Access to health care for health care consumers with mental health needs : an emergency medical service perspective

Abstract

Background: Neuropsychiatric disorders (mental illness/mental disorders) rank third in their contribution to burden of disease in South Africa. The historical socio-political climate has created multiple socio-economic burdens such as mental illness, crime, poverty, trauma and inequality: all likely social determinants of mental illness. Mental health reforms were established with the Mental Health Care Act 17 of 2002 and included deinstitutionalisation and human rights awareness. However, insufficient compensatory community mental health care services prevail. This increase in mental illness and exacerbated poor mental health provides challenges for prehospital Emergency Medical Service (EMS) care and transportation of health care consumers with mental health emergencies or needs. The South African prehospital mental illness milieu provides for a theoretical lacuna. The EMS, as a component of the health sector, should be considered in championing the human rights prerogative in mental health care. This study sought to appraise and strengthen access to health care for health care consumers who presented to a public EMS with mental health needs and to promote interventions for ameliorating human rights. Methods: The methodology followed a quantitative retrospective descriptive study design, through the paradigmatic lens of critical theory. A census of three years of Emergency Medical Service Incident Management Records from an EMS district was undertaken using an original data collection instrument. Data analysis was done with R Statistical Software, using Logistic regression models, Pearson’s Chi-squared tests of association, Fisher’s Exact test, ANOVA and Tukey’s post hoc method to find associations. Findings: Among the 2976 (N) Incident Management Records that met the inclusion criteria, 39.6% (N=1178) were regarded as having a mental illness and 59.7% (N=1776) were regarded as having a mental health emergency. Deliberate self-harm and overdose or deliberate self-poisoning presented in the majority of the health care consumers, with overdose accounting for 52%. Attempted Suicide and Suicide accounted a combined 5.8% of the health care consumers. Suicide averaged 2.8 suicides per month in the Garden Route District over the 3-year period. Furthermore, age was not a valid predictor of attempted suicide, but a significant predictor for suicide, deliberate self-harm and overdose. The expected odds of a male attempting or committing suicide are more than two and five times respectively as high as odds of a female attempting suicide. Males are more likely than females to attempt or commit suicide. The expected odds of a female overdose or of deliberate self-harm are more than 2.8 and 2.4 times respectively as high as odds of a male overdose or deliberate self-harm. Females are more likely than males to deliberately self-harm and overdose. Males are more likely to use strangulation while females are more likely to use poisoning or overdose to commit suicide in the Garden Route District. Conclusions and Recommendations: Mental Illness and mental health emergencies had a myriad of presentations in the Garden Route District over the 3-year period. The ambulance service does use the service of South African Police Services for combative health care consumers, while providing access to health care for mental health care users. It is recommended that further research is done, with consideration of change towards Section 40 of the Mental Health Care Act 17 of 2002. Recommendations toward a specific prehospital mental health care protocol are provided.