J05 – Collaboration in Emergency Mental Health Care: From Community to Paramedic Services

Summary

Paramedics are a first point of contact for many mental health emergencies and paramedics are increasingly responding to these calls. Challenges exist in emergency mental health care in the prehospital setting, however collaboration with domains outside of paramedicine offers means of improving care and better addressing the needs of those in crisis. This presentation draws on findings from a qualitative, ethnographic case study of mental health and psychosocial calls to paramedic services in Ontario, Canada. The study conducted between September 2017-October 2018 includes interviews (n=46), observation in paramedic services (n~90hr) and document analysis. Interviewees from across Ontario included front-line paramedics, management, educators and Base Hospital physicians/directors. Challenges for mental health care in paramedicine include, limited practice guidelines, training and resources, and the emergency department (ED) as a care destination. Promising practices exist in a select number of paramedic services in Ontario. These include crisis response teams, community paramedicine follow-up programs, transportation to mental health and social services rather than ED, and continuing education. Importantly, some of these programs work beyond acute care response to address the social determinants of health (SDOH). These practices involve collaboration with nurses, social workers, police, and other social services. While beneficial, such practices exist in a limited number of paramedic services. Paramedics are in the unique position of seeing individuals in their daily living environments, providing insights into the SDOH impacting mental health. Collaborative approaches to address mental health inequities in the prehospital setting require engagement and action to address the SDOH including structures such as racism, sexism, homophobia and other forms of discrimination. Further collaborative approaches are needed to improve paramedic education, guidelines and practices this field.