A Model for Developing of Mental Crisis Emergency Patients through Integration of Emergency Medical Service - การพัฒนารูปแบบระบบบริการการแพทย์ฉุกเฉินสำหรับผู้ป่วยฉุกเฉินวิกฤตสุขภาพจิตแบบบูรณาการในพื้นที่

The objectives of this study were to assess the situation and problems associated with mental crisis emergency and to exchange information as well as to brain storm for an integrated service model that could address the problems. It was conducted as a qualitative study in 4 provinces of Thailand (Nan, Udon Thani, Ratchaburi and Surat Thani) during January - March 2017. The informants were 5 groups of stakeholders, namely patients and caregivers, emergency health personnel, staff of health care facili­ties, civil society, and local administrators. Data was analyzed using content analysis. It was found that all 4 study areas had faced with the lack of knowledge and skills among the patients and their caregivers. The local community emergency response management was not well-planned and organized. The tele­phone triage system was inefficient and ineffective. Additionally, there were insufficient facilities, limited capacity of hospitals to serve mental crisis emergency patients. Some health facilities even refused to provide services to the patients in crisis. Nevertheless, there were some areas with proper practices. After information exchange and brainstorming, 5 areas of improvement were suggested: (1) providing educa­tional services to build capacity of patients and caregivers, (2) building and promoting community based self-management program, (3) developing emergency notification, counseling, evaluation and situation control systems; and establishing effective referral, tracking and fast track system for vulnerable patients. (4) developing hospitals to become “self-management mental health facilities”, and (5) encouraging collaboration among policy makers, related healthcare organizations and all stakeholders for management plan. It was recommneded that the proposed model be widely adopted and adjusted for the improvement of services for mental crisis emergency management. Continued monitoring and evaluation of the model was also recommended.