References

Arksey H, O'Malley L Scoping studies: towards a methodological framework. Int J Social Res Methodol. 2005; 8:19-32 https://doi.org/10.1080/1364557032000119616

Briggs H, Clarke S, Rees N Mental health assessment and triage in an ambulance clinical contact centre. J Paramed Pract. 2021; 196-203 https://doi.org/10.12968/jpar.2021.13.5.196

Clough AR, Evans A, Graham V Emergency examination authorities in Queensland, Australia. Emerg Med Australas. 2023; 35:(5)731-738 https://doi.org/10.1111/1742-6723.14201

College of Paramedics. 2024. https://tinyurl.com/3mjdx4f8

Department of Health and Social Care. 2024. https://tinyurl.com/3fy58aem

Ditton-Phare P, Halpin S, Sandhu H Communication skills in psychiatry training. Australas Psychiatry. 2015; 23:(4)429-431 https://doi.org/10.1177/1039856215590026

Duncan EAS, Best C, Dougall N Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study. Scand J Trauma Resusc Emerg Med. 2019; 27:(1) https://doi.org/10.1186/s13049-019-0611-9

Ellis IK, Philip T Improving the skills of rural and remote generalists to manage mental health emergencies. Rural Remote Health. 2010; 10:(3) https://doi.org/10.22605/RRH1503

Emond K, O'Meara P, Bish M Paramedic management of mental health related presentations: a scoping review. J Ment Health. 2019; 28:(1)89-96 https://doi.org/10.1080/09638237.2018.1487534

Emond K, Bish M, Savic M Characteristics of confidence and preparedness in paramedics in metropolitan, regional, and rural Australia to manage mental-health-related presentations: a cross-sectional study. Int J Environ Res Public Health. 2021; 18:(4) https://doi.org/10.3390/ijerph18041882

Ferguson N, Savic M, McCann TV ‘I was worried if I don't have a broken leg they might not take it seriously’: experiences of men accessing ambulance services for mental health and/or alcohol and other drug problems. Health Expect. 2019; 22:(3)565-574 https://doi.org/10.1111/hex.12886

Ford-Jones PC Enhancing safety and mitigating violence on prehospital mental health calls: for the care providers and care recipients. Can J Commun Ment Health. 2023; 42:(2)17-31 https://doi.org/10.7870/cjcmh-2023-014

Ford-Jones PC, Daly T Paramedicine and mental health: a qualitative analysis of limitations to education and practice in Ontario. J Ment Health Train Educ Pract. 2020; 15:(6)331-345 https://doi.org/10.1108/JMHTEP-05-2020-0031

Ford-Jones PC, Daly T Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada. Health Soc Care Community. 2022; 30:(2)744-752 https://doi.org/10.1111/hsc.13189

Gee B, Nicholls H, Rivett S, Clarke T, Wilson J, Prothero L ‘Very hit and miss’: an interpretive phenomenological analysis of ambulance service care for young people experiencing mental health crisis. Br Paramed J. 2022; 7:(1)43-50 https://doi.org/10.29045/14784726.2022.06.7.1.43

Genziani M, Gillard S, Samuels L, Chambers M Emergency workers’ experiences of the use of section 136 of the Mental Health Act 1983: interpretative phenomenological investigation. B JPsych Bull. 2020; 44:(6)250-254 https://doi.org/10.1192/bjb.2020.21

Hammarbäck S, Holmberg M, Wiklund Gustin L, Bremer A Ambulance clinicians’ responsibility when encountering patients in a suicidal process. Nurs Ethics. 2023; 30:(6)857-870 https://doi.org/10.1177/09697330221149102

Mental health, JRCALC Plus clinical guide. 2023;

Jones M, Clarke S, Amphlett S Reducing the burden on Welsh ambulance services and emergency departments: a mental health 999 clinical support desk initiative. Emerg Nurse. 2024; 32:(5)14-19 https://doi.org/10.7748/en.2024.e2195

Keefe B, Carolan K, Wint AJ, Goudreau M, Scott Cluett W, Iezzoni LI Behavioral health emergencies encountered by community paramedics: lessons from the field and opportunities for skills advancement. J Behav Health Serv Res. 2020; 47:(3)365-376 https://doi.org/10.1007/s11414-020-09687-Erratum

King SC, Rebar AL, Oliveri P, Stanton R Australian paramedic students’ mental health literacy and attitudes towards mental health. J Ment Health Train Educ Pract. 2022; 17:(1)61-72 https://doi.org/10.1108/JMHTEP-03-2021-0027

