Open access

Enhancing Safety and Mitigating Violence on Prehospital Mental Health Calls: For the Care Providers and Care Recipients

Publication: Canadian Journal of Community Mental Health
7 September 2023

Abstract

Violent encounters and safety concerns are common among paramedics attending to 911 emergency calls. These concerns are particularly salient for paramedics attending to mental health and substance use calls. This article draws on data from a qualitative case study. Findings include paramedics’ reported perceptions and experiences of violence experienced on mental health calls, success with de-escalation of those in distress, and paramedics challenging the notion that all individuals with mental distress are violent. The article explores tensions between attention to care providers’ and care recipients’ safety, the contexts in which this care takes place, and equity concerns related to appropriately managing mental health emergencies.

Résumé

Les rencontres marquées par la violence et les problèmes de sécurité sont courantes au sein des paramédicaux responsables des appels d’urgence 911. Ces situations préoccupantes sont particulièrement critiques pour les paramédicaux lors des interventions liées à la santé mentale et l’usage de substances. Cet article met l’accent sur les données d’une étude de cas qualitative. Les résultats incluent les perceptions rapportées des paramédicaux et la violence rencontrée lors d’appels liés à la santé mentale, les succès quant à la baisse de tension auprès des personnes en détresse, et le défi des paramédicaux avec l’a priori selon lequel toutes les personnes aux prises avec un problème de santé mentale sont violentes. Cet article explore les tensions entre les considérations à l’endroit des fournisseurs de soins et la sécurité des personnes soignées, ainsi que les contextes dans lesquels ces soins sont prodigués, de même que les préoccupations de sécurité en lien avec la gestion appropriée des interventions d’urgence liées à la santé mentale.

Formats available

You can view the full content in the following formats:

