NHS missing thousands of patients with mental health problems who are only seen by ambulances

Thousands of patients are missing out on official health statistics because they are not seen by hospitals or GPs, a groundbreaking study of ambulance data in England has found.

More than a third of people who called and were helped by Yorkshire Ambulance Service (YAS) last year – 288,000 out of around 800,000 – did not go to hospital. Many of these patients had mental health problems.

Some people were treated at the scene by ambulance staff, or saw a GP later or went to A&E themselves. But conditions that are not often treated in hospital, such as mental health problems, substance abuse or self-harm, are likely to be dramatically under-reported, according to the analysis by YAS and the Association of Ambulance Chief Executives (AACE).

Take, for example, the mental health issues of under-18s in Yorkshire and the Humber in 2022-23. NHS figures show there were 870 hospital admissions, but YAS received around 3,300 calls.

Verity Bellamy, senior public health analyst at YAS, said: “This suggests we are missing almost three quarters of those young people by using hospital data alone.”

The highest number of calls about mental health were received by girls and young women aged 15 to 24: approximately 13% of the 50,000 calls.

Bellamy said it may be the right thing to do not to hospitalize those young people. “But if we want to measure the prevalence of mental health needs in young people, we need to think about using ambulance data (and) hospital data.”

She conducted the research, which was presented at NHS ConfedExpo in June, with YAS colleague Ruth Crabtree, who is also the AACE national lead for public health. They plan to conduct an analysis of ambulance data across England.

Crabtree said it was the first time an ambulance service had systematically examined its data in this way. “As an industry, we typically measure performance and demand, rather than this more upstream way of looking at things,” she said.

“So it’s really interesting that Verity came in and saw something that surprised her and that’s very different from anything we’ve seen before.”

According to Dr Steven Dykes, Deputy Medical Director of YAS, ambulances are increasingly providing on-site care to people who do not want to go to hospital, such as the homeless, refugees and elderly, vulnerable people.

“One of the big things for us was that the ambulance rate for the most deprived areas is twice as high as the least deprived areas,” he said. “There’s a bigger amount that (ambulance staff) are actually managing at home and when you see that in the data it’s really quite shocking.”

The analysis found that 55% of all mental health-related calls involved people under 40, and almost a quarter involved people under 25. People in the poorest fifth of society were five times more likely to call an ambulance for a mental health issue.

People in the most deprived areas also made up 40% of the 72,000 calls for respiratory problems. “We understand why that might be. We have much higher smoking rates in the most deprived groups. We have people in more industrial jobs and poor quality housing. But we also saw a similar pattern in younger people, which we were quite surprised about. That doesn’t include smoking and it doesn’t include long-term illnesses,” Bellamy said.

The analysis also revealed the knock-on impact of the dental crisis. YAS received more than 5,000 calls for toothache in children under 10, 64% of which were from the most deprived group, compared with 4% from the least deprived group.

Some of these issues are reflected in other data, such as a Health Foundation report from earlier this year, which found that one in three people aged 18 to 24 report common mental health conditions such as anxiety or depression, with the figure rising to 41% among young women.

But Bellamy said the ambulance service could act as an “early warning system” for other parts of the health system. “We’re probably going to see this before, say, the mental health commissioners,” she said. “So we’re trying to share that data with the right parts of the system so they can plan properly.”

Dykes said YAS is working with mental health agencies and charities to give patients better access to these services.

“There’s a big problem with the transition from pediatric to adult care, namely this group of patients that we see here. Is it that the care is just not there for them and they fall between the gaps in this age group? That’s why it’s important that we turn this data around and feed it back into the system.”

Bellamy said: “We think a lot about how do we get ambulances to people quicker, but actually, if we start thinking more upstream, we can be more preventative. And that’s much better for people too.”