Repatriation of patients with mental health problems

Dr Adrian Hyzler sets out the justifications for mental health repatriation
 
Insurers unquestionably look for the best health outcomes when policyholders fall ill or are involved in accidents abroad. But while physical conditions are easy to identify in order to take the right action, the psychological impact of illness while abroad is less well understood. Healix International, the global medical and security provider, has developed a tailored solution to help insurers make the right medical decisions when dealing with travellers abroad who are facing mental health as well as physical issues.
 
Data from Healix International reveal that between five and 10 per cent of cases of physical injury cases, that we manage, have psychological complications
 
“It is not uncommon for mental health issues to arise as a reaction to the stresses involved in traumatic injuries, and these will generally resolve spontaneously as the physical condition improves”, explained Dr Adrian Hyzler, Chief Medical Officer, Healix International. “Simple conditions, such as hypoxia (reduced oxygen levels) or sepsis (generalised infection) can cause a patient to become agitated and often delirious. The same can happen with specific drugs or drug combinations. Data from Healix International reveal that between five and 10 per cent of cases of physical injury cases, that we manage, have psychological complications. There are obvious contributing factors that increase the severity of the psychological effects: being outside the normal environment; being away from the support structure of friends and family; the difficulty of coping with language and cultural issues. It is crucial for everyone in the assistance industry to recognise these symptoms and to understand the increased psychological effects in order to manage the best outcome for the policyholder.”
Repatriating mental health patients presents particular challenges. They are likely to be exposed to the hurly-burly of the airport environment, to thousands of fellow travellers elbowing themselves through check-in, security and on to the plane. It is therefore vital that the patient is provided with as calm an environment as possible during the repatriation.
 
It is therefore vital that the patient is provided with as calm an environment as possible during the repatriation
 
A chief role of medical escorts must be to provide this by utilising airport lounges, avoiding large queues, and using priority boarding. On the plane as well, patients should be protected from any potentially difficult interactions from air crew or fellow passengers. Medical escorts therefore provide a calm and capable presence, able to problem solve and take responsibility away from what is often an anxiety-producing and exhausting experience for those with mental health problems.
 
In the unlikely event that the patient becomes acutely disturbed on board, it is especially important to have two healthcare professionals, both able to help diffuse the situation as quickly as possible
 
As night-time is often associated with an increase in disorientation and confusion, the same can occur when the lights go out during long inter-continental flights: a previously stable patient can become disturbed, or refuse the medication that they have previously been taking without complaint. For this reason, Healix International uses two escorts when repatriating patients with mental health issues – usually a doctor and a nurse.
As repatriations can often last 30 hours or more, it is important that at least one of the escorts is fully awake at all times. This can be achieved by the medical staff taking shifts to ensure some rest is achieved during these long journeys. In the unlikely event that the patient becomes acutely disturbed on board, it is especially important to have two healthcare professionals, both able to help diffuse the situation as quickly as possible.
The need to create a calm and unpressured environment also justifies upgrading patients with mental health issues to business class for the repatriation. And whilst having a patient’s relative sitting with them can sometimes be helpful, it can also sometimes be a hindrance, depending on the state of the relationship. It is vital, therefore, to assess whether the loved-one should be upgraded with the patient or not to ensure a successful journey home. 
 

About the author

Dr Adrian Hyzler is Chief Medical Officer of Healix International. He qualified as a doctor in 1990 from Sheffield University Medical School and pursued a career in Emergency Medicine which led to an interest in travel medicine. Dr Hyzler joined Healix International in May 2001 as a flight doctor. He moved on to become a medical co-ordinating officer, then Senior Medical Officer, and is now Chief Medical Officer at Healix, with an additional responsibility as Director of Medical Communications. 

This article appears in the March 2019 print edition.

 

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