References

Arber A. 2006 Reflexivity: A challenge for the researcher as practitioner? Journal of Research in Nursing 11 2 147 -157
Armstrong, P., Armstrong, H., & Coburn, D. (2001). The political economy of health and care. In P. Armstrong, H. Armstrong, & D. Coburn (Eds), Unhealthy Times: Political Economy Perspectives on Health and Care in Canada (pp. vii–x). Toronto: Oxford University Press.
Bailey C. 2007 Practitioner to researcher: Reflections on the journey Nurse Researcher 14 4 18 -26
Baker D. and Pillinger C. 2020a ‘If you call 911 they are going to kill me’: Families’ experiences of mental health and deaths after police contact in the United States Policing and Society 30 6 674 -687
Baker D. and Pillinger C. 2020b ‘These people are vulnerable, they aren’t criminals’: Mental health, the use of force and deaths after police contact in England The Police Journal: Theory, Practice, and Principles 93 1 65 -81
Bigham B., Jensen J., Tavares W., Drennan I., Saleem H., Dainty K., and Munro G. 2014 Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: A mixed-methods cross-sectional survey Prehospital Emergency Care 18 4 489 -494
Boyd J. and Kerr T. 2016 Policing ‘Vancouver’s mental health crisis’: A critical discourse analysis Critical Public Health 26 4 418 -433
Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. Los Angeles: Sage.
Burstow, B. (2013). A rose by any other name: Naming and the battle against psychiatry. In B. LeFrançois, R. Menzies, & G. Reaume (Eds.), Mad matters: A critical reader in Canadian mad studies (pp. 79–90). Toronto: Canadian Scholars’ Press Inc.
Burstow, B. (2018). ‘Mental health’ praxis – not the answer: A constructive antipsychiatry position. In B. Cohen, B. (Ed.), Routeledge international handbook of critical mental health (pp. 31–38). Oxfordshire: Routeledge.
Chesire D., McIntosh A., Hendrickson S., Jones P., and McIntosh M. 2021 Dimensions of hospital workplace violence: Patient violence toward the healthcare team The International Voice of Nursing Research, Theory and Practice 31 11–12 1662 -1668
Crissman B. 2019 Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts Australasian Journal of Social Issues 54 245 -266
Daly T., Banerjee A., Armstrong P., Armstrong H., and Szebehely M. 2011 Lifting the ‘violence veil’: Examining working conditions in long-term care facilities using iterative mixed methods Canadian Journal on Aging 30 2 271 -284
Ford-Jones P. C. and Daly T. 2020a Paramedicine and mental health: A qualitative analysis of limitations to education and practice in Ontario The Journal of Mental Health Training, Education and Practice 15 6 331 -345
Ford-Jones P. C. and Daly T. 2020b Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada Health & Social Care in the Community 30 2 744 -752
Garcia J. L., Johnson A. J., Carlucci M. E., and Grover R. L. 2020 The impact of mental health diagnoses on perceptions of risk of criminality International Journal of Social Psychiatry 66 4 397 -410 https://journals.sagepub.com/doi/10.1177/0020764020913322
Garner D. G., DeLuca M. B., Crowe R. P., Cash R. E., Rivard M. K., Williams J. G., Panchal A. R., and Cabanas J. G. 2022 Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios Journal of the American College of Emergency Physicians Open 3 2 1 -11 https://doi.org/10.1002/emp2.12727
Geoffrion S., Lanctôt N., Marchand A., Boyer R., and Guay S. 2015 Predictors of trivialization of workplace violence among healthcare workers and law enforcers Journal of Threat Assessment and Management 2 3 195 -213
Giandinoto J. A., Stephenson J., and Edward K. L. 2018 General hospital health professionals’ attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: Systematic review and meta-analysis International Journal of Mental Health Nursing 27 3 942 -955
Gifford M. and Anderson J. 2010 Barriers and motivating factors in reporting incidents of assault in mental health care Journal of the American Psychiatric Nurses Association 16 5 288 -298
Glaser B. 1965 The constant comparative method of qualitative analysis Social Problems 12 4 436 -445
Hewitt J. L. 2008 Dangerousness and mental health policy Journal of Psychiatric and Mental Health Nursing 15 3 186 -194
Jarvis E., Kirmayer L., Jarvis G., and Whitley R. 2005 The role of Afro-Canadian status in police or ambulance referral to emergency psychiatric services Psychiatric Services 56 6 705 -710
Knowles, C. (2000). Bedlam in the Streets. London: Routledge.
Koritsas S., Boyle M., and Coles J. 2008 Factors associated with workplace violence in paramedics Prehospital and Disaster Medicine 24 5 417 -421
Koziarski J., O’Connor C., and Frederick T. 2020 Policing mental health: The composition and perceived challenges of co-response teams and crisis intervention teams in the Canadian context Police Practice and Research 22 1 977 -995
Liegghio, M. (2013). A denial of being: Psychiatrization as epistemic violence. In B. LeFrançois, R. Menzies, & G. Reaume (Eds.), Mad matters: A critical reader in Canadian mad studies, (pp. 195–209). Toronto: Canadian Scholars’ Press Inc.
