Having to call 111 before accessing emergency care is a barrier to treating mental health

Trials aimed at reducing transmission of COVID-19 could have a negative effect on some service users

In July, NHS England confirmed that it was expanding trials where patients are encouraged to call 111 before going to emergency departments (EDs), to reduce the risk of spread of COVID-19.

But this new strategy to limit attendances at EDs by only accepting 111 or GP referrals is inherently biased.

Placing additional barriers into the treatment pathway potentially discriminates against people experiencing mental distress, crisis or illness, or learning disabilities.

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Belittling the effects of mental distress, crisis or illness

Previous public information campaigns stressed EDs were for ‘real’ issues such as stroke, haemorrhages – physical health conditions and medical emergencies only – and the current Help Us Help You campaign and 111 advice also stress medical emergencies, omitting any references to mental health.

This suggests that mental health is not a real emergency. However, the experiences of mental distress, crisis or illnesses can be just as life-threatening as some physical health issues and deserve to be treated with the same respect, urgency and investment.

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Mental health service users have consistently identified the indignity of having to repeat their thoughts, feelings and emotional distress over and over again, which can lead to intensifying the emotional trauma, withdrawing from seeking help or feeling re-traumatised by the experience.

Using 111 places an additional triage assessment for a person to go through, adding to the number of people who will be asking the same or similar questions, and assumes that the caller is able and willing to seek advice.

Preventing people from accessing emergency care

Other mental health conditions can mean people are not aware of the risks to themselves or others, they may not consider themselves to be unwell or do not have the words to describe what is happening to them.

‘On the one hand, we are being encouraged to attend EDs, on the other, we are making this harder to access at a time when, if national media predictions are accurate, there is an imminent tsunami of mental health issues on the horizon’

Replacing ED walk in could mean this population will be excluded from support that could potentially prevent worsening of their symptoms.

Even more confusing are reports of reduced ED attendances during COVID-19 isolation that identified many people, not just those with mental health issues, attending EDs unnecessarily and those who perhaps do need these services not attending at all.

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Adding an additional step in the process of accessing emergency services is obstructive and contradicts prime minister Boris Johnson’s recent public announcements urging people to attend EDs when they need to.

On the one hand, we are being encouraged to attend EDs, on the other, we are making this harder to access at a time when, if national media predictions are accurate, there is an imminent tsunami of mental health issues on the horizon.

We might also question the ability of GPs to act as ED referral points as, let’s be honest, it can take between three and five weeks to secure a GP appointment if you are registered with one.

The problems with relying on algorithms to access services

Yes, most of the general public can call 111 services but can an algorithm determine what a person’s mental health needs might be and what support they need?

The reputation of 111’s history of triage has been patchy, resulting in poor public confidence for the service. Despite these concerns, trials of separate 111 services and mental health helplines highlighted some positive outcomes but these are specialist and separate teams for mental health. So is this 111 or a new format of crisis intervention and advice services in mental health?

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Why is there the need to have a separate service for people experiencing mental health distress or crisis when this would not be the case for someone with asthma or diabetes?

The mixed messages are confusing and the separation of services may enhance the stigmatisation and discrimination already faced by people who experience mental health distress or illnesses. This indicates that separation between mental and physical health is flourishing, despite calls for parity of esteem.

So, it seems that, yet again, mental health issues are not considered to be significant enough or worthy of ED resources unless as a patient you are willing to complete additional assessments of your situation – in which case you are obviously not in crisis and can be referred to a helpline.

Kim Moore is a senior lecturer in mental health and disability at Birmingham City University