Evaluating New Ambulance Mental Health Pathways (ENAMHP)

Evaluation of ambulance innovations and mental health pathways in the East Midlands UK: a mixed-methods study

Why the research is needed? 

The increasing number of people calling 999 for mental health emergencies shows the need for more accessible and specialised mental health care. As a result, East Midlands Ambulance Service NHS Trust (EMAS) has implemented innovative mental health services, since September 2022, which includes four components:

  • mental health training for frontline staff;
  • registered Mental Health Nurses (RMNs) within Emergency Operation Centres (EOCs);
  • dedicated Mental Health Response Vehicles (MHRVs) staffed by RMNs and paramedics; and
  • new pathways to mental health services.

These interventions seek to provide frontline EMAS staff with the necessary knowledge, skills, resources and pathways to manage mental health emergencies with competence and sensitivity. Despite these significant changes, the mental health outcomes, cost-analysis , and functioning of these pathways within the context of EMAS remain under studied. This research is needed to investigate the outcomes of these mental health services, and mechanisms by which these are achieved.

What is already known about the subject? 

Numbers of patients calling 999 emergency medical services with mental health problems has increased, placing higher demands on ambulance services to respond. Ambulance crews in England spend 1.8 million hours annually, which is equivalent to 75,000 days, responding to patients with mental health problems. In 2022, average ambulance response times for mental health presentations exceeded two hours. Severe Mental Illness (schizophrenia, bipolar disorder, personality disorders, and severe depression) affects around 551,000 people in England. In the East Midlands, 16.7% of the population reported experiencing mental health conditions in 2014.

Who we are working with? 

Academics from the University of Lincoln are working with an established and experienced patient group, together with practitioners and managers at EMAS and Lincolnshire Partnership Foundation Trust to develop and conduct this study. 

How are patients and the public involved? 

We are working with the Healthier Ageing Patient and Public Involvement (HAPPI) group established at the Community and Health Research Unit, University of Lincoln. On October 5th, 2023, we discussed this proposal with the HAPPI group and obtained feedback and offers of support. We will regularly engage with HAPPI group to incorporate patient and public perspectives in this study.

What we will do? 

We will analyse routine data from EMAS using an interrupted time-series design, encompassing periods before, during, and after introducing these services, to evaluate the effect of the intervention. We will also conduct an economic evaluation using EMAS data and NHS reference costs to understand costs of the intervention.

What the benefits will be? 

This study will generate evidence and inform policy and decision-makers at EMAS to improve mental health services in the East Midlands regions of England, to enable sustainability and spread of effective services.

When the findings will be available? 

The findings will be available on completion of the study in March 2026. 


Professor Niro Siriwardena, nsiriwardena@lincoln.ac.uk.