My colleagues in green seem a bit upset and not for the first time; my Twitter notifications are full of indignation and frustration. The Home Secretary delivered her annual speech to the Police Federation Conference earlier today and spoke for longer than ever before on policing and mental health issues – this in itself is very welcome, incidentally!!
During the speech, in an attempt to reassure the officers present that she was working to minimise the impact upon them, she stated:
“Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness – nor are you meant to be social workers or ambulance drivers.”
I’m well aware of social workers who object to the description of non-crime related police activity as “social work” and I just knew that the term “ambulance driver” was going to lead us somewhere we didn’t want to be. It reminded me of the time another parent at my son’s school asked my wife if she was pregnant when she wasn’t … the world almost came to an end!! The dog and I were immediately placed on diets and we can all understand why our pre-hospital, life-saving superheroes felt well put-out today –
PARAMEDICS
Ella SHAW, author of the Ambulance Blog, has already written to Theresa MAY protesting the use of the term and pointing out the training that has to be undertaken to qualify as a Paramedic. Ella is not the first to point out to me today, that “Paramedic” is a legally protected term which we are all prohibited from using unless we have undertaken the requisite qualifications and registered with the Health & Care Professionals Council. We see the increasing promotion of the role with the College of Paramedics pushing professionalism and the importance of the inter-relationship between the police and the ambulance service is something I’m investing time in building, both on this blog and in operational life.
But for me, the term “Ambulance Driver” indicates a deeper point about the debate we’re trying to have about policing and mental health when we’re asking for the ambulance service to play a greater role, as the Adebowale Report suggested it should. If the only important point about the transportation of someone who has been detained by the police was the important-enough issue of patient dignity, I could actually just call a taxi.
But that’s missing the point.
I don’t just want paramedics next to me after the police detain someone under the Mental Health Act because of the big yellow truck and the implicit status of “patient” that it immediately affords the person I’ve detained: I want a paramedic next to me because they are highly trained healthcare professionals who have a mass of knowledge and kit that I simply do not have. They can help me establish whether my instinct to suspect a mental disorder is roughly on track; or – as with a real case in my force area – they could tell us that despite honest efforts, we got it utterly wrong and had detained someone with diabetes. Incidentally, I was very glad they were there to tell us how wrong we got it because the bloke collapsed in the ambulance shortly after the blood sugar test and was rushed to A&E in the big yellow truck. The consultant told us that this action could well have saved his life – it certainly averted serious medical problems.
Medical conditions that officers could confuse with mental ill-health are very numerous – a stroke or a heart attack, epilepsy or Addision’s disease (which can lead to psychosis of a particular kind.) The list goes on … examples exist of paramedics pointing out to mental health professionals that someone being sectioned after what was thought to be a serious case of post-natal depression actually needed to go to A&E to have unusual physical symptoms checked out. It emerged they had a brain tumor and required emergency surgery.
And even where police officers were absolutely spot on, mental ill-health can also amount to a medical emergency –
Paramedics in any situation when police officers are having to engage in high-intensity instances of restraint to keep people safe are crucial – both in terms of the prevention of medical problems and in reaction to them. We know that the need for ongoing restraint is under-recognised as the medical emergency it is; and I don’t want a medical emergency of any kind in the back of my police car on in my custody block. I want trained, professionals with drugs, kit and competence to keep the patient in good medical nick, whilst I try to keep everybody safe in terms of personal security.
#999FAMILY
I once drove an ambulance car – when I was a sergeant, a first-responder paramedic jumped into a police vehicle with some green bags along with two of my officers and the patient we had detained. Driving that vehicle to A&E so he wasn’t stranded after delivering the patient into urgent care didn’t make me a paramedic any more than him being in the police van rendered him an attested constable who should go and deal with a riot.
These two 999 services overlap more than people realise – we share ‘customers’ on so many occasions and paramedics do deal with situations involving crime and risk. They don’t distance themselves from this any more than we should believe it’s possible to prevent mental health demand coming our way or the occasional need to administer first-aid. We’ve seen ambulance services issuing stab-vests, because they recognise that some paramedic work is risky business. However, when a certain level of risk presents and they assess it as too high, they seek police support because we know how to manage violence and risk. If having done so, we find violence and risk with a clinical undercurrent, we need them back in the situation supporting our intervention and vice versa.
Every frontline cop and every frontline paramedic gets this: our affection for them is shown in every reminder we issue that they are the second best emergency service(!) and it’s why you see hashtags on Twitter like #999family.
