Iris Mtero is helping to carve out a new care pathway for emergency mental health services
Mental health nurse Iris Mtero’s position is the first of its kind: that of clinical adviser/senior nurse practitioner with the Emergency Operations Centre at London Ambulance Service (LAS). She is one of only four mental health nurses in post, although the plan is to rapidly expand this number.
LAS started employing nurses in January to fill vacancies normally held by paramedics at the centre. Mental health was identified as a priority for the service, which sought to improve the clinical intervention and patient experience for mental health patients. The move was also seen as a solution to a national shortage of paramedics and was one that brought Ms Mtero to LAS.
”I wanted to go into mental health nursing later on in my life when a family member struggled with mental illness. I wanted to learn how to help”
“Growing up, people always said I was a very caring person,” she says. “I would put stickers on my dolls and pretend to be a nurse. I wanted to go into mental health nursing later on in my life when a family member struggled with mental illness. I wanted to learn how to help.”
Ms Mtero trained at London South Bank University and joined North East London Foundation Trust after qualifying as a registered mental health nurse.
“NELFT was like a family, I was very comfortable there,” she recalls. “I did placements in many settings – I was working in the psychiatric intensive care unit and found it very challenging. Over time, though, I realised it wasn’t right for me. I wanted something different.
“In my search for a new challenge, I interviewed for loads of positions before I saw the LAS advertisement. I knew right away it was the one.”
Ms Mtero describes her main duty as “hear and treat”. After the emergency dispatchers receive a 999 call, she carries out a full mental health assessment and advises patients and carers on the right pathway to take – that could be a GP or crisis team referral, sending a taxi instead of an ambulance, or advising on medicines management.
“Most mental health patients are already known to a service but need direction in a crisis”
“I watch the length of the calls the dispatchers take,” she explains. “They usually last for three minutes, but if it gets up to five, six, seven, they must be struggling. That’s when I start to listen in and decide if I need to jump in and help.
“Most mental health patients are already known to a service but need direction in a crisis,” Ms Mtero continues.
“Before I was hired, ambulances were sent to mental health patients in crisis and they were taken to accident and emergency. But that’s often not the right place for a mental health patient – they have to sit there alone and can wait a long time for treatment. It’s probably the worst place.”
A trailblazer in her position, Ms Mtero will be propelled to centre stage in shaping a new national model of care when it comes to emergency mental health services.
”I’m the only one doing this job full time at the moment, so there’s often no one to ask what to do from a mental health perspective if I don’t know”
“I’ve learned a lot,” she says. “I’m the only one doing this job full time at the moment, so there’s often no one to ask what to do from a mental health perspective if I don’t know. But I wanted to take a risk and do something different – I’ve identified issues and we’re getting better at dealing with them.”
Transitioning from face-to-face care to hear-and-treat was difficult for Ms Mtero and she expects it will initially be the same for those who follow her. “I miss seeing people, dispensing medication, that kind of thing. It was a hard adjustment,” she admits. “It took me two months to be comfortable, but now I like it here so much.”
LAS is now integrating face-to-face clinical shifts and ambulance ride-outs into the role to keep nurses engaged and their technical skills polished. Because nurses might feel discouraged to take a job with no face-to-face interaction, LAS hopes a mixed model will attract more nurses to the service and improve the experience for patients in crisis.
”By giving patients direction to the right services, we can make sure ambulances are only sent when needed”
“I’m bringing knowledge to the EOC – I’m trained for it,” Ms Mtero says. “By giving patients direction to the right services, we can make sure ambulances are only sent when needed, instead of to a patient who would prefer a different type of response.
“Mental health patients are receiving better care when they call 999. It’s efficient, it saves time. But it’s not just about saving time and ambulances – it’s about helping patients.”