Since then, this team has grown to just over 23 full time equivalent (FTE) staff, working 24/7, providing specialist information, advice, and assistance to people who call Triple Zero (000) in a mental health crisis.
The MHLS provides the QAS with a platform for an integrated and dynamic response to people experiencing a mental health crisis, ensuring quality and timely mental health care and effective and efficient use of resources.
The MHLS can provide direct clinical support via telehealth to people experiencing a mental health crisis including:
- gathering pertinent information from informants, carers, or service providers.
- de-escalation of high expressed emotions.
- information and psycho education regarding symptom management; and
- information and advice around appropriate referral options.
The team, which is part of the Vulnerable Persons Unit, works closely with our Emergency Medical Dispatchers (EMDs) statewide; Clinical Hub Clinicians; supervisors, managers, and paramedics to support dispatch and clinical decision making.
It also plays a key safety role, providing important advice to our responders, identifying any safety risks not just for people experiencing a mental health crisis, but also those around them.
Over the last month the team has on average:
- Reviewed 320 jobs per day.
- Provided advice to more than 40 QAS responders a day via the Consult Line.
- Cancelled 35 jobs per day, after making contact with scene and safety planning.
- Identified additional risks and upgraded 42 jobs per day.
- Made 170 calls per day to patients/informants/carers/support workers/case managers.
QAS Insight’s Caroline Page spent a day sitting with Senior Mental Health Clinicians Luke Carlyle, Catherine Hoge and Emily Cloumassis, to find out more about what the team does…
There’s a group of extraordinary professionals sitting in the Queensland Ambulance Service’s Kedron Park Operations Centre who are largely unknown, but their influence on our patients and staff since the team’s inception has been enormous.
QAS’s Vulnerable Person’s Unit Clinical Manager Steve MacIntyre said he was immensely proud of the MHLS team which was developed to ensure people experiencing a mental health crisis were responded to in a timely and appropriate way.
“Our Senior Mental Health Clinicians (SMHC) bring a wealth of knowledge and experience to QAS, with most holding nursing and post graduate mental health degrees, or social work or psychology qualifications.” Steve said.
“This is the busiest team I’ve ever worked in.
“I’m proud to say we have a direct impact on Queenslanders experiencing a mental health crisis – we save lives every day – whether it’s by keeping a Triple Zero (000) caller talking to us until paramedics arrive, or by getting help to them sooner.”
Steve said the SMHCs review all of QAS’s mental health coded calls for service and have the autonomy to upgrade or downgrade their codes.
The clinicians also return Triple Zero (000) calls either directly with the person experiencing a mental health crisis, their carer, or bystander, to check on them while they wait for a crew, and to collect more information about their situation or medical history.
In the direst circumstances, team members will keep their patients on the line, talking with them to keep them safe until help arrives.
SMHC Luke Carlyle said the team’s specialist knowledge and understanding of mental health symptoms, diagnoses, treatment, and medications, makes it unique within the QAS.
It’s also the only team in the organisation which can access important patient information from the Consumer Integrated Mental Health and Addiction (CIMHA) database, including mental health history (or lack of), medication, previous treatments.
This access also ensures our teams can flag potential patient or responder safety risks, including any triggers, history of aggressive or escalating behaviours, or environmental risks, enabling them to stage crews until Queensland Police Service (QPS) teams arrive.
The SMHCs can feed this information through to our on-road teams using The Viewer and CAD, ultimately, improving our patient understanding, care and safety.
During my day sitting with the team, I listened in on the calls Luke took and made and the occasional team brains trust sessions they’d call their “WWYDs” (what would you do).
During the quieter moments, Luke, Catherine and Emily explained how they support some of the state’s most vulnerable people and our teams.
Luke said paramedic awareness of access to the MHLS team for advice about their patients is growing and recommended staff call either before they arrive on scene, or while they’re assessing them rather than after they’ve left them.
“We can provide additional patient background information or advice, and paramedics will also often call us querying the possibility of obtaining an Emergency Examination Authority (EEA),” Luke said.
An EEA is a legal mechanism which allows a person to be taken to hospital for examination without their consent if they’re at risk of serious harm, particularly if their behaviour indicates a disturbance in their mental capacity to make good decisioin for themselves.
This can be due to illness, disability, injury or intoxication.
Luke said the calls I’d listened to while I saw with him represented a “pretty standard day”, with caller demand remaining consistently heavy.
“A challenge we have is keeping up with the demand, and it’s not uncommon for us all to be dealing with several cases at the same time,” Luke said.
Some of these calls included:
- A mother worried about her homeless son who had an acquired brain injury and who’d been camping in her backyard with his dogs. She reported he had blisters all over his feet and had trouble walking, appeared delusional and was mumbling to himself, and he’d had a history of suicidal thoughts.
- A QAS paramedic assessing this patient (above), who called the Consult wanting more information and advice to ensure he received the right care. The paramedic also checked whether this patient would meet the EAA criteria.
- A mother worried about the health and safety of both her teenage daughter and her grandfather. Her daughter had been diagnosed with ADHD and ASD and was having a meltdown at her grandfather’s house. Her daughter had a history of being destructive during these episodes.
