Mental Health Is Not a Crime: Why NHS Patients in Crisis Deserve Purpose-Built Transport

The vehicle a patient travels in during a mental health crisis is not a neutral detail. It is part of the clinical environment. It shapes the patient’s experience of the system at the moment they are most vulnerable. And for too long, the vehicle the sector has defaulted to has been built around containment rather than care.

The consequence of that default is visible in the data and in the case records. It is visible in the Mental Health Act 1983 Code of Practice requirement that conveyance be carried out with dignity and the least restrictive means available. And it is visible in the gap between what that principle requires and what most of the sector currently delivers.

What Happens When the System Is Not Built for the Patient

In April 2020, Ebow Graham, a 40-year-old musician, fell to his death during a mental health crisis. Hours earlier, despite visible signs of acute distress, it had been determined that he retained capacity over his care. He was not transported to specialist support. The case reflected systemic underinvestment in the training, protocols and transport infrastructure needed to manage mental health emergencies: an underinvestment that persists across the sector.

In 2025, NHS ambulance services spend 1.8 million hours annually responding to patients with mental health problems. That is 75,000 working days of clinical capacity directed at a patient group that standard paramedic training is not designed to serve. A 2023 scoping review published in the Journal of Paramedic Practice confirmed what those working in the field already know: paramedic training provides limited preparation for the frequency, complexity and clinical nuance of mental health presentations.

What Purpose-Built Mental Health Transport Actually Looks Like

There is a difference between a vehicle designed around containment and one designed around the patient. That difference is visible the moment you open the doors.

The vehicle

The standard secure ambulance on the market uses Category B cell design: the same Home Office designation used for convicted prisoners awaiting transfer. Metal bars, dark interiors, no visual connection between patient and crew. For someone in acute psychological distress, this environment deepens the crisis rather than containing it. Research from the Mental Health Foundation shows that nearly 9 in 10 people with mental health problems report that stigma and discrimination have adversely affected their lives. A vehicle indistinguishable from a prison van is stigma made structural.

Our Cell Secure Ambulance replaces the barred cell with full-height reinforced Perspex panels, transparent throughout, so the patient retains visual connection to the crew at all times. The interior is powder-coated white with a clinical feel, not grey or institutional. Climate control maintains comfort in the patient compartment. Anti-finger-trap hinges remove a common injury risk. Adjustable mood lighting supports de-escalation. Nine-camera HD recording with audio covers every moment of the journey, providing a complete audit trail that protects both the patient and the crew.

The crew

Secure 24 recruits specifically for mental health risk management. Our secure technicians go through a four-level progressive training framework delivered by RISKA: covering de-escalation, trauma-informed communication, the Mental Health Act 1983 and Sections 135/136, safe physical intervention as a proportionate last resort, and the operational specifics of each vehicle class. Training is refreshed quarterly as a minimum. Monthly team development sessions run year-round. Every crew includes at least one blue-light-trained member. Enhanced DBS checks are standard for all staff.

The dispatch

Every job is handled through our control room, which builds a risk profile before the crew departs. The referring clinical team provides the relevant patient information: presentation, history, risk markers, contraindications. Our dispatch team matches vehicle class, crew size and equipment to that profile. A patient who needs a standard secure ambulance does not arrive in a Cell Secure. The matching is risk-led, not availability-led.

What Purpose-Built Transport Changes for NHS Trusts

For NHS clinical commissioners and patient safety leads, the practical implications of getting mental health transport right are measurable:

• Restrictive interventions in transit reduce: the vehicle design removes the need for prolonged restraint as the only available containment method
• The audit trail is complete and defensible: CCTV with audio, body-worn video, dispatch records, if a coroner, CQC or board asks for it
• AMHP confidence in transport partnerships improves: handovers happen as planned, at the right vehicle class, with the right crew
• Family and patient complaints reduce: the vehicle does not resemble a custody suite
• Staff injury rates in transit reduce: crews are trained for the specific patient group they are transporting

Category B Prison-Cell Vehicle vs. Secure 24 Cell Secure Ambulance

Feature	Category B cell vehicle	Secure 24 Cell Secure Ambulance
Original design	Home Office specification for convicted prisoners	Purpose-built for patients in mental health crisis
Patient compartment	Metal bars, no visual link to the crew	Full-height reinforced Perspex; the patient sees and speaks to the crew throughout
Interior	Dark and institutional	Powder-coated white, climate controlled, adjustable mood lighting
Injury prevention	Containment-focused	Anti-finger-trap hinges and a de-escalation environment
Recording	Limited or none	Nine-camera HD recording with audio across the whole journey
Effect on the patient	Reinforces stigma and can deepen the crisis	Supports dignity and a calmer arrival at the place of safety

Why Paramedics Cannot Fill the Specialist Transport Gap

Paramedics are highly skilled professionals. Their role: emergency clinical response, immediate physical healthcare, trauma management, is clearly defined and demands a specific depth of training to do well. That role does not include specialist mental health transport.