You need more qualifications and training to be a paramedic than you do to be a police officer (or for that matter a politician!) – it’s why every police officer knows that our colleagues in green are far more than “Ambulance Drivers”.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2013
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 
What training in mental health do paramedics receive?
We don’t get enough training to be honest. But as MentalHealthCop pointed out, we get FAR more training in recognising other conditions such as low blood sugars, strokes etc. We can help rule out the life threatening and treat if found.
I feel both us Paramedics and our friends walking the ever thinner blue line don’t get enough to deal with mental health. But by working in partnership we will always try and do the best for our patients.
I ask because I volunteer for SJA and trained as an ETA (one step down from tech but people at my level regularly provide an emergency service for the local ambulance trust) the only MH training we had was about conveying under the MHA – last year the trainer was still referring to ASWs – and vague deescalation skills for intoxicated/mh patients.
I am confident to a degree about providing medical support for most physical health problems but in essence my role is around getting to a qualified professional.
I wear green!
I am studying BSc Paramedic Science at Canterbury Christ Church. We have a 5 week complex practice module in our third year studying paediatric, maternity and mental health pre-hospital treatment. Additionally, the treatment of those with mental health issues is a regular reference throughout the course, with a good knowledge of the legal aspects of treatment as well as the clinical. There are a number of workshops run by or attended by mental health service users of local trusts throughout the degree.
Well said, working in the ambulance service myself I see many of the challenges you’re talking about on a daily basis! It’s great to see a publication like this being publically accessible! I’m running a series of blogs on mental health in awareness for mental health week so can really relate to this! Well done!
In a recent experience with a manic friend in a crisis situation I was asked by emergency services if my friend might need sectioning and would an ambulance be required. We were able to enough information for them to provide one.
The police and paramedics were excellent in managing the situation.
Whilst some paramedics complain, in reality fully qualified paramedics make up only a proportion of the ambulance service workforce.
There are technicians (being passed out in many but not all areas to save money) and care assistants (who are replacing them at lower cost).
The current structure is such that there isn’t a catch all term for “all people who wear green and show up in an ambulance”.
Ambulance CREW??? As a Paramedic who takes my job and responsibilities very seriously and who works hard to keep my skills up to date with all the new advances, I do resent being called a driver with it’s connotations of being an unskilled job that anyone could do, and think ‘crew’ as a catch-all term for people in green is much more appropriate!
It.s kind of sad really, because no matter how much we are trained & to the extent of qualifications we have as Health Care Professionals, we will always be Ambulance Drivers to the, media, public, the government & our employers. Unless, of course we are being disciplined & then we will be reminded of our Professional Status, which does not seem to come up when negotiating our salaries. Funny that.
I don’t think that by saying police were being used as ‘ambulance drivers’ she was using doing paramedics a disservice.
I’m a police officer, I don’t think my 1 day first aid course every year or so or zero training in mental health qualifies me to be a paramedic. However all to often our partner agencies (social workers, gp’s, ambulance control) are calling me to attend to people in mental health crisis. As stated before I’m not a paramedic so my only option is to wait hours for a qualified person or take this person to hospital; so I’m an ambulance driver, another phrase could be taxi driver.
It really does pain me to defend Theresa May though!
I think this is casual language – it’s like when Tom WINSOR said some officers were “barely literate.” It was, quite simply, never going to go down well with the broad group of people to whom the language relates.
It is casual you’re right however I think having this argument detracts from the point she was trying to make which is a police officer with 1 daya year first aid and ncalt mental health training is regularly being called to attend to persons in crisis by our ‘partners’and are then transporting them to hospital in the cage of my transit van because I can’t get a highly skilled paramedic colleague to help because they don’t have capacity. As I said taxi would be a better word.
The system is broken from the top down, it’s not just down to a lack of paramedics, a lot of people would never get to the point of crisis if there was better community mental health services or out of hours emergency care.
Don’t forget Ambulance technicians and ECAs – we are out there on ambulances dealing with these patients too. The ambulance service isn’t staffed solely by Paramedics!
Well said Matt
I think most people are missing the point here? no matter what the home secretary has said it does not detract from the fact that Police Officers and Ambulance Staff alike do not receive sufficient training to adequately deal with people suffering from a mental health issue in the acute setting. Ambulance staff are given a small insight into the legalities of transporting people detained under the mental health act! they have no specific training in the conditions that lead to this but are still expected to deal with them? this they do on a daily basis to the best of their skills and knowledge as do our police colleagues! this they do because at what ever level they are ECA, Tech or Paramedic they are professionals and work with the interests of the patient in the forefront of their actions.
