The justifications for mental health repatriation

Dr Simon Worrell, Head of Medical Communications at Healix International, sets out the justifications for mental health repatriation.

Insurers unquestionably look for the best health outcomes when policyholders become ill or are involved in accidents abroad. But whilst 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 has therefore developed a tailored solution to help insurers take the right medical decisions when dealing with travellers abroad who are facing mental health as well as physical issues.

Mental health issues caused as a result of a physical injury are more often than not fairly short-lived, and would be expected to resolve as the patient’s physical condition improves. For example, patients may become agitated if septic or short on oxygen; they can become confused if suffering from delirium and certain drugs can have psychological side-effects.

Around five to ten physical cases we handle a month may have psychological complications.

The added stress of being outside the normal environment and perhaps even without friends and family, certainly is a factor in increasing the risk of psychological side-effects from physical injuries. Understanding and recognising the symptoms is, therefore, crucial to help insurers manage the best outcome for their 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.

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.

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 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.

Although challenging, performing repatriations of psychiatric patients can be some of the most rewarding. It is clear that without medical assistance, the individuals we assist would continue to be stranded in countries often with very limited healthcare provision, and thousands of miles from home.

FIND OUT MORE

At Healix, we have a wealth of experience in helping insurance companies manage complex medical claims and emergencies. To find out more about our Medical Assistance services, click here.

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