- A carer worried about a patient who suffered severe anxiety who had fallen, injured her hip and had been lying on the couch for days. A CIMHA search revealed the patient also required regular bipolar medication which the carer didn’t mention, which if it was missed, could affect both her behaviour and treatment.|
- A Queensland Health case manager reporting welfare concerns for their patient who’d been diagnosed with treatment-resistant schizophrenia, who was suicidal and had removed themselves to a basement carpark. After checking this person’s mental health history using CIMHA, Luke upgraded the QAS response to a Code 1C.
- A paramedic attached to the above job, wanting more background information on the patient and instructions on how to find them. Luke discussed their medication history and its special requirements before providing the case manager’s contact details to help the team locate them.
- A school worried about a student experiencing a mental health crisis who had a history of suicide attempts, and had spent time in hospital last year as a result.
- An aged care facility seeking service for two of its residents after one attacked the other, attempting to strangle them.
Luke, Catherine and Emily all have mental health nursing backgrounds but have worked across different fields.
Emily said the team’s diverse background in mental health brought a significant knowledge bank to the service.
“We’ve worked with children, in drug and alcohol teams, in eating disorders, and acute care assessment teams, and together we know what to look for in terms of risk assessment for people experiencing all different kinds of mental health crises,” said Emily.
“We can bring knowledge and experience of these niche areas of mental health that QAS otherwise wouldn’t have had and that paramedics likely haven't had any significant training in.
“Prior to the MHLS being implemented, the QAS didn't have the option of a mental health clinician who’d speak directly with the patient or informant, or the ability to conduct a thorough risk assessment.
“By doing this, we can ensure paramedic and patient safety is at the forefront of these jobs, hopefully resulting in better outcomes for our patients and frontline staff.”
Luke has worked extensively with patients with eating disorders and harnesses his professional skills and knowledge to ensure these people receive the right treatment and follow-up if needed.
“I feel this population has the potential to fall through the gaps,” Luke said.
“These disorders are extremely complex, and these patients are extremely vulnerable and risky given the mortality associated with eating disorders.”
Catherine has an acute mental health nursing background.
“I spent 17 years at The Prince Charles Hospital in various mental health roles and spent a long time on the acute in-patient wards which was very rewarding.
“I also spent quite a while with the Acute Care Team (mental health assessments), Community Case Management, and as a Student Facilitator, which I thoroughly enjoyed.
“As a nurse, I have a good all-round knowledge of health care but specifically with mental health nursing, I have a great understanding of treatments from medication knowledge to psychological and social interventions, along with drug and alcohol treatments, and the legalities of the Mental Health Act.
“Our team’s ability to access to the state’s mental health database which usually contains an MSE (Mental Status Examination) means we can review a patient’s physical and mental presentation and it’s been really valuable to our service.
“It can paint a picture of the accepted base line for a patient, and it allows QAS to base important clinical decisions around this, for example, to transport a patient to hospital when they don’t want to go, might mean having to sedate them (chemically restrain by intra-muscular injection), to facilitate safe transport.
“This option isn’t taken lightly and comes with considerable risk to both the patient and QAS staff.
“It might be that a patient is psychotic at baseline and was assessed a week ago with the same presentation the paramedics currently on scene are facing.
“This MSE, which our paramedics don’t have access to, allows us some insight into a reasonable threshold for transporting a patient against their will.”
Luke, Catherine and Emily are all passionate about their roles and are proud of what the MHLS achieves each day.
“Everyone on this team has saved a life – and that’s definitely a big win,” Catherine said.
“Little, but important wins, are when you’re dealing with someone (who may not have even called for themselves), who is upset or distressed, but don’t need to go to hospital, and you can have a good chat with them, hear and understand what is happening for them and support them to problem solve.
“Sometimes, our patients really appreciate it when you add a Co-Responder for that extra face-to-face support, and when someone says ‘thank-you’ for this help, you know they’re genuine.”
Emily said she always feels a small win when she sees a patient have a really good outcome they might not have had if the MHLS hadn’t been involved.
“For example, if a paramedic was planning to take a patient to hospital and we can formulate a plan with them which allows the patient to safely stay at home or find an alternative to taking them to a hospital’s Emergency Department,” Emily said.
“Or conversely, where a paramedic had planned to leave a patient at home, but after we’ve assessed and identified their patient as being quite unwell or at high risk due to a mental health concern and then advocated for them to go to hospital.
“Quite often when you follow up on these patients, you can see they've been admitted to hospital and are getting the treatment they need – this is a win for everyone.”
Luke said one win which has stayed with him for a long time was when a teenager’s friend had called Triple Zero (000) worried about her as she’d been threatening suicide.
“I couldn’t make contact with her and therefore I assumed she was suicidal and alone and upgraded the job to a lights and sirens response – a Code 1A,” Luke said.
“This resulted in an extremely fast QAS response, and it turned out the teenager had attempted suicide and when our team arrived, she wasn’t breathing and had no pulse.
“The paramedics started cardiopulmonary resuscitation (CPR) and obtained return of spontaneous circulation (ROSC), and she made a full recovery.
“I think this is another good example of how the work we do supports our paramedics to save lives.”
Last year, Queensland's Mental Health Commissioner Ivan Frkovic met with QAS Mental Health Director Sandra Garner and Vulnerable Persons Unit Clinical Director Steve MacIntyre before touring the Kedron Operations Centre and meeting the MHLS team.