Here's the truth about EMTs handling mental health patients -Barre Montpelier (VT) Times Argus

Letter: June 27, 2007

By Anne Donahue

The comments (letter of June 19) of the local EMT regarding emergency care of those with mental illness was a sad reflection of inadequate training. Fortunately, I know directly of many other emergency personnel who share in recognizing that mental illness in its acute phases is an illness that needs the expertise of medical personnel, including EMTs, and that individuals suffering from them should not be transported by sheriffs as though they were criminals unless it is necessary for safety.

The writer has his direct facts wrong.

He alleges that dangerous patients are now being dumped on local ambulance services without regard to safety of the EMTs, a subversive change from what he sees as appropriate shackling of ill persons.

Statutory changes were made in 2004, and refined in 2006, based upon recognition that some involuntary patients were not a safety risk to transport in a less traumatic ways than the use of leg irons, waist chains and handcuffs that traditional sheriff transport required.

Those changes, however, do not remotely resemble what the writer alleges.

First, the statute requires that while the transportation to inpatient settings use the least restrictive method of transportation that is necessary for the safety of the patient, it also requires that transportation protocols be "reasonable and appropriate measures consistent with public safety" (18 VSA 7511.) Patients at risk of injuring others, or themselves (by jumping out the ambulance door, the writer suggests, when strapped to a gurney and under the direct care of the treating EMT, as every type of patient already is?) are still always transported by sheriff.

In fact, the protocols established by the Department of Health in 2006 establish three options, depending on the level of safety needs: a) transport by a mental health staff person; b) transport by ambulance accompanied by a mental health specialist; or c) transport by sheriff. None of those options resemble the alleged "duping" of EMTs to have them unknowingly transport potentially violent ill patients. The protocols require an extensive assessment of any risk factors.

Statistics are maintained of all such transports. The fact is that last year, 100 percent of the nine transports from Central Vermont Medical Center to another hospital, and 25 of the 29 transports from the community to a hospital were done by a sheriff, a similar figure to 2004, when 32 persons from Washington County were transported by sheriff. The four other patients in 2006 are the total number that represent the "change from the past," and they include those transported by Washington County Mental Health staff; only one was by ambulance.

Interestingly, this is an area in which Washington County and most of Vermont is backward compared to many other states. Massachusetts uses ambulance only for all emergency mental health transportation; in Pennsylvania the law bans the use of metal restraints for such transports; in Florida, most transports are done by civilians with ambulance or law enforcement if needed as back-up; in New Hampshire, law enforcement is available as "back-up."

Most telling is what happens in Bennington County. Perhaps the air is different there.

All transports from the emergency room at Southwestern Medical Center (which has no psychiatric inpatient service) are by ambulance. All of them. One hundred percent. If security is an issue, a sheriff rides along.

The introductory training for ambulance service staff from the Office of Emergency Services is 120 hours. Three of those hours address mental health. A 2004 report from the Division of Mental Health noted a need to increase the mental health component. The slow move to a society that recognizes that mental health is a part of health requires more comprehensive training.

The numbers are similar in training of corrections staff and for law enforcement. Police officer training has traditionally included one day on mental health response out of six weeks of training, despite the fact that police are the most frequent "first responders" to such crises. There is now an excellent initiative through the law enforcement Training Council to enhance training opportunities.

It is often inadequate training that leads to comments such as those in the June 19 letter, or to debates such as in Montpelier, where police argue that Taser guns are necessary tools, often to de-escalate mental health crises that could be "talked through" with the right training. Tasers, a risky and painful alternative, is a "quick fix" substitute that reflects sadly on our social priorities.

In 2001, in an earlier phase of my recovery from my own mental illness, I was the subject of a 911 response in Barre, but took off on foot. Somewhere around 12:30 a.m., a local police officer spotted me. He took advantage of my confused and distraught condition to convince me that the only way he could help me make a phone call was to offer me a ride to Central Vermont Medical Center, which I accepted. Once there, I agreed to voluntary hospitalization. If hospitalization had been presented as the true reason for the ride, I would have refused it.

I am forever grateful to that officer's sensitivity and skill; without it, I, too, may have ended up temporarily committed against my will and therefore transported — as the June 19 letter writer would have preferred — by local sheriff in shackles. That outcome would not have been helpful either for my mental health, for the long-term costs to our medical system for my medical care and recovery, or for society as a whole.

Rep. Anne Donahue is a Republican who represents the town of Northfield.