Mental Health and Psychosocial Calls in the Prehospital Setting in Ontario: A Qualitative Case Study

Paramedics have seldom been included in discussions of mental health care and yet play a significant role in the chain of mental health care for many. This thesis explores the nature of paramedic work and the mental health and psychosocial calls encountered by paramedics in the community. This project is a case study of mental health and psychosocial calls in paramedicine in Ontario and was designed to explore the care provided by paramedics on mental health and psychosocial calls, the training and resources for these calls, and the experiences of paramedics in managing these calls. Using both a feminist political economy and social determinants of health approach, this thesis explores questions around care provision on the front lines, but also beyond into community mental health services and to the social determinants of health impacting an individuals need for care from paramedic services. I conducted interviews with front-line paramedics, paramedic services management, paramedic educators and Base Hospital physicians/managers; observation in three paramedic services including urban, rural/suburban and rural with varying degrees of engagement on the issue of mental health in paramedicine; and document analyses of the standards guiding paramedic practice in this area. This thesis reframes issues of mental health calls in paramedicine from an issue of misuse of emergency services, to one which accounts for the contexts creating distress as well as existing constraints for work and care. Findings from this study support enhanced training and education for paramedics, specific mental health related programming for paramedic services, as well as the importance of working conditions for both care providers and care recipients. I argue that there must be a balance between efforts placed on establishing appropriate supports for managing mental health and psychosocial calls as well as addressing necessary training and education in this area, while simultaneously ensuring sufficient focus remains at the level of prevention at the broader social, political, and economic determinants of physical and mental health.