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Driving Around Stockholm in Sweden's Only Mental Health Ambulance

PAM was launched in March 2015, and it's kind of like a therapy room on wheels.

In 2015, 1,554 suicides and over 15,000 suicide attempts were reported in Sweden. What's even sadder is that these have pretty much been the same numbers reported every year of the last decade. In an attempt to squelch them, in March 2015, Stockholm's care services introduced PAM – the country's first mental health ambulance.

From the outside, the vehicle looks like any other ambulance. Inside, however, it's furnished with seats instead of a stretcher – a sort of therapy room on wheels. On average, PAM responds to about 135 emergency calls a month. Apparently, 85 percent of these calls are related to suicide in one way or another.

So far, Stockholm is the only Swedish city with a mental health ambulance driving around its streets and according to Fredrik Bengtsson, Head of Mental Health Emergency at Sabbatsberg Hospital, PAM has already been given an unofficial green light to keep up the good work. "I can't see any reason as to why the project shouldn't continue," Bengtsson told VICE Sweden. "It has been considered a huge success by police, nurses, healthcare officials, as well as by the patients."

Because of its success, other regions – like Skåne, Örebro, Blekinge and Jönköping – have recently started looking into getting PAM too. In Gothenburg, a similar project that involves mental health nurses coming to a location by car in order to help out on-site is already available.

To find out more about PAM's practices, I met up with Anki Björnsdotter. She's a nurse who specialises in mental health care and a member of PAM's team.
 

Mental health nurse Anki Björnsdotter with PAM

VICE: What kind of staff are required in ambulance when responding to an emergency call?
Anki Björnsdotter: We are two nurses, who are specialised in mental health care, and one paramedic. There is currently only one vehicle that covers the entire Stockholm region – a total of 165 kilometres – all the way from Hallstavik to Gnesta. It's a gigantic area to cover with only one vehicle.

What is a typical kind of call you get?
We help people who are suicidal and people who suffer from severe mental illness. It can be someone who is manic and not aware of their own mental state, i.e. a person who needs to go to a hospital without realising they need to. Also, people who are psychotic and people suffering from schizophrenia who haven't taken their medicine and are in distress.

It used to be the police who handled these kinds of calls. But just the presence of the police can easily cause a patient to feel like they've done something wrong. Mental illness is nothing criminal so it doesn't make sense to be picked up by the police.

How do you handle these cases?
When we first arrive at the scene, we evaluate the situation. If it's a suicide case, it can take some time before you reach a contact person or someone who's able to calm the patient down. We talk to the person in order to make a call about whether we should bring the patient to the hospital, or give them a ride home.

For example, if we get a call about a person on a bridge about to commit suicide and things have cooled down by the time we arrive, we might consider the situation and decide that, in this particular case, the patient won't try to commit suicide after all and won't need to be hospitalised.

How do you prepare yourself on the way to a call? 
When we are dispatched we usually get a social security number so we can view the patient's medical records. In that way, we'll get an idea of what kind of issues they have. It can tell us a lot – but definitely not everything.

Since we're dealing with people, we rarely predetermine who will do what, when we arrive. For example, one of us might need to take care of the patient and the other to handle the relatives. Everything depends on the situation. Sometimes the patient is a woman, who doesn't want to get treated by a man or vice versa. It can also be that one of us is approaching, but the patient rejects us. So we'll have to compromise and find out what's best for the patient.

Do you prepare yourself mentally in any way? 
When something seems to be particularly serious, SOS Alarm will give us a heads up. In that way, we can prepare ourselves mentally as much as possible. You see all kinds of heavy stuff. It's especially hard to see children in distress.

Have you ever felt unsafe or afraid while working with PAM?
No, I have never felt afraid. Sometimes I feel like I have to be a little more cautious. If we feel that there could be danger in some way, we wait for the police to arrive with us so they can back us up. You can't really be too cautious since you never know what to expect. I believe the ambulance and our uniform give the patient some degree of comfort. People who feel like they are taken care of tend to pay more attention to what we're saying.

What do you think about the future for PAM? 
I believe we will look back and think, 'Why didn't we do this sooner?' I really hope similar services will be available to cover Sweden's major cities, at least.

This article was first published on Vice and was written by JOHN-DAVID RITZ

13 Feb 2017