A Critical Analysis of Debates Around Mental Health Calls in the Prehospital Setting

Abstract

Paramedics, health care workers who assess and manage health concerns in the prehospital setting, are increasingly providing psychosocial care in response to a rise in mental health call volume. Observers have construed this fact as “misuse” of paramedic services, and proposed as solutions better triaging of patients, better mental health training of paramedics, and a greater number of community mental health services. In this commentary, we argue that despite the ostensibly well-intentioned nature of these solutions, they shift attention and accountability away from relevant public policies, as well as from broader economic, social, and political determinants of mental health, while placing responsibility on those requiring services or, at best, on the health care system. We also argue that the perspective of paramedics, who are exposed to, and interact with, individuals in their everyday environments, has the potential to inform a better, structural and critical, understanding of the factors driving the rise in psychosocial crises in the first place. Finally, we suggest that a greater engagement with the political and social determinants of mental health would lead to preventing, rather than primarily reacting to, these crises after the fact.

A retrospective comparison between non-conveyed and conveyed patients in ambulance care

“…Literature shows contrasting results, with studies reporting 9.0–19.1% psychiatry or alcohol/drugs abuse reasons for care in the non-conveyance group [ 15 , 16 , 18 ], and another study reporting that patients with psychiatric reasons for care were more likely to be conveyed [ 19 ]. These patients represent a vulnerable patient group in which it can be questioned if ambulance care is the most appropriate [ 20 ], and if ambulance staff currently have the competencies to manage patients with psychological and social problems. Our results indicate that the development of guidelines and alternative care options for these patients is needed, for instance mental health acute assessment teams [ 21 ].…”

Focus on Mental Health During the Coronavirus (COVID-19) Pandemic: Applying Learnings from the Past Outbreaks

“…The total number of infected health personnel as of February 11, 2020 was 1,716 (3.8%) of the total confirmed 44,672 cases with five reported deaths [6]. Notably, there are not enough services that are set up to provide psychological counseling and psychiatric screening services for anxiety, depression, and suicidality for medical practitioners dealing with infected patients [9].…”

Psychological health during the coronavirus disease 2019 pandemic outbreak

“…The emergence, prevalence and transmission of COVID-19 are beyond physical health, and emotional distress, anxiety, fear, depression, suicidality, public stigma, discrimination, racism, xenophobia, posttraumatic symptoms and sleep disturbance are some of the consequences on psychological health. The physical counteractive measures toward managing COVID-19 include early identification and separation of suspected cases, biological and clinical data collection, consensus of expert medical interventions, establishment of quarantine units and strengthening of medical staff in the affected regions ( Ford-Jones & Chaufen, 2017 ; ‘Report of the WHO’, 2020 ; Severance et al, 2011 ). These infection prevention and control practices interventions have proven to be effective for combating the pandemic but have serious psychological health impacts on the medical teams and the general public ( Rubin & Wessely, 2020 ).…”