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Mental health emergencies attended by ambulance services in rural England

A study examining mental health-related ambulance callouts in rural England during the COVID-19 pandemic, highlighting differences in presentations and service pressures compared with urban areas.

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.

Health and wellbeing challenges in rural England

A report examining health outcomes, deprivation and service access in rural England, highlighting hidden health inequities and the need for locally tailored public health strategies.

Key statistics 

  • 19% of England’s population lives in rural areas, yet these areas cover around 85% of the country’s land area 
  • people living in rural areas generally have better overall health outcomes than those in urban areas, including longer life expectancy 
  • however, rural areas contain small pockets of significant deprivation and poor health outcomes that may be hidden within overall averages 
  • rural populations tend to be older on average, with higher proportions of residents aged 65 and over compared with urban areas 
  • the sparsity of rural populations and greater travel distances can affect access to services, employment and support networks 

Key messages 

  • overall health indicators in rural England often appear favourable, but they can mask significant local variations in deprivation and health outcomes 
  • rural populations are typically older, increasing demand for health and social care services 
  • geographic sparsity and distance between communities can influence access to services and support 
  • local authorities need detailed knowledge of rural populations to identify hidden health challenges 
  • better local data and more granular statistics are needed to reveal health disparities within small rural communities 

Policy implications 

  • improve local data collection to identify hidden deprivation and health needs in rural areas 
  • develop rural-specific public health strategies rather than relying on national averages 
  • strengthen collaboration between health services, social care providers and local authorities in rural communities 
  • consider transport, service accessibility and population ageing when planning rural services 
  • support community-based approaches that address local health needs in dispersed populations 

Gaps 

  • national and regional statistics often mask variation within rural communities 
  • limited granular data exists on health outcomes in smaller rural settlements 
  • further research is needed to understand how service accessibility affects health outcomes in rural areas 
  • more evidence is needed on the effectiveness of rural-focused public health interventions 

Commentary 

This report examines the health and wellbeing of people living in rural England and highlights the complexity of rural health outcomes. Rural areas cover most of England’s land area but contain a relatively small proportion of the population. Despite this, rural communities play an important role in the national health and social care landscape. 

On average, people living in rural areas experience better overall health outcomes than those living in urban areas. For example, life expectancy tends to be higher and some health indicators appear more favourable. However, these averages can hide important differences within rural communities. 

The report emphasises the presence of “hidden deprivation” in rural areas. Small pockets of poverty and poor health may exist within otherwise affluent rural districts. Because rural populations are smaller and more dispersed, these issues may be less visible in national or regional statistics. 

Rural populations also tend to be older than urban populations. Higher proportions of residents aged 65 and over increase demand for health and social care services, including community support and long-term care. 

Geography plays an important role in shaping access to services. Rural communities often experience longer travel distances to healthcare facilities, fewer public transport options and limited availability of specialised services. These factors can make it more difficult for people to access timely support. 

From a health and social care equity perspective, the report highlights the importance of recognising rural diversity. While some rural areas experience strong health outcomes, others face significant challenges linked to deprivation, ageing populations and limited service access. 

The report argues that local authorities need detailed understanding of their rural populations in order to identify and address these challenges. More granular data and locally tailored policies may help ensure that rural communities receive appropriate support and that hidden inequities in health and wellbeing are addressed. 

Recruitment and retention challenges in adult social care

A study examining recruitment and retention challenges in adult social care services in England, including workforce mobility, rural employment barriers and the role of commissioning and labour market conditions.

Key statistics 

  • the adult social care workforce in England includes around 1.47 million jobs (at the time of publication), making it one of the largest employment sectors in the country 
  • the sector experiences high staff turnover and vacancy rates, reflecting ongoing recruitment and retention challenges 
  • competition with other sectors, including the NHS and retail, contributes to recruitment difficulties because these sectors may offer higher pay or more predictable working conditions 
  • some rural areas report additional recruitment barriers linked to travel requirements and limited public transport, meaning staff often need access to personal vehicles to undertake care roles 

Key messages 

  • recruitment and retention difficulties in adult social care are longstanding and influenced by pay, working conditions and labour market competition 
  • local labour market conditions and geography influence the ability of providers to recruit and retain staff 
  • rural areas may face additional workforce barriers due to travel distances and limited public transport 
  • care providers have limited control over service prices, which affects their ability to improve pay and working conditions 
  • diversifying the workforce, including attracting groups currently underrepresented in social care employment, may help strengthen workforce sustainability 

Policy implications 

  • improve pay, working conditions and career development opportunities within adult social care 
  • strengthen workforce planning across health and social care sectors 
  • consider transport and travel barriers when planning workforce strategies in rural areas 
  • clarify the role of local authorities in market shaping and supporting workforce sustainability 
  • develop initiatives to attract a wider range of people into the social care workforce 

Gaps 

  • much of the evidence is based on interviews and stakeholder perspectives rather than large-scale workforce data 
  • the study focuses primarily on England and may not fully reflect workforce conditions in other UK nations 
  • limited evidence is presented on the long-term effectiveness of specific recruitment or retention interventions 
  • further research is needed on how workforce policies affect regional workforce stability 

Commentary 

This study explores the challenges involved in recruiting and retaining staff in adult social care services in England. The social care workforce is large and diverse, yet the sector continues to experience difficulties attracting and retaining staff. 

Low pay and demanding working conditions are commonly cited reasons why people leave social care roles. Care providers must also compete with other sectors such as the NHS, hospitality and retail, which may offer higher wages or more stable working hours. These labour market pressures can make it difficult for social care employers to recruit and retain staff. 

Geography also influences workforce recruitment. In rural areas, care workers often need to travel between people’s homes to provide support. Where public transport is limited, workers may need access to a personal vehicle to take up these roles. This requirement can limit the pool of potential staff and make recruitment more difficult for rural providers. 

The report also highlights the influence of commissioning and funding arrangements. Social care providers often have limited control over service pricing because fees are set through local authority commissioning processes. When funding levels are constrained, providers may struggle to improve pay, invest in training or create more stable working conditions. 

From a health and social care equity perspective, workforce shortages can affect the availability and quality of care services. Areas that face greater recruitment challenges may experience reduced service capacity or higher staff turnover, which can affect continuity of care for people receiving support. 

Overall, the report suggests that improving recruitment and retention will require coordinated action across workforce policy, funding arrangements and labour market conditions. Addressing these issues is important for building a sustainable social care workforce and ensuring equitable access to care services across different regions.