Knowles E, Long J, Turner HJ Reducing avoidable ambulance conveyance in England: interventions and associated evidence. Prepared for NHS England and NHS Improvement/ University of Sheffield. 2020; https://tinyurl.com/mt23hem2

McCann TV, Savic M, Ferguson N Paramedics’ perceptions of their scope of practice in caring for patients with non-medical emergency-related mental health and/or alcohol and other drug problems: a qualitative study. PLoS One. 2018; 13:(12) https://doi.org/10.1371/journal.pone.0208391

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018; 18:(1) https://doi.org/10.1186/s12874-018-0611-x

National Institute for Health and Care Research Applied Research Collaboration East Midlands. 2024. https://tinyurl.com/2wfuct8f

NHS Digital. 2016. https://tinyurl.com/2avmdu8p

Office for National Statistics, Coronavirus and depression in adults, Great Britain: July to August 2021. 2021. https://tinyurl.com/y7fcajkp

Parent A, Smith R, Townsend R, Johnston T Mental health education in Australian paramedic curriculum—a scoping review. Australasian Journal of Paramedicine. 2020; 17:1-9 https://doi.org/10.33151/ajp.17.791

Patterson C, Curtis J, Reid A Skills, knowledge, and attitudes expected of a newly-graduated mental health nurse in an inpatient setting. Int J Ment Health Nurs. 2008; 17:(6)410-418 https://doi.org/10.1111/j.1447-0349.2008.00572.x

Phillips P, Trenoweth S Crossing the ‘flaky bridge’—the initial transitory experiences of qualifying as a paramedic: a mixed-methods study. Br Paramed J. 2023; 8:(1)18-27 https://doi.org/10.29045/14784726.2023.6.8.1.18

Rees N, Porter A, Rapport F, Hughes S, John A Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology. PLoS One. 2018; 13:(10) https://doi.org/10.1371/journal.pone.0205813

Rolfe U, Pope C, Crouch R Paramedic performance when managing patients experiencing mental health issues—exploring paramedics’ presentation of self. Int Emerg Nurs. 2020; 49 https://doi.org/10.1016/j.ienj.2019.100828

Rolfe U, Partlow D Mental health in paramedic practice. 2022;

Tricco AC, Lillie E, Zarin W PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169:(7)467-473 https://doi.org/10.7326/M18-0850

Williams B, Beovich B, Olaussen A The definition of paramedicine: an international Delphi study. J Multidiscip Healthc. 2021; 14:3561-3570 https://doi.org/10.2147/JMDH.S347811

Paramedic management of patients with mental health issues: a scoping review

02 October 2024
Volume 16 · Issue 10

Abstract

Background:

Since the COVID-19 pandemic and the introduction of the National Partnership Agreement: Right Care, Right Person in the UK, paramedics spend about 1.8 million hours per year managing people with mental health issues. The UK health service needs to address the urgent training requirements for paramedics to provide mental healthcare in emergency care provision.

Aims:

To identify and examine current research on how paramedics manage people with mental health issues.

Methods:

A scoping review was carried out using the five stages of Arksey and O'Malley's framework. A research question—’How do paramedics manage patients with mental health issues?’—was developed, databases searched, studies identified and data charted, summarised and reported.

Findings:

Fifteen papers were included, and five themes identified: perceptions and expectations; call triage and inter-service collaboration; communication skills; lack of education and training; and assessment and evidence-based interventions.

Conclusions:

There is global evidence of the deficiencies in paramedic education around mental health presentation and a need for evidence-based education and interventions to improve patient outcomes.

Paramedics spend about 1.8 million hours per year (the equivalent of 75 000 days) managing patients with mental health issues (National Institute for Health and Care Research Applied Research Collaboration East Midlands (NIHR ARCEM, 2024). England's ambulance services received 524 485 999 calls in 2018--2019, which increased to 652 720 in 2021-2022—a rise of 24% (NIHR ARCEM, 2024). The National Audit Office (2023) reported in February last year that 1.2 million people were waiting to receive care and treatment from NHS community mental health services.

Before the Covid-19 pandemic, rates of mental illness in England were steadily rising, according to the British Medical Association (BMA, 2024). The prevalence of common mental health disorders (such as anxiety or depression) among adults aged 16-64 years had increased from 17.5% in 2000 to 18.9% in 2014. The BMA (2024) added that Covid-19 accelerated this trend, generating an increase in the number of people who are in contact with secondary mental health services. Mental health services in England received a record 4.6 million referrals during 2022 (up 22% from 2019). Nearly half (43.4%) of adults (24.5 million in England) think they have had a diagnosable mental health condition at some point in their life (NHS Digital, 2016), with prevalence of depression increasing during pandemic years (Office for National Statistics, 2021).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed