Chaiwat Duangkem receives a bone-chilling call from a frantic woman, whose mentally unstable husband is in the middle of committing suicide. As team leader at privately owned ambulance service Medical Safety Team (MST) Thailand, which caters largely to mentally ill individuals, he learns that members of the patient's family restrained the hallucinating man, who is profusely bleeding from a self-inflicted wound but refuses to go to the hospital, before calling MST as their last resort.
The wife relates to Chaiwat that for two nights, her middle-aged spouse, who suffers from bipolar disorder, has been binge drinking. Coupled with the fact that he had stopped taking his medication for a month, his mental condition deteriorated to this evening, all the while his family being unable to coax him to seek medical assistance.
Chaiwat and his assistant gather further information about the man's medical history, basic physical measurements and number of entrances to the house before jumping into a standby ambulance.
"Prior to reaching the residence, we need a clear picture of what we are dealing with. Every minute counts, so the best we can do is access the situation as it unfolds," said Chaiwat. The ambulance is equipped with all the facilities the aforementioned individual might need when they meet him in person.
"By the time we reach the patient's doorstep, we should be ready to start our mission," he explained. "Time is of the essence, because the emotionally unstable can often behave erratically, putting their life and those around them in jeopardy. We prioritise safety, both for the patient and for ourselves."
Just as the ambulance turns into the housing estate on Chaengwattana Road, both men get to work. Chaiwat knows he needs to work fast as the patient continues to lose blood. When all their attempts to negotiate fail, they know the only way to subdue him and get the weapon out of his hands would be to charge. And that is exactly what they do, tying the man with a piece of rope.
While performing First Aid on the man's gaping wound, they calm him down with words of assurance, telling him he has the support of both his family and doctors to see him through this tough time. The conversation between Chaiwat and the patient becomes more cordial on the way to the hospital, where he is then admitted to the relief of his family.
The Medical Safety Team (Thailand) regularly has missions like these, trying to help rescue suicidal individuals from harming themselves. Troubled rock singer Seksan Sookpimay, or Sek Loso, who has suffered from bipolar disorder for years and an equally long drug addiction, was also taken to hospital by the team following his marathon Facebook Live session at his Sai Mai home last month, which sparked concerns that he would harm himself.
It was Theerapong Laksanawong and his team who led the three-day mission to bring the celebrity to the hospital.
Chaiwat, who went with Theerapong on the mission, explained how that case unfolded, saying: "In Sek's case, we had to construct an airtight plan, because he was in dire straits both physically and emotionally, so we needed to work fast.
"As he is passionate about donating money for a good cause, we were able to meet him disguised as a non-profit organisation. When inside his home, we had to also ascertain that there was no objects near him which could become a potential weapon if he decided to retaliate.
"When we introduced ourselves, he looked surprised and displayed aggression, that is when we charged in to subdue him. He knew it was futile to resist and soon afterwards he agreed to go with us to the hospital."
A lion's share of the cases Medical Safety Team takes on involve psychiatric patients that are being treated at government hospitals. The private ambulance service has three branches in Bangkok, two in the South and two in the Northeast. They claim to be 30% cheaper than ambulance services in private hospitals. It is also their company policy to waive charges for low income families.
"Our ambulances have everything a hospital ambulance would have; while our staff have experience working in hospitals in various capacities. We also have medical staff on standby when needed," remarked Chaiwat.
"What we don't have in common with hospital ambulances is probably the public recognition. Without batting an eyelash, anyone would pick a hospital ambulance over us when the need arises, because you have the impression it is the best choice.
"Where we differ is the service. We believe the client is our family member. We have a heart of service. I bet this is an area that will support a person's decision to use our service when an emergency arises."
From Chaiwat's experience, drug addiction is the major cause for their patients' mental instability and suicidal episodes. Experience has also taught him that the more time he takes trying to persuade patients to go to the hospital with him, the more aggressive they become. By restraining them first, he said, they are able to calm down to a point, where they listen to reason.
One of the biggest hurdles his assistants often face when dealing with patients who still live at home are family members. "When some parents watch us restrain their child by tying their hands with a rope, they get soft-hearted and tell us to release them. That is why our mission goes beyond the line of duty. So our work involves not just using psychology with patients, but also parents."
Sharing one of his biggest concerns, Chaiwat remarked that government psychiatric hospitals customarily don't encourage patients be admitted for overnight observation if their condition is not life-threatening. Based on the cases he has worked so far, however, he believes that this is more often than not required.
Individuals "that we service are in a serious state otherwise they would have willingly come to see the doctor. They also have a tendency to come across as being coherent enough to be classified as outpatients when they are evaluated by psychiatrists, so after receiving their medication they are allowed to go home. "This is risky because a significant amount of them go back to their old ways, and we end up being called the next day. That is why I would recommend that patients brought to the hospital by ambulance be admitted overnight for observation.
"Some who might sound coherent at first might at a later stage show serious signs of a psychiatric disorder that previously didn't manifest.
"If left untreated, my fear is that they might develop suicidal tendencies, which I have seen a sudden increase in."
Chaiwat also suggests families take better care of their mentally ill spouses and children.
"There has to be someone in the house who sees to it that the patient takes their medication regularly and has a healthy lifestyle. Alcohol and drugs should be kept at bay. Society as a whole should pay more attention to mental health.
"As the saying goes, prevention is better than cure."
The Medical Safety Team (Thailand) can be contacted at 095-527-4277 or 091-172-7300.
