Supporting the NHS to Deliver Safe Mental Health Patient Transport
July 21, 2026
At A Glance
UK ambulance services spend around 1.8 million hours a year responding to mental health calls, without training built for the scale or complexity of those encounters.
- That figure is equivalent to roughly 75,000 days of emergency ambulance capacity each year
- A 2023 scoping review in the Journal of Paramedic Practice found paramedic training remains weighted towards trauma and physical emergency care
- Some patients in psychological distress are still conveyed in vehicles built to a Home Office Category B prisoner specification
- Secure 24 technicians are trained quarterly as a minimum through a four-level progressive framework
- Our fleet is purpose-designed for mental health conveyance, with safe spaces rather than cells
A mental health emergency rarely announces itself as one. It arrives as a welfare call, a missing person report, a collapse in a public place, a family member who cannot get someone to open a door. By the time a clinical decision has been made and conveyance is authorised, several services have already been involved, and the question of who physically moves the patient is often the last thing anyone plans for. That final step, the specialist mental health transport itself, is where this article sits.
In April 2020 Ebow Graham, a 40 year old musician, fell to his death during a mental health crisis. Hours earlier, despite visible distress and the concern of people around him, it was judged that he had capacity over his own care. An ambulance service and an NHS trust have since admitted failures. The case was reported by The Guardian, and reading it as an indictment of individual clinicians misses what it actually shows: a system under sustained pressure, making difficult judgements without the specialist resources those judgements depend on.
We work alongside NHS mental health and acute trusts every day, and the pressure is not abstract to us. What follows is the operational case for treating mental health conveyance as its own discipline, and what changes when it is.
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What Mental Health Patient Transport Actually Involves
Mental health patient transport covers a wider range of work than most people outside the sector expect. It includes conveyance following a Section 135 or 136 detention, planned admissions and discharges, inter-hospital transfers, out-of-area placements where no local bed exists, repatriations back to a home trust, and movement between secure units. Some journeys run twenty minutes. Others run six hours across three counties.
What unites them is that the journey itself carries clinical risk. A patient who was settled on the ward can become distressed in a vehicle. A patient who agreed to the transfer at eleven can change their mind at half past. The crew have to hold that situation, in a moving vehicle, often without a clinician present, for the whole duration.
This is why we treat conveyance as a specialist discipline rather than an extension of standard patient transport services. Three investments produce the difference: the training the crew receive, the vehicle they work in, and the recruitment decisions made long before either. Where one of those is missing, it shows up as an incident.
Paramedics Are Not the Answer, and That Is Not a Criticism of Paramedics
Paramedics provide emergency assistance and immediate clinical support to an extraordinary standard. Mental health intervention was never the job they were trained for, and the numbers show how far the demand has drifted from the training.
UK ambulance services spend approximately 1.8 million hours a year responding to patients with mental health problems, according to the NIHR Applied Research Collaboration East Midlands. That is the equivalent of around 75,000 days of emergency capacity. Against that volume, a 2023 scoping review published in the Journal of Paramedic Practice found that paramedic education remains predominantly focused on trauma and emergency physical healthcare, with limited emphasis on mental health.
Foundational mental health content exists in paramedic training. It is not proportionate to 1.8 million hours of exposure. In a service already running at the edge of its capacity, asking general ambulance crews to absorb specialist mental health conveyance on top of everything else is not sustainable, and in our experience it is not safe either.
Where the gap sits
The problem is capacity and training, not competence
An emergency crew arriving at a mental health call is being asked to do a job they were not resourced for, then hand over to a system that may not have a bed. Specialist conveyance does not fix bed shortages. It does remove one pressure point from a pathway that has very few left to give.
Our technicians are trained quarterly as a minimum through a four-level progressive framework delivered by our training arm, RISKA. The content covers Mental Health Act awareness, verbal de-escalation, dynamic risk assessment, restraint reduction and safeguarding. Physical intervention is taught, and taught properly, as the last option rather than the default one. You can read more about how that training framework is structured and why we run it at that frequency.