The 1.8 million hours NHS ambulance services spend annually on mental health calls are hours directed at a patient group that paramedic training does not prepare them to serve. Volume targets push generalist services to absorb mental health jobs because the capacity has to come from somewhere. Undertrained crews in inappropriate vehicles, without the de-escalation framework and the operational experience to apply it under pressure, produce incidents. Those incidents generate paperwork, complaints, regulatory scrutiny and legal exposure. They cost the commissioning trust more than the specialist contract would have.

Related reading

• When a Community Is Strong, Recovery Is Possible: how specialist transport connects the mental health network, 24 hours a day
• Ward Assist and Bed Watch: how active engagement from trained secure technicians protects patients and staff on the ward
• Section 135/136 Support: specialist conveyance under the Mental Health Act: what it looks like in practice
• Secure Ambulance: vehicle classes, the Perspex safe space, and how vehicle matching works

Related services

• Ward Assist and bed watch: trained secure technicians providing active ward supervision

Frequently asked questions

How is Secure 24 different from a standard NHS ambulance service?

NHS ambulance services are built for emergency physical healthcare across all call types. Secure 24 is a specialist mental health transport provider: our vehicles, training, dispatch and crew profile are all built specifically for patients with mental health conditions, complex needs and challenging behaviours.

Are your vehicles genuinely different from competitors’ secure transport?

The standard across most of the secure transport market is a vehicle adapted from a Category B prison-cell design: metal bars, dark interior, no visual connection to the crew. Our Cell Secure Ambulance uses full-height reinforced Perspex panels instead of bars, so the patient can see and communicate with the crew throughout. The interior is white, climate-controlled and designed around patient dignity rather than containment.

How do you ensure staff are trained for mental health specifically?

Our secure technicians complete a four-level progressive training framework through RISKA, our specialist training partner. The framework covers de-escalation, trauma-informed communication, the Mental Health Act 1983, safe physical intervention as a proportionate last resort, and the operational specifics of each vehicle class. Training is refreshed quarterly as a minimum. Monthly development runs year-round.

Can you transport patients detained under the Mental Health Act?

Yes. We provide specialist transport for patients detained under Section 135, Section 136 and other provisions of the Mental Health Act 1983. Our staff are trained in the legislative framework and the protocols applicable to each detention type. We coordinate with AMHPs, police and receiving facilities to ensure every handover is clean, legally compliant and documented.

How does commissioning work with NHS trusts?

We work with NHS trusts on both a spot-purchase and contracted basis. For trusts with frequent transport needs, we offer service level agreements with priority response and pre-agreed terms. Larger multi-year procurement contracts are available for NHS trusts and ICBs procuring through NHS SBS or regional frameworks. Onboarding typically takes around ten working days.

Do you have CQC registration?

Yes. Secure 24 is registered with the Care Quality Commission and rated GOOD across all service areas. Our CQC registration scope and inspection record are available on request. Contact info@secure24.org.uk for the relevant documentation.

Is the Cell Secure Ambulance used for every patient, or do you match the vehicle to the case?

We match the vehicle to the case. A patient who needs the highest level of secure conveyance travels in the Cell Secure Ambulance; a patient whose risk profile calls for a standard secure ambulance is not placed in a higher-security vehicle unnecessarily. The matching is risk-led, decided by our control room from the clinical information provided before the crew departs, never by whatever happens to be available.

What areas of the UK do you cover for secure mental health transport?

We provide UK-wide coverage, with established operational strongholds in East Surrey, West Sussex, Hampshire and the Isle of Wight where response is fastest. For locations outside these areas, coverage depends on crew availability at the time of booking. Call our control room on 0330 320 1159 and we will confirm availability and mobilisation time for your area.