This paper is the fourth in a series that heralds a study that examines paramedic accounts and constructs of judgment and decision-making (JDM) of mental health and mental illness. This paper will provide the results of one stage of this study in which a discourse-historical case study of paramedic JDM of mental health and mental illness using ethnographic and ethnomethodological research methods was conducted. Preliminary themes describing the ways in which paramedics officially account for their judgments of mental illness will be presented.

Mental health and illness are global health priorities. International reforms of mental health care systems repeatedly call for increased participation of a wide range of health, welfare, and disability professionals and organisations in providing services to people with mental disorders. There are increasing needs to improve mental health skills of all health-care professionals, improve coordination of services provided to consumers of mental health services and their and carers, and foster greater community interest and involvement in mental health issues. Despite this, the roles of paramedics and contributions they can make to the care of the mentally ill in the wider continuum of health care have not been fully recognised. Traditionally, the work of paramedics has been limited to managing specific conditions such as suicide. The reasons for this are many and varied, but one consequence of it is that research into paramedic judgment and decision-making of mental illness is rare. This paper will present a review of key research examining mental health assessments in the emergency care context, with a specific focus on paramedics. It will examine the use of mental assessment tools or instruments by ambulance and emergency medical personnel and highlight the needs for future research into this important area of health-care. Central to global mental health reforms is the preparedness of health care professionals, including paramedics, to recognise, assess, and manage mental illness in everyday practice and the sufficiency of education and training programs, clinical standards, policy, and legislation to ensure quality and accountability in the care of the mentally ill.

This is the third paper in a series that heralds a study that examines paramedic accounts and constructs of judgment and decision-making (JDM) of mental health and mental illness. This paper will overview an innovative theoretical framework for conducting a discourse-historical case study of paramedic judgment and decision-making of mental health and mental illness using ethnographic and ethnomethodological research methods. The review of the existing research and literature suggests an insufficiency of current theoretical and methodological frameworks to address the research problem and questions of this study. Little examination of judgment in mental illness and health has occurred, which is discussed in an earlier paper.1 Those studies, and the theoretical frameworks used, are insufficient in addressing key aspects of inquiry in judgment and decision-making, particularly in the paramedic ecology. The theoretical framework described here seeks to begin addressing this insufficiency in a new and innovative way.

Summary This paper is the first in a series that heralds a study examining paramedic accounts and constructs of judgment and decision-making (JDM) of mental health and mental illness. Providing an introduction and background to the evolving study, the paper will establish a warrant for the research and scope of the research agenda and methods of inquiry.

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