In safe hands: Caring for the mentally ill

ER24 paramedics are frequently called to assist in mental health cases, known as “behavioural emergencies”. Ryan Wills, Training Manager: Emergency Medical Care Mediclinic, says this kind of emergency can stem from a number of causes, including a lapse in management of a chronic mental illness or a psychotic episode brought on by factors such as drug use.

“There is a broad spectrum of mental illness and we’re generally called when the patient is a danger to themselves or others,” he explains. “This can be anything from suicidal ideation to a manic episode or violent psychosis. Often a family member will call if they notice a decline and possible relapse in the person’s mental health or a sudden acute episode of mental illness.”

Nduduzo Vilakazi, an ER24 Counsellor, says paramedics need to be aware of four scenarios when they suspect mental ill health – and know how to respond to each one:

Cognitive effect. Is the patient mentally sound, or are they repeating themselves, zoning out, or speaking incoherently? Try to follow their thought pattern and don’t interrupt as they might start realising they’re sounding unwell. Ask: Are you okay? Are you thinking about something in particular? Is there something specific I can help you with?

Emotional effect. This can include anything from anger and crying, to despondency and hopelessness. “Even silence is a statement,” Vilakazi says. “It tells us something unusual is going on.” Ask: How are you feeling? Is there a specific incident or tragedy that has made you feel this way? 

Behavioural effect. Some patients may change from being talkative and hyperactive to sad and silent. If a patient snaps for no reason, or displays sudden changes in behaviour, they could be dealing with something internally. Ask: Have you noticed you’ve been doing things differently recently? Have you noticed you are more tired, irritable, sad recently? In what way has your behaviour changed over the last while?

Physical effect. Unexplained headaches, chest pains and random body pains could suggest they’re dealing with some trauma or negative emotional experience they’re not processing. Ask: How can I help? If there is no obvious medical cause for their physical discomfort, bear in mind that neck pain, chest pains and lower back pain might indicate tension, anxiety, or a panic attack. 

“Patients might only display one of the signs above – or a combination of them,” Vilakazi says. “Once paramedics are aware of what they’re dealing with, they’re likely to be more empathetic. Taking the time to try and understand what the patient is experiencing will help rather than hurt. It’s difficult because paramedics don’t always have the luxury of time – they’re primed to respond fast to medical emergencies. But talking and understanding can go a long way towards helping a patient who is mentally unwell.”

Wills says ER24’s role is typically to make sure the patient and others in the vicinity are safe – to advocate in the patient’s best interests. “We don’t diagnose on the scene, and we can’t by law force the patient to go anywhere against their will except in very specific defined situations,” he explains. “We try to build a rapport, and should it be in their best interest, facilitate their transport to be seen by a mental healthcare professional.”

He adds that if the patient is unwilling to be admitted to a psychiatric facility and the ER24 responders deem it necessary, they’re able to contact the police, who can lawfully restrain the patient and assist in a transfer to hospital. “If the patient is too violent and disturbed, we may need to sedate them before transporting them to hospital, but this is deemed a last resort when all other methods to manage the patient have failed,” he says. “Once there, the patient will be placed under 72-hour observation by a medical officer, who will evaluate their case and refer them to the appropriate mental health professional for further treatment if necessary.”

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