S.TRUEMAN PhD THESIS 2016

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Accordingly, their mental healthcare expertise is greater than those of the remote nurses, they have greater authority to use medications and have more experience in handling acute mental health presentations: It amazes me that these nurses are after hours caring, they’re in charge of this facility, and yet their hands are tied at times because when it comes to things like pharmacology, there’s very little—even when they’ve done their RIPEN training that they can do off their own bat. They’ve got to talk to the medical officer. I think—and especially some of the more senior and confident ones, there’s no difference between me and them. I can sedate someone because I can deem that it’s safer to do that. (T23, p. 19) When they do deliver a mental health patient to an emergency department, paramedics and ambulance officers are often informally consulted by remote nurses concerning the best immediate future management of a mental health patient. The paramedics and ambulance officers also stated that when remote nurse staff numbers are low, they will stay for a while to ensure that mental health patient’s presentation does not deteriorate, So a lot of the time, and particularly if … someone who’s distressed, potentially maybe some self-harm or suicidal thoughts, we’d [paramedic] be quite concerned with that. We’d be handing over and maybe staying around to help and assist. (T23, p. 9–10) While contact between paramedics and ambulance officers is episodic and irregular, there is a high level of mutual professional recognition of the benefit both professions can bring to the delivery of mental healthcare, especially concerning mental