I think most people are missing the point here? no matter what the home secretary has said it does not detract from the fact that Police Officers and Ambulance Staff alike do not receive sufficient training to adequately deal with people suffering from a mental health issue in the acute setting. Ambulance staff are given a small insight into the legalities of transporting people detained under the mental health act! they have no specific training in the conditions that lead to this but are still expected to deal with them? this they do on a daily basis to the best of their skills and knowledge as do our police colleagues! this they do because at what ever level they are ECA, Tech or Paramedic they are professionals and work with the interests of the patient in the forefront of their actions.
This.
Training, communication and engagement.
Excellent blog btw.
I’m not sure it does miss the point – the points were:
1. What the Home Secretary said, as liable to cause consternation.
2. The importance of paramedic and proper clinical triage.
Training, or lack of, is a topic of discussion – it just wasn’t the one that this post focussed on!
This is partially wrong. I’m studying BSc Paramedic Science. We have a 5 week complex care module about acute treatment of paediatric, maternity and mental health patients in our third year as well as numerous workshops with mental health service users throughout the degree. Not all paramedics on the road are graduate paramedics therefore you would be right in saying some don’t have the training. But some of us do!
Interesting! – first example I’ve come across and I’m glad to hear it, although some of my networking ahead of making the statement was with student paramedics in university courses. Obviously regional differences apply – very apt ahead of a career in the NHS! 🙂
“The system is broken from the top down, it’s not just down to a lack of paramedics, a lot of people would never get to the point of crisis if there was better community mental health services or out of hours emergency care.”
Well said!!
Paramedics in the UK are fast approaching an al degree profession. Most education is. and have been unviersity based for atleast the past 10 years. A standard which is atleast on par with other professional groups and in many cases exceeds..
Thank you for sharing your views, as part of the ever thinning blue/green line I see every day how we manage together to resolve very difficult situations between us. Fortunately for them the vast majority of the public and politicians will never have to face ( and remember ) what we do.
I’m a paramedic. My title does not matter. The patients outcome does. Just my opinion.
An yet you define your social media identity around paramedic and not any other term? Can only suggest, based on the comments in response to this post across social media and the sheer volume of interest it has provoked, that you are in a definite minority.
A lot of talk about mental health and the lack of training. The ambulance service is meant to be an ‘Emergency’ service, not a Mental Health Team, the name of the side of the trucks is a bit of a give away! Unless those patients have done something life threatening like overdoesed or severely cut themselves then it’s not an emergency and should be dealt with by Mental health workers. Ambulances today respond to far to many incidents that to do not require or deserve an ambulance! Today’s ‘nanny state’ need a long hard look at themselves and if it was my decision I would allow the call takers to tell them….NO, YOUR NOT GETTING AN AMBULANCE!
And as long as you start doing that for all the other punters ringing up who don’t have an emergency, then we’d have to say fair enough! But if you continue to service the feckless whilst also adopting attitudes towards only those in crisis, you’re just reinforcing discrimination.
And it shouldn’t need a policeman to point out to a paramedic that legitimate life-threatening mental health emergencies go way beyond overdose and serious self-harm.
The ‘your not getting an ambulance’ comment was aimed at every unsuitable call, not just mental health e.g today alone….cramp in feet and headache, were 2 examples!!
I’m not saying mental health emergencies don’t extend past overdoses and self harm but as fair as ambulance service response, then yes I think it does. We’re not mental Heath workers and 9/10 times A&E isn’t suitable for them. No, it’s not ‘a place of safety’ for either them or other members of the public waiting to be seen. In their time of need, in their ’emergency’ they need a professional mental health worker that can actually help them through their crisis!
What if several things you’ve just assumed and claimed were wrong, either objectively or subjectively? What if … just consider that.
What if I won the lottery, what if the next world war started…what if, what if.
Not really a valid argument for anything.
The fact is, someone who just has a headache doesn’t need an ambulance. The fact is someone who has cramp in their feet doesn’t need an ambulance. Someone who is having a mental health crisis needs and mental health support worker and not A&E. Would you send a Mental health worker to a cardiac arreset or RTC with severe trauma?
Mental Health jobs are tedious, they pull our already thin lines ever thinner and it is not ours or the polices fault. Calling me an ambulance driver is an insult, shows a lack of understanding of one of the root causes why the NHS, the ambulance service, the police and the judiciary are in the state they are and, making matters worse, all four mentioned services have an over the norm exposure to people, humans with mental health problems yet this and several governments before them have consistently diminished the provision of mental health services.