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The ambulance is the first call people make when there's an emergency, but now, in cases of severe psychological distress, there's a new 24-hour response service available, writes Helen Grange HE YEAR 2014 has been marked by a series of high-profile personal tragedies, the most recent being the suicide of Robin Williams. All too often, these travesties carry the hallmark of individuals who were in psychological crisis. In South Africa, mental illness and psychological breakdown are pandemic. Formal statistics have it that 22 people a day commit suicide, while 220 try to take their own lives. Our country ranks second-highest for substance abuse disorders compared with 14 other countries according to the SA Depression and Anxiety Group (Sadag), while mental health disorders are the third-highest contributor to the local burden of disease, after HIV and other infectious disorders. What happens when a situation spirals out of control and an emergency call is made, by a person in crisis, or a relative or friend? An ambulance is sent, and hopefully it arrives in time to save a life. Yet the medical team who come with it may not have a grip on the psychological ramifications of the crisis. Enter a psychiatric response unit, courtesy of the Akeso Psychiatric Clinics group, which runs specialised clinics in Gauteng, KwaZulu-Natal and the Western Cape. Suicidal teenagers, young women overdosing, bipolar men threatening harm to themselves or others... this is all in a day's work for paramedics dispatched by Akeso. These operators have been working below the radar in Gauteng for a few weeks, receiving far more calls than they expected, and last week made their presence public. The Akeso Emergency Service differs from an ambulance in that it offers immediate intervention in cases of depression, bipolar and anxiety disorders primarily, when these psychological conditions have flipped into lifethreatening emergencies. "This service is intended to fill the gap for emergency response units in the mental health arena," explains Akeso spokeswoman Sandy Lewis. In Gauteng there are two dedicated Akeso Clinic Response Units, manned by paramedics trained to assess and manage the psychological state of the patients. "There is a real need for a specialist psychiatric unit, geared to recognise and help people suffering from mental health disorders," says Lewis. The service was recently launched in KwaZulu-Natal and is to be expanded to the Western Capes soon. Mental illness is linked to the high levels of violent crime, according to Lewis. "There is a high prevalence of mental illness among prison inmates in South Africa compared with the general public, which shows it is significant in our high crime levels. Yet there is a terrible stigma attached to mental illness, which prevents open and frank discussion about what it is, how it displays and how it is managed. "Because of this stigma, many mental illnesses are left undiagnosed, the consequence of which can be dire for the individuals suffering from the illness as well as their friends and family" Most of the calls Akeso response units have attended to have involved domestic violence, substance abuse, geriatric patients who've become a danger to themselves or others, patients experiencing a manic mood disorder episode, or patients seriously threatening suicide. Paramedic Wayne Grindell, experienced in the more serious call-outs, says the most challenging calls are those not made by the people involved, but by relatives or friends who are frightened and need help. "Sometimes we have to physically restrain and sedate a patient because they may be aggressive and intoxicated, and clearly posing a threat to themselves. It's a fine line, because the Mental Health Care Act prohibits the use of force, so the situation has to be properly assessed," he says. Grindell says that, tragically, the unit will sometimes arrive to find a suicide, but more often a patient is just calling out for help and the intervention is a lifesaver. Sadag, which offers a 24-hour helpline, has found the Akeso Response Units invaluable since they've been on the road. "We get more than 400 calls a day from people who feel helpless, hopeless or suicidal. Many of them are serious cases that require urgent crisis intervention. There have been many instances that our counsellors have called on the Akeso emergency units to assist with cases such as attempted suicides, patients suffering from psychosis and people feeling desperately depressed. The emergency response unit has always assisted in these cases, whether in admitting the sufferer to hospital or just calming and containing them," says Cassey Chambers of Sadag. People sometimes use social media to send out an alarm call if they fear someone may injure themselves. In one case last month, Sadag was notified through Twitter about a distressed woman in Rosebank. The counsellor notified the Akeso Response Unit paramedic, who was able to calm the woman and take her to a police station for assistance. Everyone has the right to refuse to go to hospital, but in extreme cases, Akeso paramedics may make that call. "We motivate the patient to come to a clinic, but if they're posing harm to themselves or others and we've assessed there's a mental health issue that needs to be treated, we take the patient to hospital. Police officers are often there to help us make that decision," says Grindell. The most commonly used hospitals for psychiatric patients without medical aid are Natalspruit, Helen Joseph, Charlotte Maxeke and South Rand. Akeso owns the Crescent Clinic, in Randburg, and psychiatric clinics in Parktown and Alberton to which private patients can be admitted. Life Health Care clinics also have psychiatric facilities. "The imperative is that the clinic is equipped to deal with psychiatric patients. Last month, we had 83 hospital admissions," says Lewis. 'Akeso has stepped into the breach where the government is not doing enough, especially in funding for mental health patients. While we can't fix the ills in the system, these response units will make a difference to the lives of those in severe psychological stress. If we can prevent just one tragedy a day, it may not be much, but I can assure you it would mean the world to that one person and his or her family" Akeso emergency helpline: 0861 HELP US (435787). S actor and comedian Robin Williams posing for photographs in Sydney, Australia. Reports on August 11 said the Oscar-winning actor had been found dead at his ome in California. It later emerged he had committed suicide. Fashion designer, L'Wren Scott, the girlfriend of Rolling Stone singer, Mick Jagger, was found dead in her New York flat in March this year from an apparent suicide. An Akeso Emergency Response Unit vehicle that will be used to assist in severe psychological distress cases.