Compassion, respect and empathy are three of our six values, alongside safety, excellence and unity. Values are easy to print. What makes them operational is the training calendar that sits behind them.
Where does your mental health pathway lose time?
A 30 minute call with our operations team. We will walk through your conveyance points and flag where the friction actually sits, with no slide deck and no pitch.
Mental Health Is Not a Crime, and the Vehicle Should Not Suggest Otherwise
Some people experiencing mental illness are still transported in vehicles fitted with cells built to a Home Office Category B specification. Those vehicles were designed to contain prisoners securely, and at that job they work. They were never designed for a person in psychological distress, and nothing about the environment supports the calm that the situation needs.
For someone already frightened, being placed in a dark, hard, enclosed space is not a neutral experience. It communicates something about how the person is seen. Research cited by the Mental Health Foundation found that nearly nine out of ten people with mental health problems report that stigma and discrimination have had a negative effect on their lives, and one consequence is that people delay seeking help. A conveyance environment that feels custodial reinforces exactly the association that keeps people away from services.
The reason this persists is not indifference. It is procurement. Cost-led tendering rewards the lowest price per journey, and a vehicle built to a prisoner specification is cheaper to buy and cheaper to run than one designed around a patient. Where the specification does not name dignity, dignity is the first thing removed from the bid.
The distinction that matters most is the third row. Where a patient with challenging behaviour has to be managed in a seated position, the only tool available is prolonged restraint. A safe space allows the behaviour to be contained while the person stays free to move. That is the operational argument for the design, and it is why we will not compete on a specification that removes it.
What Purpose-Designed Mental Health Transport Looks Like
Every booking runs through our control room, which builds a risk profile before the crew leaves. That profile draws on the clinical information supplied by the referring team: presentation, history, known triggers, medication, whether police involvement is expected, whether a gender-matched crew is needed, whether the patient has been through a difficult conveyance before. The crew arrive knowing who they are meeting.
The vehicle they arrive in is one of our purpose-designed secure ambulances rather than a converted van. The safe space is finished in off-white powder coating so that light is maximised and the feel is clinical rather than custodial. Hinges are anti-finger-trap. Observation panels are Perspex, so the patient can see out and interact with the crew and does not experience the journey as isolation. Climate control is fitted because a hot, still vehicle escalates distress on its own.
None of these details are decorative. Each one exists because it removes a specific reason for a patient to become distressed, and each one reduces the likelihood that restraint becomes necessary. Those are the terms on which the fleet is specified.
Where police are involved, the handover is planned in advance rather than negotiated at the scene. Under Right Care, Right Person, officers are standing down from mental health calls that were never police work, and someone has to be the specialist replacement. We work with police forces on that handover so that the patient is not waiting in the back of a police vehicle while two agencies establish who is responsible.
Secure 24 is our number one provider for transporting our sectioned patients. The crews treat our patients with care and compassion by the crews, and they are meticulous in ensuring all paperwork is accurate and complete.
Sara Reeve
Logistics Coordinator, East Surrey Hospital Trust
Transport Belongs in the Care Pathway, Not After It
Mental health transport is usually the last line in a care plan and the first thing cut from a budget. The consequence is a pathway with a gap in the middle of it. A bed is found, the assessment is complete, the paperwork is signed, and the patient waits because no appropriate vehicle is available. A ward holds a bed it cannot fill. An A&E cubicle stays occupied. A police officer stays on scene for another three hours.
We cannot fix the bed shortage and we do not claim to. What we can do is make sure the conveyance element of the pathway is not the part that fails. That means answering the phone at three in the morning, giving honest mobilisation times, arriving with a crew who have read the risk profile, and completing the handover with paperwork that survives an audit.
Over a decade of doing this work with NHS trusts, ICBs and independent providers has left us with a clear position on what good looks like, which we set out in more detail on why trusts choose Secure 24. It is not a complicated standard. It is just an expensive one to hold, and the sector does not always reward holding it.
