Using data to understand the needs of frequent 000 callers with mental illness
By identifying these people early, the researchers hope that healthcare systems can respond in ways that better support the acute and unmet mental health needs of this patient group.
One in every four people who are attended by paramedics for mental health-related presentations are doing so repeatedly, in some cases up to 20 times in a year.
Described by researchers as “frequent presenters” and defined as having 5 to 39 ambulance attendances per year, people in this group comprise up to 23% of those receiving care from paramedics. They also contribute to up to 40% of total ambulance transports.
By developing a robust method to predict who may frequently need an ambulance, researchers from Monash University and Turning Point hope that healthcare systems can respond in ways that better support their mental health needs.
“If we can identify these people early and respond in ways that better support their acute and unmet mental health needs, their long-term health outcomes could improve, and some of the pressure on healthcare organisations could also be eased,” says psychiatrist Dr Anthony Hew, the study’s lead researcher.
Given that ambulance attendances in Australia are increasing, with the greatest growth in demand occurring as a result of people with mental health and alcohol-and-other-drug issues, addressing this situation could also reduce the burden on ambulance services.
The human stories behind the numbers
Compared to non-frequent presenters, frequent presenters have greater odds of experiencing social disadvantage, experiencing homelessness and housing issues, and residing in areas of socioeconomic disadvantage.
“Frequent presenters also have greater odds of needing care as a result of self-harm, suicidal behaviour, substance use issues and psychosis,” Dr Hew explains.
“These combinations of vulnerabilities and complex needs highlight the need for broader, systems-based approaches to care for people with repeated mental health-related emergency presentations,” Dr Hew says.
For example, beyond clinical treatment, he says that opportunities exist for broader care approaches that address factors such as socioeconomic stability and provide access to secure housing.
Signs that other approaches are not working
The researchers found that compared to non-frequent presenters, frequent presenters have greater odds of needing care from paramedics after hours.
“This may be because the patients experience a build-up of issues and symptoms during the day but have not been able to access suitable care,” Dr Hew explains.
“Family or mental health workers might also become increasingly concerned during the day,” he adds. “This might lead to them calling emergency services after hours, after other attempts to support them have failed.”
“Health services could re-consider their opening times and allocation of available resources to better meet the mental health care needs of this group,” Dr Hew says.
Trajectories for people who frequently need care
As part of the study, the researchers explored the longer-term trajectories of frequent presenters.
Current research shows that only a minority of frequent presenters continue to need repeated attendances from emergency services beyond one year.
“Our research found that less than 56% of all frequent presenters to ambulance services remained a frequent presenter the following year and less than 27% remained a frequent presenter over three consecutive years,” Dr Hew explains.
“Together, these findings highlight how most people with frequent presentations have acute, rather than chronic patterns of care needs,” he says.
“Defining frequent presenters according to one-year periods may have limited value in clinical settings,” Dr Hew adds.
This is because services need to wait a year until people at risk can be identified. Only then can a targeted intervention be provided.
According to the researchers, alternative definitions of frequent presenters are needed to identify people at risk earlier.
“An example could be defining frequent presenters according to service use over one-month time periods which could allow for more timely clinical responses tailored to the dynamic nature of attendances by this group,” Dr Hew says.
He also recommends choosing a statistical method that is most closely aligned with the reasons and goals for identifying frequent presenters, with specific recommendations for a variety of different research and health settings described in the paper.
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