Key messages

• neighbourhood health and care models must embed mental health support within local multidisciplinary teams
• separating mental health from neighbourhood delivery risks perpetuating inequities in access and outcomes
• prevention and early support are central to reducing crisis demand
• community engagement and co-production are important for designing responsive neighbourhood services
• mental health integration should be treated as a core component of neighbourhood care.

Policy implications

• neighbourhood teams should include mental health expertise as standard
• commissioning and workforce planning may need to support integrated mental, physical and social care delivery
• prevention-focused approaches at neighbourhood level could reduce pressure on crisis services
• equity goals depend on addressing mental health alongside other aspects of care.

Gaps

• limited evaluative evidence on outcomes of neighbourhood mental health integration
• lack of data on workforce capacity to deliver integrated models
• limited insight into how integration affects inequalities over time.

Commentary
This paper positions mental health as fundamental to the success of neighbourhood health and care. By arguing against separating mental health from physical and social care, it highlights how fragmented delivery can reinforce existing inequities.

The focus on prevention and early intervention aligns with neighbourhood approaches that aim to support people closer to home. From a care equity perspective, integrating mental health within neighbourhood teams may improve access for groups who face barriers to specialist or crisis-based services.

The emphasis on community engagement and co-production reflects the importance of trust and local relevance in neighbourhood delivery. Without meaningful involvement, neighbourhood models risk replicating top-down approaches that fail to meet local needs.

Overall, the paper reinforces that neighbourhood health and care cannot deliver equitable outcomes without addressing mental health as an integral part of integrated, place-based support.

Key statistics 

• the study analysed ambulance attendances for mental health emergencies in rural England during the COVID-19 pandemic using routinely collected ambulance service data 

• people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises compared with people living in urban areas 

• rural ambulance services experienced longer response times and greater travel distances when responding to mental health emergencies 

Key messages 

• mental health emergencies attended by ambulance services increased during the COVID-19 pandemic 

• people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises 

• rural ambulance services face operational challenges including longer travel distances and response times 

• limited access to specialist mental health services in rural areas increases reliance on ambulance responses for crisis situations 

Policy implications 

• strengthen community-based mental health support in rural areas to reduce crisis presentations 

• improve integration between ambulance services, mental health teams and community services 

• invest in rural mental health services to reduce reliance on emergency responses 

• develop targeted crisis response pathways for rural populations 

Gaps  

• the study focuses on ambulance attendances and does not capture individuals who experienced mental health crises but did not contact emergency services 

• the analysis is limited to the COVID-19 pandemic period and may not reflect longer-term trends in rural mental health emergencies 

• the research focuses on ambulance service data and does not include patient outcomes following emergency response 

• further research is needed to understand how service availability affects crisis presentations in rural communities 

Commentary 
This study examines mental health emergencies attended by ambulance services in rural England during the COVID-19 pandemic. Ambulance services often act as the first point of contact for people experiencing acute mental health crises, particularly when other services are difficult to access. 

The findings show that people attended by ambulances in rural areas were more likely to present with behavioural disturbance, suicidal thoughts or actions, and anxiety-related crises. These types of emergencies often require specialist mental health support, yet access to such services can be more limited in rural areas. 

Rural ambulance services also face practical challenges that differ from urban settings. Longer travel distances, fewer nearby healthcare facilities and limited availability of specialist services can affect response times and the type of support that can be provided during an emergency. 

During the COVID-19 pandemic, many community and mental health services experienced disruption. As a result, ambulance services often became an important entry point into care for people experiencing acute distress. 

From a health and social care equity perspective, the study highlights how geographical location can shape access to crisis support. People living in rural areas may have fewer options for urgent mental health care and may rely more heavily on emergency services. This can place additional pressure on ambulance services and may delay access to specialist support. 

Overall, the findings suggest that improving access to community mental health services and crisis support in rural areas could reduce reliance on emergency responses and help ensure more equitable access to mental health care.