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Mental Health Presentations to Ambulances in Rural-Urban Areas

A systematic review on interventional studies for people presenting with mental health symptoms to ambulance services in rural and urban settings

Why the research is needed

There is a lack of literature review studies of ambulance personnel delivered interventions for managing people with mental health conditions despite these being a common and important presentation to ambulance services. There is also no existing review that has explicitly considered the impact of rural-urban setting within this context.

What is already known about the subject

In the UK and internationally, people with mental health problems account for a considerable proportion of presentations to ambulance services. Despite the frequency of presentation, prehospital clinicians have perceived that they lack expertise and confidence in managing people with mental health conditions. They also face personal, organisational, and ethical challenges with this group of patients and that increasing knowledge, skills, treatment options and support could enhance the care that is provided. Finally, it is well known that emergency medical services in urban areas have shorter prehospital times, response times, on-scene times, and transport times when compared to those in rural areas.

Who we will be working with

The project is being led by a team of researchers from the University of Lincoln working with the East Midlands Ambulance Service NHS Trust (EMAS) and Lincolnshire Partnership Foundation NHS Trust (LPFT). The project also benefits from international collaboration with researchers from La Trobe University in Australia.

How patients and the public are involved

We have representation from two members of the public on our study steering group. They will have the opportunity to feed into the ongoing development of the project with a particular focus on the interpretation of findings and how we disseminate the results.

What we will do

We will search a range of academic databases to retrieve relevant published literature that reports on interventions that are delivered to support the presentation of mental health emergencies to ambulance services staff within rural and urban settings.

What the benefits will be

The review will bring benefits to ambulance services staff, patients and the public through a better understanding and awareness of effective mental health interventions and intervention components for ambulance services. The findings will inform the development and evaluation of mental health services within both rural and urban settings.

The findings will be transferable across different systems and settings and will consider both national and international literature that will encompass different healthcare systems, demographics, and rural-urban geographies.

When the findings will be available

We expect our findings to be available in Summer 2024.

How we are planning for implementation

We will develop a comprehensive engagement and dissemination strategy to ensure that our findings are fed back into the NHS. We will engage with a range of stakeholders to contribute to the planning, development, and dissemination of the study. The study will also be presented to the National Ambulance Research Steering Group which includes research leads of all ambulance services.


Dr David Nelson,