Frequent callers to UK ambulance services in the COVID-19 pandemic: managing mental health, social isolation and loneliness

Abstract

Objectives: Patients who frequently call ambulance services are a vulnerable yet heterogeneous population with unmet multiple and complex physical health, mental health and/or social care needs. In this article, we report the challenges that the COVID-19 pandemic has introduced for ambulance services across the UK when managing frequent callers, and reflect on how existing systems and practices are adapting to support changing patient needs.Methods: Data reported in this article comprise reflections from the frequent caller leads in each ambulance service in the UK. All data were provided between 23 April 2020 and 1 May 2020, shortly after the peak of the outbreak in the UK. A single anonymised case study is also reported to illustrate how the pandemic is affecting people’s circumstances and contributing to frequent caller behaviour.Results: Ambulance services are observing changes to the frequent caller population, with many new frequent callers due to health anxiety caused or exacerbated by the pandemic. Management of frequent callers is also changing, with multidisciplinary and multi-agency working becoming more challenging due to decreased access to external services, whether in social care or the community and voluntary sector, and the redeployment of ambulance service staff. There is also decreased face-to-face contact with frequent callers, meaning that opportunities to deliver person-centred care are reduced. However, the introduction or increased use of tele/video conferencing with other organisations has mitigated some of these challenges, and in some cases has improved engagement among external organisations.Conclusions: Health anxieties, lack of access to other health, social and community and voluntary sector services and exacerbations of social isolation and/or loneliness have reportedly contributed to changing behaviour among frequent callers. The COVID-19 pandemic has also affected how ambulance services have been able to manage frequent callers. Ambulance services should continue to engage with external organisations to aid the delivery of person-centred care, particularly organisations with experience in multiple complex needs such as mental health, social isolation and/or loneliness. Future research should examine the consequences of the pandemic for frequent users of ambulance services, and how these impact on the wider health and care community.

Defining a threshold above which an adult can be considered to frequently use ambulance services: a retrospective cross-sectional study of emergency calls to an ambulance service in England

“…It should be noted that the data were based on call disposition only, and the accuracy of these dispositions is unknown. The evidence base suggests that poor mental health is a significant contributing factor in frequent use of healthcare services ( Soril et al, 2016 ), and therefore the 8.4% of incidents identified as being psychiatric / suicide attempt, which is the only disposition related solely to mental health, is likely to be a large underestimate of the extent that poor mental health is contributing to frequent use, or the complex interaction that exists between the triad of physical health, mental health and social conditions ( Kuek et al, 2019 ; Scott et al, 2021 ; Søvsø et al, 2019 ; Urbanoski et al, 2018 ). Similarly, none of the dispositions are able to identify social conditions or wider determinants of health which are known to contribute to frequent use ( Agarwal et al, 2019 ; Kuek et al, 2019 ; Mahmuda et al, 2020 ).…”

“…Other countries where similar issues have been identified include -but are not limited to -Denmark (Søvsø et al, 2019) Netherlands (Maruster et al, 2021) and Singapore (Kuek et al, 2019). Furthermore, mental health, specifically anxiety, and social isolation were identified by emergency medical service providers in the United Kingdom to have been contributing factors in changes to frequent use during the early stages of the COVID-19 pandemic (Scott et al, 2021). Systematic reviews of frequent ambulance service use identified that there was no single standard definition internationally for adult (Scott et al, 2014b) or paediatric patients (Scott et al, 2022) and a recent commentary on the topic by Brown et al (2019) called for standardised definitions of frequent use of ambulance services.…”

“…Other countries where similar issues have been identified include, but are not limited to, Denmark ( Søvsø et al, 2019 ), Netherlands ( Maruster et al, 2021 ) and Singapore ( Kuek et al, 2019 ). Furthermore, mental health, specifically anxiety, and social isolation were identified by emergency medical service providers in the United Kingdom to have been contributing factors in changes to frequent use during the early stages of the COVID-19 pandemic ( Scott et al, 2021 ).…”