The Non-Emergency Patient Transport (NEPT) Regulations 2005 were been changed in August 2014 so that people receiving mental health services may be transported by NEPT services. People must be assessed as stable and suitable for transport according to the criteria in the NEPT regulations.
Emergency ambulances may still be the most appropriate transport for people with a mental illness. It is up to the health practitioner authorising the transport to determine whether NEPT is appropriate and what level of NEPT service is required, as for all other patients.
These changes have been reflected in the updated Protocol for the transport of people with mental illness 2014, which can be downloaded from this webpage.
Note the following definitions of people who may be transported and those who may authorise their transport.
Persons with a mental illness versus patients
Ambulance Victoria and NEPT regulations and clinical practice protocols use the term ‘patient’ to refer to all persons requiring, or potentially requiring, transport for clinical reasons, including mental illness.
Under the Mental Health Act 2014, ‘persons with a mental illness’ is preferred as a general term and has been used where possible. Under the Mental Health Act, ‘patient’ specifically refers to compulsory, security or forensic patients.
Assessment by authorised practitioners
The NEPT clinical practice protocols require a ‘medical practitioner’ to assess patients prior to transport by medium and high acuity NEPT services, and assessment by an ‘appropriate health professional’ for low acuity NEPT services.
‘Authorising practitioner’ has been used here to refer to both 'medical practitioners' and ‘appropriate health professionals’ listed for low acuity services.
Expanded definition of ‘appropriate health professional’
The definition of ‘appropriate health professional’ in the low acuity section of the protocols has been expanded with an additional category to allow for ‘mental health practitioners’ as defined under the Mental Health Act.
A ‘mental health practitioner’ is:
- a medical practitioner who has knowledge of the patient and has decided that the patient complaint is not urgent
- a division 1 registered nurse who has examined the patient
- an ambulance paramedic in the communications department of an ambulance service who has decided that the patient complaint is not urgent based on a discussion with the patient or a health professional who has seen and examined the patient
- an ambulance paramedic or registered nurse working for an ambulance service telephone referral service who has triaged the patient to NEPT transport according to medically approved triage guidelines
- a mental health practitioner who has assessed the patient as suitable for transport by low acuity NEPT services
- any of the following who is employed or engaged by a designated mental health service: a registered psychologist, registered nurse, social worker or registered occupational therapist.
An ‘authorised person’ is defined in the Mental Health Act as a:
- police officer
- ambulance paramedic working for Ambulance Victoria
- registered medical practitioner employed or engaged by a designated mental health service
- mental health practitioner (see above).
Responsibilities of the authorised person
The Mental Health Act permits authorised persons to enter premises, apprehend people, use force, use bodily restraint and transport people to a designated mental health service in prescribed circumstances.
These circumstances include ones where:
- a person is subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order to enable the person to be taken to a designated mental health service
- a person is apprehended under section 351 of the Mental Health Act and police request an ambulance to take the person to a designated mental health service
- a patient is absent without leave from a designated mental health service.
NEPT personnel are not authorised persons even if they also work as paramedics for Ambulance Victoria, or as medical or mental health practitioners for a designated mental health service.
Implications for non-emergency patient transport providers
Changes to the NEPT regulations have a number of implications for NEPT providers. These changes are:
- removing limits on departure and arrival points
- enabling all levels of acuity to be used
- removing restrictions on restraint and sedation
- removing the restriction of compulsory, security and forensic patients.
Removing limits on departure and arrival points
NEPT regulations and protocols have changed to remove restrictions on where people with a mental illness can be transferred from and to. NEPT can now be used in such situations such as transport from a person’s residence to a health service, where it is deemed appropriate.
Where a patient’s journey is not commencing at the location of the authorising practitioner, the practitioner has to be confident of the patient’s suitability for NEPT and the proposed NEPT acuity at the time of the transport. This is most likely to occur in situations where:
- the patient’s condition has been stable over an extended period, or
- the practitioner has been able to assess the patient by phone and has reasonable confidence in their assessment.
Enabling all levels of acuity to be used
NEPT regulations and protocols have been changed so that low acuity NEPT may be used for people with a mental illness where appropriate.
Low acuity NEPT services may have only one staff member who is a Certificate III qualified Patient Transport Officer. That staff member can undertake basic clinical observations and provide supervision and support during loading and unloading and handovers, but is mainly occupied by driving during transport.
Consequently, persons with a mental illness should only be transported by low acuity NEPT if they do not require observation or assistance during transport.
If they do require observation or assistance, they need to be accompanied.
Removing restrictions on restraint and sedation
NEPT regulations and protocols have been changed to remove restrictions on NEPT being used where persons with a mental illness require restraint or sedation during transport.
NEPT can now transport patients subject to the Mental Health Act who require restraint or repeat doses of sedation, or are significantly affected by sedation during transport. This is provided the patient is accompanied by someone authorised under the Mental Health Act to use the restraint or administer the sedation.
The changes do not allow NEPT staff to use restraint or administer sedation.
A patient requiring restraint
An authorised person needs to be physically present in the vehicle if a patient requires restraint.
A patient requiring sedation
If a person with a mental illness requires sedation during transport, a registered medical practitioner or a registered nurse or ambulance paramedic at the direction of a registered medical practitioner must administer it.
Typically, sedation is administered before transport commences.
If repeat doses of sedation are likely to be required during transport, the person needs to be accompanied by a registered medical practitioner or a registered nurse or an ambulance paramedic who has been authorised to administer the additional sedation.
Sedation for the purposes of safe transport
The Mental Health Act authorises the use of sedation if it is necessary to enable the safe transport of a person to or from a designated mental health service or any other place.
A registered medical practitioner may administer sedation to a person or direct a registered nurse or ambulance paramedic to administer sedation to the person if:
- all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable and
- the sedation to be administered is necessary to prevent serious and imminent harm to the person or to another person.
The appropriate level of acuity of NEPT is dependent on clinical presentation in accordance with NEPT regulations.
Where a person with a mental illness requires restraint or sedation, they need to be accompanied by an appropriate person (in accordance with the Mental Health Act), as described above.
Other considerations for patients requiring restraint or sedation may include:
- the equipment required (noting that the authorised person or an accompanying practitioner may bring some equipment with them)
- the level of assistance that the authorised person or accompanying practitioner requires (NEPT staff may assist someone administering restraint or sedation, but not provide the restraint or sedation themselves)
- the degree of sedation and the level of clinical monitoring required.
NEPT drugs and poisons certificates do not allow any NEPT staff, including registered nurses, to hold drugs for sedation.
Removing the restriction of compulsory, security and forensic patients
NEPT regulations and protocols have been changed so that it no longer matters whether the person is being transported under a provision of the Mental Health Act or the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997. This means that NEPT can be used for compulsory (formerly called involuntary), security and forensic patients when appropriate.
Patients may be able to be adequately supervised by NEPT personnel or accompanied by an authorised person to be appropriately transported.
Patients in police custody require police escort to travel by NEPT.
The changes increase the potential scope of NEPT services; it is up to each provider to determine if and when they expand the services they offer to clients.
NEPT providers are not legally required to provide all possible services allowed. For providers who specialise in standby services at events, or on industrial sites, the new provisions may not have any material impact on their services.
NEPT providers that work with Ambulance Victoria or health services should liaise with these agencies to manage any changes to their existing arrangements.