A network for students interested in evidence-based health care

How can the Paramedics’ performance in respect of delivering care in a mental health crisis be improved? A literature review

Posted on 1st June 2020 by

Evidence Reviews

During the final year of their Paramedic Science (BSc Hons) course at Oxford Brookes University, students carry out a literature review and critical appraisal of a topic relevant to their future practice.  This blog presents the abstract of a literature review on ‘The Paramedics’ performance delivering care in a mental health crisis’. Other Paramedic topic blogs can be found here.


Mental health crisis in the pre-hospital setting is an under-explored topic within paramedic practice yet there has been a sharp rise in this presentation.  Lack of knowledge, skills, resources and alternative models of care for pre-hospital mental health has resulted in a call for more appropriate provisions to be introduced.  The purpose of this literature review is to gain an insight into the perceptions of paramedics, current practices and potential innovations for mental health crisis in the emergency setting in order to identify how paramedics’ performance in respect of delivering care in a mental health crisis can be improved.


A comprehensive and systematic search on pre-hospital mental health was carried out on CINAHL, Medline and PsycINFO databases, Journal of Paramedics, British Paramedic Journal and Australasian Journal of Paramedicine.  Evidence was selected systematically using inclusion and exclusion criteria.  Evidence was critically appraised and thematically analysed in order to assess quality and evaluate.


The seven papers selected resulted in four key themes identified: education and research, perceptions, provisions and the role of the paramedic.  These themes were analysed for interlinking sub-themes and key concepts relevant to the research aims.  Identified themes were then discussed in the concept of pre-hospital mental health.


Pre-hospital mental health is fast becoming a ‘hot topic’ within paramedic practice.  It is evident that paramedics have competing perspectives but, in general, feel under-educated and under-prepared, and their perceptions of mental health crises impacts on the care provided.  It is widely acknowledged that the provisions for mental health are not adequate, patients who suffer a mental health crisis often being transported to the emergency department even when it is felt inappropriate.


With the government’s ambitious plans to revolutionise mental health provisions, the issues surrounding pre-hospital mental health crises necessitate further exploration.  Innovative programs and alternative models of care are being trialled with initial reviews showing positive outcomes.  There is scope for further research to be conducted in order to investigate this topic and introduce more appropriate provisions for pre-hospital mental health.

References (pdf)


Angie Cox

I am from Reading in Berkshire and have recently completed my final year studying the BSc Paramedic Science at Oxford Brookes University, having previously worked as a Project and IT Manager within the corporate environment. Throughout my three years of study, I have taken a particular interest in pre-hospital mental health and hope to incorporate my interests further within my work and studies in the future. View more posts from Angie

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