Mental health conditions are becoming an increasingly common consideration in international medical transport.

In addition, mental health transport is challenging to provide. On the one hand, it requires providing quality medical assistance. For air ambulance providers, these missions present a particular challenge: how to ensure patients receive the care they need while protecting their dignity, respecting their rights and maintaining the safety of everyone involved.

While some other illnesses can be estimated easily in the case of a patient's assessment, psychiatric patients' condition and willingness to be transported may change suddenly over time.

At MTI 24/7, we have found some of the most important decisions in mental health transport take place long before the patient boards the aircraft.

Understanding the patient beyond the diagnosis

One of the critical questions in the assessment of psychiatric patients is whether they are at risk of harm. Is the patient at risk of harming themselves? Could their behaviour present a danger to medical personnel, flight crew or others?

Such questions are inevitable in working with patients with mental health issues, however, it should be understood the patient does not have to be potentially violent or aggressive just in virtue of the disease.

Thus, it is crucially important for medical air ambulance providers to estimate the patient's current mental status, not only his/her past history.

All of the information that medical providers receive from the psychiatrists, hospital personnel, or family members can prove invaluable for this kind of mission.

How changing environments affect patients

Another issue that often is not paid attention to by air ambulance transport providers but proves to be extremely vital – the change of environments the patient undergoes.

Consider that someone has spent several weeks in the hospital with mental illness. He/she knows the medics and doctors, understands the routine procedures and gets accustomed to the hospital.

But what happens when you tell this patient to leave the familiar territory, get into the ambulance, visit the airport and then fly to another country on an aircraft? Every change of environment implies a variation of surroundings and people, new sounds and expectations.

In some cases, the result of the changed surroundings might appear in such forms as shouting, swearing, spitting, refusal to co-operate and many other things that might raise security issues.

And here, the medical transport team should think and act with great judgment. What may appear manageable inside the hospital might become completely out of control on board an aircraft.

The legal and ethical challenges of patient consent

However, in my opinion, the most challenging part of air ambulance transport with the patients with psychiatric problems is related to their consent to travel.

What happens when a patient needs treatment abroad but does not want to travel? What if family members believe repatriation is necessary while the individual refuses?

Furthermore, patients with psychiatric problems may be prone to changing their mind. They can give their consent to the transport beforehand but may retract their consent once the time to travel has come.

The necessity of medical transportation does not imply the obligation to provide the service. Moreover, this situation might concern the use of sedation if the patient is not willing to be transported and starts acting aggressively.

Sedation cannot be used merely to overcome a patient's refusal to travel, as doing so without appropriate consent or legal authorisation could have serious legal consequences.

Preparing medical teams and flight crews

Once the mission to transport the patient is accepted as appropriate, thorough preparation is required. The medical team should correspond to the patient's condition, risks of aggression and necessary measures of medical treatment.

Communication with the treating facility is extremely important. The medical team should know about the recent incidents of agitation or self-harm risks of the patient, his medication and the ways to calm him down.

Some measures can prove very useful. Explaining each step of transportation, limiting additional people and reducing sensory stimulation can reduce the patient's stress.

Pilots should have all necessary information on cabin safety and contingency procedures, with a clear plan in place to respond if the patient's condition or behaviour changes during the flight.

Knowing when not to fly is part of responsible care

In medical aviation, there is often understandable pressure to transport patients quickly. Families may be desperate to bring loved ones home, while hospitals may be seeking access to specialised treatment.

Yet mental health transport requires balancing urgency with restraint.

If a patient's condition is deteriorating, their behaviour presents an unacceptable safety risk or legal authorisations are absent, postponing the mission may be the most responsible decision.

We must also avoid allowing safety concerns to reinforce misconceptions about psychiatric patients. Most individuals experiencing mental health conditions are not violent and decisions should reflect their actual circumstances rather than assumptions associated with a diagnosis.

As these requests become more common in our operations, I believe the industry must continue improving its approach to patient assessment, informed consent and co-ordination between medical and aviation professionals.