Building the business case?
Procurement pack: CQC report, RISKA training framework, fleet specifications, sample SLA.
Related reading
- Section 135 and 136 conveyance: How we support AMHPs and police from detention through to a place of safety.
- Our four-level training framework: What quarterly training covers and why de-escalation sits at the centre of it.
- Inside our secure ambulances: The safe space specification, from anti-finger-trap hinges to Perspex observation panels.
- Working with NHS trusts and ICBs: Commissioning routes, onboarding timescales and how dispatch integrates with ward teams.
Frequently Asked Questions
What Is Mental Health Patient Transport?
Mental health patient transport is the specialist conveyance of people experiencing mental illness or acute psychological distress between care settings. That includes Section 135 and 136 conveyance, admissions and discharges, inter-hospital transfers, out-of-area placements and repatriations. It differs from standard patient transport in three respects: the vehicle is designed to contain risk without restraint, the crew are trained in de-escalation and Mental Health Act awareness, and the journey is planned against a risk profile built before the crew departs.
Why Can NHS Ambulance Crews Not Simply Handle Mental Health Conveyance?
They can and frequently do, but the training does not match the demand. UK ambulance services spend around 1.8 million hours a year responding to mental health calls, and a 2023 scoping review in the Journal of Paramedic Practice found paramedic training remains focused on trauma and emergency physical healthcare with limited mental health content. Paramedics provide excellent emergency clinical care. Asking a stretched emergency service to also deliver specialist mental health conveyance stretches it past what is safe.
How Do You Get Someone Sectioned Under The Mental Health Act?
Detention under the Mental Health Act 1983 is a clinical and legal decision, not one a transport provider can make or arrange. An assessment is carried out by an Approved Mental Health Professional working with two doctors, one of whom is usually Section 12 approved. If you are worried about someone right now, contact their GP, the local crisis team, or NHS 111 and select the mental health option. In an emergency where there is immediate danger to life, call 999. Secure 24 becomes involved once conveyance has been authorised by the clinical team.
What Is A Category B Vehicle And Why Does It Matter For Patients?
Category B refers to a Home Office prison categorisation, and the cellular vehicles built to that standard were designed for secure containment of prisoners. Some mental health patients are still moved in vehicles built to that specification. The vehicles do their job, but they were never intended for someone in psychological distress and the environment works against the calm the situation needs. Our safe spaces are built to a different brief: powder coated in an off-white finish to maximise light, with anti-finger-trap hinges, Perspex observation panels and climate control.
Does Secure 24 Work Directly With NHS Trusts And ICBs?
Yes. We work with NHS mental health trusts, acute trusts and Integrated Care Boards, alongside private hospital groups, local authorities, police forces, courts and prisons and care homes. Work is commissioned through preferred-supplier arrangements, framework agreements and direct booking. Onboarding takes around ten working days and covers paperwork, induction and dispatch integration.
How Quickly Can A Specialist Crew Reach A Ward Or Scene?
Our control room is staffed 24 hours a day with an average call answer time of under one minute. Mobilisation depends on your location and crew availability at the time of booking, and it is fastest within our established strongholds in East Surrey, West Sussex, Hampshire and the Isle of Wight. Our dispatch team will give you a realistic mobilisation time when you call 0330 320 1159 rather than an optimistic one.
What Training Do Secure 24 Technicians Receive?
Our technicians are trained quarterly as a minimum through a four-level progressive framework delivered by our training arm, RISKA. It covers Mental Health Act awareness, verbal de-escalation, dynamic risk assessment, restraint reduction, safeguarding and physical intervention as a last resort. The emphasis sits on the skills that prevent escalation rather than the skills that respond to it.
Can Secure 24 Support A Mental Health Act Assessment In The Community?
Yes. Our crew can attend a community assessment and stand by while the AMHP completes their work, taking over once conveyance is required. Where police are involved under Section 135 or 136, we plan the takeover in advance so the handover at scene is clean and the patient is not left waiting while agencies negotiate responsibility.
