ARMHS is an interdisciplinary research network connecting academics, health professionals, policy, third sector, public sector, and lived experience around the common topic of urgent and emergency care for people with mental health and substance use issues. 

The problem

Deaths from alcohol, drugs, and suicide [1] have reached epidemic levels in many industrialised countries and there is a pressing need to understand their drivers [2]. Scotland has high rates of these deaths, specifically the highest drug-related death rate in Europe [3]. While the evidence on mortality from these causes is growing, there is a gap in knowledge of the impact of ‘presentations despair’ to emergency services.

Calls to 999 and ambulance callouts have increased in recent decades [4-6]. Evidence from Australia show key drivers of demand include pre-existing mental health conditions, drug and alcohol dependence, comorbidity, and socio-economic disadvantage [4]. Similarly, demand on emergency departments (EDs) has also increased [7] and on police responses to non-crime related incidents, mostly due to individuals in mental distress [8]. In Scotland, about one in ten police callouts mental health-related [8] and international literature suggests most individuals ‘brought in by the police’ to EDs are for mental health, acute behavioural disturbance, or substance use [9]. Alcohol-related ambulance callouts accounts for about 20% in Scotland [10], mental health for around 10% [11], while there currently are no estimates for drug-related harm. Within the ED, based on English data, about 10% of all attendances are alcohol-related [12] and international evidence suggests 4% of ED attendances are for mental health problems [13]. Data on drug-related attendances is scarce, though a high proportion of people with substance use disorder report recent ED use [14]. In summary, the prevalence of presentations of despair is likely high but due to the siloed nature of research, and complexity of presentations while data is collected for single problems, the true prevalence is unknown.

The Network

The network was established to: i) share knowledge and research, ii) create a common voice to advocate for emergency responses as a priority area for research and public health policy, iii) create multidisciplinary collaborations for grant applications, and iv) produce academic outputs. While focus is on Scotland, we are connected to international experts who have developed and evaluated care models/interventions to reduce presentations of despair. In the longer term, we aim to become an international research network. 

Through a coordinated effort to bring different strands/stakeholders together, we can further this field of research to better support currently underserved communities in Scotland and beyond. 

To date we have about 130 individuals linked up with the Network. 

References

  1. Case A, Deaton A. Mortality and morbidity in the 21(st) century. Brookings Pap Econ Act 2017; 2017: 397-476.
  2. Brignone E, George DR, Sinoway L, et al. Trends in the diagnosis of diseases of despair in the United States, 2009–2018: a retrospective cohort study. BMJ Open 2020; 10(10): e037679.
  3. Dowd JB, Angus C, Zajacova A, Tilstra AM. Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly? BMJ Open 2023; 13(8): e069905.
  4. Andrew E, Nehme Z, Cameron P, Smith K. Drivers of Increasing Emergency Ambulance Demand. Prehospital Emergency Care 2020; 24(3): 385-93.
  5. Birmingham LE, Arens A, Longinaker N, Kummet C. Trends in ambulance transports and costs among Medicare beneficiaries, 2007–2018. The American Journal of Emergency Medicine 2021; 47: 205-12.
  6. Association of Ambulance Chief Executives. Annual Report 2018-19, 2019.
  7. Strum RP, Drennan IR, Mowbray FI, et al. Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019. Canadian Journal of Emergency Medicine 2022; 24(7): 742-50.
  8. HM Inspectorate of Constabulary in Scotland. HMICS Thematic review of policing mental health in Scotland, 2023.
  9. Crilly J, Johnston AN, Wallis M, et al. Review article: Clinical characteristics and outcomes of patient presentations to the emergency department via police: A scoping review. Emerg Med Australas 2019; 31(4): 506-15.
  10. Manca F, Lewsey J, Waterson R, et al. Estimating the Burden of Alcohol on Ambulance Callouts through Development and Validation of an Algorithm Using Electronic Patient Records. International Journal of Environmental Research and Public Health, 2021. (accessed.
  11. Duncan EAS, Best C, Dougall N, et al. Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2019; 27(1): 34.
  12. Phillips T, Coulton S, Drummond C. Burden of Alcohol Disorders on Emergency Department Attendances and Hospital Admissions in England. Alcohol Alcohol 2019; 54(5): 516-24.
  13. Barratt H, Rojas-García A, Clarke K, et al. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis. PLOS ONE 2016; 11(4): e0154449.
  14. Armoon B, Griffiths MD, Mohammadi R, Ahounbar E, Fleury MJ. Acute care utilization and its associated determinants among patients with substance-related disorders: A worldwide systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2023; 30(6): 1096-113

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