Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study

Abstract

Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.

‘Are we opening a can of worms?’: Community‐based occupational therapists' experiences working with clients with unexpected mental health issues

“…Some specific areas for skill development relate to managing difficult conversations, integrating the mental screening tool into OT assessment and competently ‘responding in the moment’ to people found to have mental illness. These findings resonate with other studies that have shown a lack confidence and skills in non‐mental health specialist workers when assessing and managing mental health‐related presentations and consultations (Emond et al, 2021; Nollett et al., 2020). Scanlan et al.…”

Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey

“…Overall, our study further describes a marginal sex difference in overall emergency preparedness for handling issues related to mental health. These findings are in line with those of Emund et al, who found that among paramedics in Australia, women were less confident than their male counterparts in handling mental illness, especially those related to anxious behaviors [ 23 ]. Mason cited female leadership and a culture of gender in ambulance care as an explanation for these differences [ 24 ], which we think could also apply in Sweden.…”

Paramedic Workforce Disparities Marked by Geographical Positioning

“…This correlation between frequency of exposure and confidence was reported across a range of presentations, including trauma triage, management of patients having acute myocardial infarctions, out of hospital cardiac arrest management, stroke recognition, and management of mental health patients (Coleman, Barry, Tobin, Conroy, & Bury, 2019;Deeb et al, 2020;Emond et al, 2021;Hodell et al, 2016;Martin Lorelle et al, 2020;Ro et al, 2013). One US study reported under triage of trauma patients was higher among patients in rural areas (8.6% versus 3.4% in urban areas).…”

“…This was attributed to the infrequent exposure of rural paramedics to trauma cases and the lack of continuing professional development in trauma care (Deeb et al, 2020). Rural paramedics in one US study reported challenges with stroke recognition due to infrequent exposure which was in contrast to their urban colleagues who reported difficulties with stroke recognition arising from language barriers due to the diverse population in the large urban cities (Emond et al, 2021). Paramedics in rural Australia reported lack of confidence with managing complex cardiac patients due to infrequent exposure and lack of training (Martin Lorelle et al, 2020).…”

“…Lack of exposure was problematic in most rural locations as was managing the disparity between the characteristic caseloads for rural which saw more trauma than urban who dealt with more medical calls. Several strategies to counter the impact of infrequent exposure were discussed with one Australian study noting that it would be beneficial for rural paramedics to have professional development sessions in managing mental health patients delivered by specialised mental health professionals (Emond et al, 2021). While potentially beneficial, the study highlighted the challenge of this approach due to the lack of specialised mental health professionals working in rural areas.…”