2020, we completed a further, more in-depth evaluation that covered patient experience, economic evaluation and a deep dive into patient care and outcomes. I am proud to say that we now have six mental health joint response cars (MHJRCs) in operation across the city and are now a fully commissioned service. The team has won an HSJ Patient Safety Award and a London region NHS Parliamentary Award and they couldn't have been prouder.
Setting up and developing the cars has definitely been the highlight of my career and one of the accomplishments of which I am proudest. It has been a significant undertaking, but we have built an outstanding team, and it has been humbling to watch our staff develop and grow. I regularly undertake clinical shifts on the MHJRCs, which is vital to maintaining my clinical skills and being a visible role model across the trust.
‘Setting up and developing the mental health joint response cars has definitely been the highlight of my career and one of the accomplishments of which I am proudest. It has been a significant undertaking, but we have built an outstanding team ’
Expanding the team and training
MHJRCs are just one aspect of my work within the service. In addition to providing expert advice on complaints, inquests, and patient safety incidents, I also help set the strategic direction for mental health care within the trust. I am currently in the process of expanding the team to enhance our telephone-based assessment service, and we are exploring advanced practice in mental health within the trust.
During my time at LAS, we have heavily focused on training and educating our workforce. A significant part of my role has been developing and rolling out training packages across the trust. This included launching a year-long programme of bimonthly training sessions, which more than 1500 staff attended. I still maintain some teaching commitments, allowing me to engage with staff in various teams within the trust, which I thoroughly enjoy. I am proud to say that I have co-authored two chapters in texts for paramedics and pre-hospital clinicians. It was a memorable moment when I received copies of the texts and saw that mental health and my work had been included.
A creative approach
Working as a specialist within the ambulance service has been immensely rewarding, particularly the ability to innovate and think creatively to develop and test new ways of working. Mental health has emerged as a significant area of focus within the ambulance service and I have been able to use my creativity to drive change.
There is a pressing need to address health inequalities within our society and I was able to work on a novel approach to meeting the needs of one a small cohort of patients, along with two colleagues. Our mental health paramedic lead, a critical care paramedic and clinical supervisor and I – joined forces to champion the healthcare needs of patients who engage in chemsex (the use of recreational drugs, usually methamphetamine, mephedrone, gammahydroxybutyrate (GHB) and gammabutyrolactone (GBL) during sex, predominantly by gay men). This demographic often faces overlooked health concerns due to the secretive nature of chemsex activities. In collaboration with an external organisation, we developed a discreet resource aimed at facilitating access to follow-up care for these individuals. On the back of this work we have spoken at various conferences and received positive feedback.
A team effort
As you can see, my role is varied and no day is the same. I am truly delighted to have received the award but it is important to acknowledge the team around me who have supported and encouraged and worked with me on this journey. When I look back over the past 9 years it is truly remarkable to see the changes that have been made. I send my thanks to all of them.