National safety priorities in mental health: a national plan for reducing harm

Safe transport of people experiencing mental disorders

Page last updated: October 2005

Rationale

A range of agencies have statutory or service responsibility for providing transport of people experiencing mental disorders, or suspected of experiencing mental disorders. Arrangements vary across jurisdictions. Frequently transport of mental health consumers, when it is not provided by carers, families or consumers themselves, is organised and undertaken by community mental health professionals. Ambulance services, police services, air services, and occasionally private companies, may also play a role in transporting mental health consumers to treatment and assessment services. While generally the transport of mental health consumers by service providers is incident free, it is apparent that incidents are more likely to arise in mental health crisis situations.

Clearly mental health consumers have the right to safe transport that minimises interference with their rights, dignity and self-respect and that avoids traumatising family members, particularly children. This right, however, needs to be balanced with the safety of the transport provider.

In the consultation (refer appendix 4) transport providers indicated that transportation of people experiencing mental disorders is a high priority, both in terms of the safety of mental health consumers and the personal safety of staff and others. The use of restraint, including sedation, during transportation was also a high priority issue for transport providers.

Mental health consumers are frequently sedated and/or restrained by service providers during transportation. They may also experience significant stigma that adds to psychological distress and creates a negative perception of care.

A systems oriented approach to reducing adverse events and overly restrictive interventions during transportation is needed, along with a non-punitive culture that rewards incident reporting and supports its use in continuous quality improvement.

The least restrictive safe transport of people experiencing mental disorders cannot be achieved without considerable partnership activity between all services involved and processes that include consumer and carer participation. As many transport provider services are outside the governance structures of mental health services, developing strategies for improving safety needs to occur in consultation with the police services, ambulance services and other transport services.Top of page

Table 4: Safe transport of people experiencing mental disorders

Objectives

  • Mental health consumers are safe during transportation.
  • Staff involved in transportation are safe.
  • Reduced adverse events associated with transport of people experiencing mental disorders.
  • Clear policies and protocols to ensure that the least restrictive safe transport of people experiencing a mental illness are used.

Priority settings

  • Mental health services.
  • Ambulance services.
  • Air services, for example the Royal Flying Doctor Service.
  • Police services.
  • Other services, such as private contractors that provide transport of mental health consumers.

Known problem areas

  • Emergency transportation in mental health crisis situations.
  • Restraint use during transport.
  • Routine use of sedation during transportation regardless of circumstances.
  • Heavy sedation that requires consumers to be intubated is a major medical intervention that carries its own risks of adverse drug events.
  • Reliance on police to apprehend and transport consumers known to mental health services when alternative means are available.
  • Police transporting consumers without the support of clinical staff.
  • Adverse events associated with transport with or without restraint use, including adverse drug events.
  • Stigma experienced by consumers from emergency care providers.
  • Transport from within rural/ remote settings.
  • Timelines of transport between hospitals, particularly between private and public mental health services.Top of page

Strategies

  • Convene a cross-sector workshop to develop common direction in identifying best practice in the safe transport of people with mental illness.
  • Identify good practices and policies for the safe transport of people with mental disorders, in consultation with mental health consumers and carers, mental health services and emergency services, such as emergency departments and police, ambulance, air ambulance/ Royal Flying Doctor Service. Assessment/ review of the suitability and design of vehicles used in transportation, including air and road ambulance and police vehicles.
  • Best practices and innovations are identified and disseminated. This includes staff education and training being provided where required.
  • Monitor and report instances of incidents during transportation between services and use this information for quality improvement.
  • Identify good practice services/ leaders and facilitate their role in influencing clinical and service management change across the services that provide transport.
  • Mental health services develop protocols about working with other agencies and training staff in transporting mental health consumers.
  • Clarify legislative issues in existing and future protocols about working with emergency services.
  • Implement existing recommendations for joint information sharing protocols and practices in mental health crisis situations. 18 Ensure clear joint protocols and practices for sharing information in mental health crisis situations between mental health services and relevant emergency services are in place. 19
  • Develop mechanisms to improve skills, competence and confidence of mental health professionals in engaging with their consumers and carers.
  • Identify and/or develop models of transportation practice where mental health consumer or carer advocates/ representatives are involved in supporting mental health consumers and carers during, or prior to, transportation.
  • Evaluate changes in practice and outcomes.

Complementary/ linked strategies/ activities

  • Existing State/ Territory initiatives, such as the South Australian Policy on emergency transport of mental health consumers from country locations.

Footnotes

18 Recommendations regarding establishing such information sharing protocols can be found in - Expert Advisory Committee on Information Sharing in Mental Crisis Situations (2000) Toward a national approach to information sharing in mental health crisis situations, Commonwealth Department of Health and Aged Care, February 2000.
19 ibid.