6 Things EMTs Should Remember When Responding to Mental Health Calls

One night a few years ago, while at a summer pre-college program, I experienced a familiar feeling. My heart was racing, I was dizzy and I felt like I couldn’t breathe quickly and deeply enough. I was quite certain that it was a panic attack, which I had experienced many times before. Though it certainly wasn’t comfortable, I had no reason to believe that my life or health was immediately in danger. Unfortunately, my RA saw me in distress, and as per her protocol, she had to call for an ambulance to check me out. I was horrified, due to my internalized stigma and fear of judgment from others. But, the ambulance encounter wasn’t nearly as bad as I had expected.

The EMTs (Emergency Medical Technician) were validating and not (outwardly) judgmental. After taking a couple sets of vitals and having me sign a refusal of medical assistance, they left without transporting me.

 I have since become an EMT myself. Over my two years of EMS (Emergency Medical Services) experience so far, I have responded to multiple mental health-related calls. Most of my EMS experience as of now is with collegiate EMS (as a member of my college’s EMS agency), which is certainly a unique environment. The types of calls we receive (and the distribution) tend to be different from the general population and a significant portion of our calls have a mental health component (even if it isn’t the chief complaint). As a result, I’ve had the opportunity to receive extra training on responding to these types of calls, particularly from our school’s counseling services.

Over the past two years, I’ve interacted with a lot of EMS personnel in various settings, such as in my EMT class, on my ride-alongs as a student and with paramedics who have responded to our calls. During many of these interactions I have heard misinformed comments about mental health, such as the suggestion that suicidal patients would be fine if they simply took up a new hobby, or that patients with psychosomatic symptoms were unnecessarily wasting time and resources. Even with the relatively limited experience I have so far, I understand EMS can be chaotic, exhausting and rushed. Things don’t always go perfectly, and like any other humans, EMS personnel make mistakes. However, based on my extensive personal history with mental health (both my own and of certain people close to me), here are a few things I’d like EMS personnel to keep in mind.

1. Mental health issues are very common.

The National Alliance of Mental Illness (NAMI) estimates that approximately 1 in 5 American adults have from a mental illness in a given year. Due to the stigma surrounding mental health, these issues are rarely discussed (though this has improved in recent years), and therefore mental illnesses are perceived as rarer than they actually are. 

2. Mental health issues can produce intense physical symptoms.

I can best speak to this in the context of panic attacks, which essentially involve a fight-or-flight response as a reaction to a perceived threat. These biological changes are very helpful for running away from a bear in the forest, but can otherwise can present as chest pain and trouble breathing (among other symptoms). I know from personal experience that this can be extremely uncomfortable and scary. At times I’ve had trouble determining whether my symptoms were from anxiety or something else, often not even being cognitively aware that I was anxious. 

3. For an anxious patient, it can be really helpful to know what the EMTs are doing. 

When I had my ambulance encounter, I really appreciated that the crew told me before taking vitals and verbalized their thoughts about transport decisions throughout the call. During or after a panic attack, unexpected touch can exacerbate my symptoms. Eliminating some of the unexpected in this type of situation can make things easier and more pleasant for everybody involved. I truly believe that in my case, these actions by the EMTs helped the call go smoother and helped them get off scene sooner.

4. People with mental health issues often feel like they’re being shamed or punished for their illness.

We don’t choose to have mental health issues, but we too often are shamed. People often speak of mental illness as if it’s a moral issue or due to a lack of willpower. Though I’ve fortunately never been through this, I’ve heard that many patients in the hospital for mental illness feel they were treated like criminals. Many experiences related to mental illness and receiving care can be incredibly dehumanizing. These experiences can affect a person in both the short- and long-term. While the primary priorities are scene safety and preserving life, please keep this in mind, especially if the police are present or a patient needs to be restrained.

5. Suicidality is usually a response to intense pain and the person probably already feels guilty.

Contrary to popular belief, suicidal ideation and attempts are not usually just a cry for attention. Mental illnesses can cause people to suffer immensely to the point that death can seem like welcome relief.  People often experience guilt about struggling with mental health and suicidal thoughts (in large part due to prevalent stigma), which can exacerbate suicidality. Common, well-intended comments, such as, “How could you do that to your family?” that guilt people with suicidal ideation usually do more harm than good.

6. Expressing empathy goes a long way.

Ultimately, there is only so much EMS can do in calls related to mental health, compared to a respiratory emergency or an orthopedic injury. And that’s OK. Acknowledging and validating the patient’s distress can provide comfort, make the experience less dehumanizing and also encourages people to seek help in future emergencies.