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“Treat them like a person:” An exploration of behavioral health emergencies and stigma in the Emergency Medical Services
Introduction
Behavioral health emergencies (BHEs) represent a significant percentage of calls for service in the Emergency Medical Services (EMS), yet very little is known about their training to manage BHEs and despite a significant body of evidence pointing to stigma as a factor influencing outcomes in health care, the prevalence of stigma and the impact of training or personal experience on reducing stigma is underexplored.
Objective
The purpose of this exploratory study is to describe the frequency and type of behavioral health training received by EMS personnel, the perceived adequacy of the training, the relative confidence in treating patients with behavioral health concerns, and how training and personal experiences may influence stigmatizing views related to behavioral health. Finally, qualitatively, how do EMS personnel feel about managing BHEs?
Methods
A convenience sample of EMS personnel were invited to complete a survey which included both quantitative and qualitative open-ended questions exploring frequency and type of training related to BHE, mental health stigma, and personal experiences with BHE. Univariate and bivariate statistics were used to assess the quantitative results. Qualitative data were coded and thematically analyzed using a constant comparative method. Critical mental health perspectives inform the analysis and discussion.
Results
A total of n=512 respondent completed the survey. While respondents reported frequent training in BHEs as well as high levels of satisfaction with training, training did not appear to significantly influence stigmatizing views. However, personal experiences were significantly related to lower levels of stigma. Qualitatively, participants reflected on themes around communication and interpersonal approach, safety, not knowing “what to say” and changes in training including de-escalation and crisis intervention.
Conclusion
Contemporary, biomedical understandings of mental health and approaches to care which are common in paramedicine training may have significant implications for stigma and the care paramedics provide. These findings, while exploratory, demonstrate that while participants have received training on BHEs, the current training does not appear to mitigate the stigma against those with mental health concerns. Implications for future educational efforts are discussed.
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