Lim M. C., Jeffree M. S., Saupin S. S., Giloi N., and Lukman K. A. 2022 Workplace violence in healthcare settings: The risk factors, implications, and collaborative preventive measures Annals of Medicine and Surgery 78 1 -5
Magnavita N. 2014 Workplace violence and occupational stress in healthcare workers: A chicken-and-egg situation – Results of a 6-year follow-up study Journal of Nursing Scholarship 46 5 366 -376
Maguire B., O’Meara P., O’Neill B., and Brightwell R. 2018 Violence against emergency medical services personnel: A systematic review of the literature American Journal of Industrial Medicine 61 2 167 -180
Mausz J., Johnston M., and Donnelly E. A. 2021 The role of organizational culture in normalizing paramedic exposure to violence Journal of Aggression, Conflict and Peace Research 14 2 112 -122
Meng Y. 2014 Racially biased policing and neighborhood characteristics. A case study in Toronto, Canada Cybergeo: European Journal of Geography 1 -24
Mfoafo-McCarthy M. 2014 Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system International Journal for Equity in Health 13 1 69 -79
Ministry of Health and Long-Term Care. (2018a). ALS: Advanced life support patient care standards, Version 4.5. Emergency Health Regulatory and Accountability Branch. https://ontariobasehospitalgroup.ca/wp-content/uploads/2021/10/2018-05-01_ALS-PCS_v4.5.pdf
Ministry of Health and Long-Term Care. (2018b). BLS: Basic life support patient care standards, Version 3.0.1. Emergency Health Services Branch. https://www.lhsc.on.ca/media/2899/download
Moroz N., Moroz I., and D’Angelo M. S. 2020 Mental health services in Canada: Barriers and cost-effective solutions to increase access Healthcare Management Forum 33 6 282 -287
Murphy E. and Dingwall R. 2007 Informed consent, anticipatory regulation and ethnographic practice Social Science & Medicine 65 2223 -2234
Paramedic Chiefs of Canada. (2018). Position statement: Violence against paramedics in Canada. https://www.paramedicchiefs.ca/docs/zerotolerance/PCC%20Violence%20Against%20Paramedics%20Position%20Statement.pdf
Pescosolido B. A., Manago B., and Monahan J. 2019 Evolving public views on the likelihood of violence from people with mental illness: Stigma and its consequences Health Affairs 38 10 1735 -1743 https://doi.org/10.1377/hlthaff.2019.00702
Pope C. 2005 Conducting ethnography in medical settings Medical Education 39 12 1180 -1187
Pourshaikhian M., Gorji H., Aryankhesal A., Khorasani-Zavareh D., and Barati A. 2016 A systematic literature review: Workplace violence against emergency medical services personnel Archives Research 5 1 1 -14
Reavley N. J., Jorm A. F., and Morgan A. J. 2016 Beliefs about dangerousness of people with mental health problems: The role of media reports and personal exposure to threat or harm Social Psychiatry and Psychiatric Epidemiology 51 9 1257 -1264
Reid C., Clark N., Landy A., and Alonso M. 2019 The lived experience of recovery: The role of health work in addressing the social determinants of mental health Canadian Journal of Community Mental Health 38 45 -61
Ross L., Gibson M., Daley A., Steele L., and Williams C. 2018 In spite of the system: A qualitatively driven mixed methods analysis of the mental health services experiences of LGBTQ people living in poverty in Ontario, Canada PLoS ONE 13 8 1 -23
Sowislo J. F., Gonet-Wirz F., Borgwardt S., Lang U. E., and Huber C. G. 2017 Perceived dangerousness as related to psychiatric symptoms and psychiatric service use: A vignette-based representative population survey Scientific Reports 8 45716
Spelten E., van Vuuren J., O’Meara P., Thomas B., Grenier M., Ferron R., Helmer J., and Agarwal G. 2022 Workplace violence against emergency health care workers: What strategies do workers use? BMC Emergency Medicine 22 78 1 -11
Speroni K., Fitch T., Dawson E., Dugan L., and Atherton M. 2014 Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors Journal of Emergency Nursing 40 3 218 -228
Spielfogel J. and McMillen C. 2017 Current use of de-escalation strategies: Similarities and differences in de-escalation across professions Social Work in Mental Health 15 3 232 -248
Yin, R. (2014). Case study research: Design and methods. Los Angeles: Sage.

Information & Authors

Information

Published In

cover image Canadian Journal of Community Mental Health
Canadian Journal of Community Mental Health
Volume 42Number 2August 2023
Pages: 17 - 31

History

Version of record online: 7 September 2023

Key Words

  1. safety
  2. violence
  3. paramedicine
  4. prehospital care
  5. qualitative research

Mots-clés

  1. sécurité
  2. violence
  3. paramédicaux
  4. soins préhospitaliers
  5. recherche qualitative

Authors

Affiliations

Polly C. Ford-Jones [email protected]

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

View options

PDF

View PDF

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Canadian Journal of Community Mental Health

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media