28 January 2013

Rwanda: Spotlight On Mental Health Emergency Response Systems


FACT: 80 percent of people with mental disorders in developing countries do not receive any treatment.

A couple of weeks ago, I witnessed a sad sequence of events: a mid-30-year-old man fell into an epileptic seizure right in the middle of Rue Commerciale. Instead of passers-by rushing to pull out their phones to dial emergency response, the unconscious man had become a mid-afternoon spectacle. I quickly learned that everyone thought there was "no point" calling for an ambulance as it would take about an hour to get there; I was also stunned to see a local defence officer (maroon uniformed) brazenly walk by the still body of a man on a busy street!

I am yet to dial 112 to gauge how fast the response time is but twenty minutes at the scene was an eye-opener about a few things: first of all, for whatever reason, citizens don't have faith in the emergency response system, and secondly, some members of the law enforcement community need to revise their responsibility to citizens. Let it be clear that this is not a reflection on the entire enforcement community as I have witnessed policemen go out of their way to help people.

Determining the most appropriate way of responding to mental health crises in the community deserves attention in policy and legislation; I am not aware of what protocols are in place but improving the capacity of our first emergency system to respond to mental health crises, together with improvements in cooperation with health facilities is important in delivering a streamlined response to citizens with mental health problems who deserve access to timely, high quality care and support to live successfully in the community.

I am well aware that given our limited resources, our emergency preparedness and response capabilities are minimal. But I get the impression that mental health incidents (and their impact on society) are yet to weigh in as critical events, in the same way say, accidents, do. But a wide range of incidents related to mental health can pose risk to the patients or those around them such as suicide threats, violent behavior, and threatening harm to others, to mention but a few.

A dual police and mental health secondary response unit, for example, could be an effective model of care. Early intervention and assessment would reduce requirement for transportation to emergency departments (unless required of course, in which case the response time should be fast). This could be done by onsite clinical assessment or telephone advice on mental health referral options or even appropriate transport option: for example, the epilepsy patient could receive care on-site by a trained professional, or advice could be given to a Good Samaritan on the street as to how to take care of him.

This model would also allow for advice on de-escalation options (for threatening cases) and design of intervention strategies for first responders; it would also allow up-to-date electronic patient records to be kept in case of future incidents. At the end of the day, all we are looking for is improved patient outcomes. Let me note that the patient on the street was taken to CHUK Emergency Unit but a phone call still had to be made in order for him to receive medical attention in appropriate time.

This model could also be instrumental in providing support to family or caregivers of mental patients, for example following a loved one's suicide, or tragic incident as a direct result of their mental health. My two cents hardly cover all that is needed in this regard: that epileptic patient didn't deserve to lie on the street like that with no care. What do you think?

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