The Community Paramedic’s Role in Treating Mental and Behavioral Health Patients

Utilizing community paramedics in a postacute or chronic disease management role has been shown to be a real benefit to populations both rural and urban. Today the struggle in almost every community in the United States is access and treatment for mental health issues. Mental illness is a disease that can impact many patients as a significant comorbidity and is a major factor in overall health.

There is some mystique around mental health, and it’s generally the last thought for most providers. Paramedics and EMTs get very few hours of education on the subject, didactic or clinical. Yet it is one of the most common issues practitioners face in the field on a daily basis.

Community paramedics (CPs) are well positioned to work with patients with mental illness and help them address the needs of mental and behavioral health. With additional education and clinical time to prepare them to provide assistance to this population, community paramedics can help patients deal with emotional distress resulting from an accident, injury or a sudden shocking event. They have the tools to identify the different signs of stress, observe and document various defense mechanisms, and analyze existing conditions and situations that affect how the patients will react to stressors. They can also provide psychological first aid by meeting the basic physical needs, then the most basic psychological needs of the patient.

Further education can be obtained to help deal with the medications of psychosis, addiction or other mental health issues. Understanding the other types of mental health issues can help a CP relate better to patients or inform the patient’s primary care provider of an underlying mental health issue. Sometimes the mental health issue may not present at a physician’s office but might be more readily apparent at home. When the CP visits the home, they need to be prepared to identify, document and notify of mental health conditions observed there.

The CP should be aware of medications a patient is taking. Often the diagnosis with a mental health issue may not be part of the patient’s medical record. Upon further inspection the CP may find prescriptions from one physician that interact or interfere with the medication regimen of the primary care provider.

The CP Curriculum

To become a community paramedic, the provider must complete the core competencies of the national community paramedic curriculum. One component of this education covers the mental and behavioral health of the patients they will encounter on a daily basis. Community paramedics are uniquely poised to assess, identify, treat and refer their patients to the appropriate level of care in the right setting. Different than the traditional 9-1-1 paramedic, CPs have the time, education and resources to meet different aspects of the patient’s health needs. They might not be the expert in all areas, but they have the knowledge to get the patients the care and resources they need.

Despite the prevalence of mental and behavioral health disorders, detection is difficult, and recognition and treatment rates are low. Even if patients obtain care, adherence to treatment guidelines is usually less than 50%. With this in mind, the national community paramedic curriculum development team made this part of the education a priority.

During the didactic portion of the course, students are taught how to conduct a psycho-psychological assessment. They evaluate how the patient is functioning, determine if they are in a psychiatric crisis, determine current psychological status, collect history about substance abuse, and assess the social margin of the patient. Their time is spent learning about how to conduct the mental status examination and screening for depression, suicide, dementia and substance abuse. Ultimately they bring everything together and determine the patient’s unmet or undermet needs and get them connected with resources to improve their overall mental and physical health. Important areas of the mental status examination are noted in Figure 1.

Figure 1: Important Areas of the Mental Status Examination

• Appearance and behavior
• Speech and language
• Mood
• Thoughts and perceptions
• Cognition, including memory, attention, information and vocabulary, calculation, abstract thinking and construction ability

The clinical portion of the class re-emphasizes the learning by having the students attend a Psychological First Aid course and obtain clinical hours in behavioral health settings unique to the service area of the CP. Their time is spent in mental health settings, hospital social work departments, and with other social service and public health organizations. These settings allow the students firsthand experience working alongside nurses, social workers, therapists and caseworkers. These professionals can provide the students with exposure to patients in a controlled environment, ideal for learning. The community paramedics not only gain the knowledge and understanding to care for patients in the out-of-hospital environment, but also create relationships through which they can collaborate in the future. Now these professionals will have the resources to refer patients to so they can continue their care and treatment once they have gone home or between visits.

The Wellness Coordinator

With the rising costs of health insurance and pressure to provide coverage for everyone, did you ever consider employing a wellness coordinator? A wellness coordinator organizes and directs programs, people and activities to achieve the best mental and physical health possible.

What about using a community paramedic as the wellness coordinator for your organization? A community paramedic receives the education needed to guide individuals through a physical and mental well-being evaluation. They can assist personnel through nutrition and activity assessments, smoking cessation programs, an evaluation of the effects of stress and burnout, and overall discussion of the benefits of wellness. CPs can provide prevention services like cardiac screens, vaccinations, ergonomic evaluations and stress management classes. All of these can improve the health of employees, decrease lost work days and ultimately increase productivity.

Look to healthcare partners in your area, such as hospitals and public health clinics. They might already have a program in place your CP can work alongside and expand to your employees. Some wellness programs even extend to employees’ families, if they are covered by the insurance plan. Just think if you had the opportunity to prevent on-the-job injury, illness or burnout—what a way to save healthcare costs! If EMS wants to work beside other healthcare professionals and be considered part of the healthcare team, we need to start acting like other healthcare agencies.

Conclusion

Mental health issues will continue to increase and change, and community paramedics can be part of the solution. Start today by talking to stakeholders such as your crews, your emergency physicians and nurses, and mental health professionals to find those gaps. You probably already know them in your community. Community paramedics get to be part of a team of care and will see successes with the interventions they can provide.

Anne Montera, RN, BSN, has 19 years of nursing experience in public health, labor and delivery, patient safety/quality improvement and EMS coordination in urban and rural hospitals and community settings. In her current role as a public health nurse consultant, she works in grant coordination and implementation for various projects, assisting with program development and statewide stakeholder engagement. She is the cocreator and public health partner for the first national community paramedic pilot program in Eagle, CO. Montera is also the executive director for the Central Mountains RETAC, representing the rural, remote and tourist regions of Colorado. She has been a leader in the CP curriculum, leading a team of experts in developing the 3.0 version in 2012, coordinating the California CP statewide course and currently leading the team to develop the CP National Standard Curriculum. She received the Colorado Nightingale Luminary Award for Innovation work on the Colorado CP program in May 2011. Montera was appointed to the National EMS Advisory Council and is serving her first term in the vice-chair position, representing public health.