What is it about?
Rural communities face unique challenges related to wellbeing and mental health, including difficulty accessing mental health services in regions with low population density, extreme mental health stigma, and limited education about mental health symptoms. During the COVID-19 pandemic, it was difficult for people in England to access mental health services, particularly in rural areas. At this time, ambulance use increased and the role of paramedics changed to include referring patients to mental health services. Our study involved analysing ambulance call ('999') data to better understand the impact of the pandemic on the mental health of people in rural England. We compared the clinical details of mental health emergencies attended by ambulances in regions classified as 'rural towns' and 'rural villages' during the first national lockdown in 2020 to data from the same period in 2019. We also compared mental health emergencies occurring in urban areas to those in rural areas. We found that mental health emergencies in rural areas are more likely to involve behavioural disturbance, suicidality and anxiety compared to in urban areas. Comparing data from during the pandemic to before the pandemic suggests that increased behavioural disturbance is likely to be an outcome of pandemic conditions like isolation. However, higher rates of suicidality in rural areas may reflect more persistent inequalities regardless of the pandemic.
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Why is it important?
Rural communities worldwide experience higher suicide rates than most urban areas. Suicidality and behavioural disturbance are particularly prolific among men and males who are also less likely to help-seek and access mental health services. In the aftermath of a global pandemic with myriad economic consequences, it is critically important to establish research methods that capture the needs of people in traditionally 'hard to reach' places like rural England. Ambulance data overcome many of the limitations of traditional health service data because people other than the patient tend to call '999' on behalf of those experiencing mental health emergencies. Ambulance records could be used more systematically to understand and address the needs of people in rural and remote locations in England and elsewhere. Mental health emergencies reflect the escalation of often manageable mental health symptoms and conditions. High rates of mental health emergencies suggest opportunities for improving care networks to prevent escalation and reduce health burden.
Perspectives
"Working with ambulance data has helped our team to identify vulnerable regions and communities. We encourage other mental health researchers to consider using emergency medical data to better understand the experiences of vulnerable people who do not necessarily show up in health data related to scheduled health appointments." Dr Harriet Elizabeth Moore, University of Lincoln.
Harriet Moore
University of Lincoln
Read the Original
This page is a summary of: Exploring mental health emergencies attended by ambulances in rural England during the COVID-19 pandemic., Rural Mental Health, December 2023, American Psychological Association (APA),
DOI: 10.1037/rmh0000250.
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Resources
Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 "Lockdown" in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data
The widespread psychological effects of contagion mitigation measures associated with the novel coronavirus disease 2019 (COVID-19) are well known. Phases of "lockdown" have increased levels of anxiety and depression globally. Most research uses methods such as self-reporting that highlight the greater impact of the pandemic on the mental health of females. Emergency medical data from ambulance services may be a better reflection of male mental health. We use ambulance data to identify unusual clusters of high rates of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national "lockdown" and to explore factors that may explain clusters. Analysis of more than 5,000 cases of male mental health emergencies revealed 19 unusual spatial clusters. Binary logistic regression analysis (χ2 = 787.22, df = 20, p ≤ .001) identified 16 factors that explained clusters, including proximity to "healthy" features of the physical landscape, urban and rural dynamics, and socioeconomic condition. Our findings suggest that the factors underlying vulnerability of males to severe mental health conditions during "lockdown" vary within and between rural and urban spaces, and that the wider "hinterland" surrounding clusters influences the social and physical access of males to services that facilitate mental health support. Limitations on social engagement to mitigate effects of the pandemic are likely to continue. Our approach could inform delivery of emergency services and the development of community-level services to support vulnerable males during periods of social isolation.
Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies Attended by Ambulances During the First National “Lockdown” in the East Midlands of the United Kingdom
The novel coronavirus disease 2019 (COVID-19) pandemic and associated mitigation strategies such as “lockdown” are having widespread adverse psychological effects, including increased levels of anxiety and depression. Most research using self-reported data highlights the pandemic’s impact on the psychological well-being of females, whereas data for mental health emergency presentations may reflect the impact on male mental health more accurately. We analyzed records of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national “lockdown.” We computed two binary logistic regression models to (a) compare male mental health emergencies occurring during “lockdown,” 2020 (5,779) with those occurring in the same period in 2019 (N = 4,744) and (b) compare male (N = 5,779) and female (N = 7,695) mental health emergencies occurring during “lockdown.” Comparisons considered the characteristics of mental health emergencies recorded by ambulance clinicians (Primary Impressions), and the socioeconomic characteristics of communities where emergencies use the Index of Multiple Deprivation. We found that during “lockdown,” male emergencies were more likely to involve acute anxiety (odds ratio [OR]: 1.42) and less likely to involve intentional drug overdose (OR: 0.86) or attempted suicide (OR: 0.71) compared with 2019. Compared with females, male emergencies were more likely to involve acute behavioral disturbance (OR: 1.99) and less likely to involve anxiety (OR: 0.67), attempted suicide (OR: 0.83), or intentional drug overdose (OR: 0.76). Compared with 2019, and compared with females, males experiencing mental health emergencies during “lockdown” were more likely to present in areas of high deprivation. Understanding the presentation of male mental health emergencies could inform improved patient care pathways.
Mental health emergencies and COVID-19: the impact of 'lockdown' in the East Midlands of the UK
Background The most immediate response of the research community to COVID-19 has been a focus on understanding the effects, treatment and prevention of infection. Of equal and ongoing importance is elucidating the impact of mitigation measures, such as lockdown, on the well-being of societies. Research about mental health and lockdown in the UK has predominately involved large surveys that are likely to encounter self-selection bias. Further, self-reporting does not constitute a clinical judgement. Aims To (a) compare the age, gender and ethnicity of patients experiencing mental health emergencies prior compared with during lockdown, (b) determine whether the nature of mental health emergencies has changed during compared with before lockdown, (c) explore the utility of emergency medical service data for identifying vulnerability to mental health emergencies in real time during a pandemic. Method A total of 32 401 clinical records of ambulance paramedics attending mental health emergencies in the East Midlands of the UK between 23 March and 31 July 2020 and the same period in 2019 were analysed using binary logistic regression. Results People of younger age, male gender and South Asian and Black ethnicity are particularly vulnerable to acute mental health conditions during lockdown. Patients with acute cases of anxiety have increased during lockdown whereas suicide and intentional drug overdose have decreased. Conclusions Self-reported data may underrepresent the true impact of lockdown on male mental health and ethnic minority groups. Emergency medical data can be used to identify vulnerable communities in the context of the extraordinary circumstances surrounding the current pandemic, as well as under more ordinary circumstances.
Exploring mental health emergencies attended by ambulances in rural England during the COVID-19 pandemic.
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