Transport for people in mental health services

People with a mental illness may need to be taken to or from a hospital or mental health service. Transport choices should be appropriate to the person and their circumstances and should use the least restrictive option possible.

Ambulances provide emergency transport, while other options depend on the amount of support required by the patient.

In many cases a person with a mental illness can be safely transported by private car, in a mental health service vehicle or by non-emergency patient transport. However, where this is not safe, Ambulance Victoria is responsible for providing transport.

Protocol for the transport of people with a mental illness 2014

There are a number of transport options available to safely transport people with a mental illness. The Protocol for the transport of people with a mental illness 2014 provides information on emergency ambulances, other options, and the role of police to assist health and mental health professionals, transport providers, carers and people with a mental illness make appropriate transport decisions.

Mental health triage is generally the first point of contact for people with a mental illness, their carers or others seeking assistance.

The Mental Health Act 2014 (the Act) has resulted in significant changes in terminology and some changes in practice that will affect transport decisions.

The Act sets out who can apprehend and transport people with a mental illness and the actions they can take.

The Act enables authorised persons (including ambulance paramedics) to enter premises, apprehend people, use reasonable force and bodily restraint, and transport people to a designated mental health service in prescribed circumstances.

Transport options

In all situations where a person requires transport to or from a designated mental health service or any other place, the decision about what form of transport is appropriate should be based on an assessment of the:

• person’s mental and/or physical state
• person’s immediate treatment needs to prevent serious deterioration in their physical or mental health, or serious harm to themselves or to another person
• likely effect on the person of the proposed mode of transport
• availability of the various modes of transport, including private and non-emergency patient transport (NEPT) vehicles
• distance to be travelled
• the person’s need for support and supervision during the period of travel, including any potential safety issues
• expressed preferences of the person and/or their family or carer. Reasonable efforts should be made to help the person to make or participate in decisions about their transport and to transport them in the least restrictive manner possible.

Before arranging transport to a designated mental health service, a health or mental health professional should contact the receiving service to make arrangements for the person to be received.

The least restrictive transport option possible should be used. A range of transport options are described below.

Emergency ambulance

At times, emergency ambulances are the most appropriate transport option. Anyone can call for an emergency ambulance by dialling 000. The ambulance response time will be determined by the person’s clinical needs and available resources. The 000 call taker may also refer callers to a secondary triage service to determine whether an alternative response might be appropriate.

An emergency ambulance must always provide transport if the person’s medical needs can only be met by an ambulance service.

Mental health service vehicle with accompanying clinical staff

Mental health practitioners have access to service vehicles and may transport people to or from a designated mental health service. Where the person does not require active monitoring or medical care and there are no perceived risks to the safety of the person or the mental health practitioners, agency vehicle transport may provide a less restrictive means of transport than ambulance or police vehicles.

In situations where a person is being transported to an inpatient service in a service vehicle, it is preferable that two mental health practitioners travel with the person, as driver and escort. A family member, carer or friend may also accompany the person in a service vehicle; however, consideration must be given to ensuring that the accompanying person has the means to return home.

Police may be able to provide an escort as a means of reducing the risk associated with transport in a service vehicle under certain circumstances and with clear expectations established and communicated between the mental health practitioner and police in the event of police intervention being required.

Private vehicle

In many instances a private vehicle driven by a family member, carer or friend may offer the person a supportive and familiar form of transport. Consideration should be given to the willingness and ability of family members, carers or friends to provide safe transport, as well as the person’s mental and physical state.

Taxi

Transport by taxi in the company of a family member, carer or friend may be appropriate for a person who needs to travel to or from a designated mental health service. Consideration must be given to the physical and mental state of the person and the availability and affordability of the taxi service.

Other non-emergency patient transport

In some areas, non-emergency patient transport (NEPT) is available. This service transports people who do not require a 000 ambulance response (who can wait a minimum of 90 minutes), with most transfers occurring between hospitals or from home to hospital.

NEPT may provide a more timely response than ambulance in non-urgent cases where NEPT is able to meet the clinical needs of the person.

NEPT includes high, medium and low acuity road and air transport.

Non-emergency patient transport may be booked:

• by contacting a licensed provider
• through Ambulance Victoria by calling 1300 366 313

The NEPT Regulations 2005 and Clinical Practice Protocols were changed in 2014 to reflect the Mental Health Act 2014. The changes mean that persons receiving services for mental illness who are assessed as stable and suitable for transport according to the general criteria in the NEPT Regulations may be transported by NEPT, regardless of:

• the departure and arrival points of the transport
• the level of acuity
• whether restraint and sedation may be required during transport. As NEPT providers cannot use restraint or sedation, this is only permitted where the requirements of the Act are met, for example if the person is accompanied by an authorized person under the Mental Health Act 2014 who takes responsibility for the use of restraint or a person authorised to administer sedation in accordance with the Act
• whether the person is being transported under a provision of the Act or the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997.

Police

Police transport should only be considered where a person cannot be safely transported by any other means. The experience of being apprehended and/or transported by police can be traumatic.

Less restrictive alternatives to police transport could include an ambulance with an accompanying mental health practitioner or police member in the ambulance.

Police procedures for transporting people with a mental illness can be found in the Protocol for mental health – Department of Health and Victoria Police.

Ambulance transport payment guidelines

The Ambulance transport payment guidelines for Victoria outline who has responsibility for the payment of clinically necessary patient transport provided by Ambulance Victoria and licensed NEPT providers

For transport to be considered clinically necessary, it must be medically authorised by an appropriate health professional.

Please note, the guidelines will be updated periodically.

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