Barriers and facilitators of psychiatric ambulance and street triage models: A cross-country comparative study

People with mental illness can experience mental health crises (MHCs) that manifest in behaviours risky for the affected persons and for others, often resulting in unwanted police encounters and detention. Mobile crisis teams employing the psychiatric ambulance model (PAM) have shown positive effects when responding to MHCs, including diverting patients from police custody. However, the literature contains few reports about PAM. The emerging model of street triage (ST) is more frequently used and better researched. This study explored and compared facilitators and barriers of PAM and ST from the perspective of professionals from different countries. We conducted 12 semi-structured interviews with key PAM stakeholders in Sweden and the Netherlands and ST stakeholders in England, then performed comparative thematic analysis. Participants believed that PAM and ST led to better care for persons in MHC, reducing stigma and use of force. The main facilitators for Swedish participants were that PAM is a specialty with highly experienced and autonomous
staff. For Dutch participants, the more generalized medium-care ambulance led to success. Street triage enhanced overall safety and interagency collaboration. A common barrier was the lack of (emergency) treatment options and funding to meet the high demand for mental health care. Future research should explore collaboration between mobile crisis teams and community care to improve MHC response, and the perspectives of persons with mental illness on mental health emergency response models. Careful assessment is recommended to determine which mental health emergency response model best suits a specific local or national context.