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Mental health legislation: an era of change in paramedic clinical practice and responsibility

05 September 2011
Volume 1 · Issue 1

Abstract

For emergency health professionals, the response to a mental health emergency in the community is often brief in nature and centred on quickly ascertaining whether a patient is psychiatrically or physically unwell. For paramedics, mental health emergencies are often challenging because of the ambiguous nature of clinical presentations, lack of collaborative information such as a patient's medical history and back up assistance. Mental health emergencies require paramedics to possess advanced interpersonal skills and patient assessment competencies. With the introduction of new emergency powers across Australian state and territory-based mental health legislation, the roles and responsibilities of paramedics across some jurisdictions has changed significantly. In response to these changes, a number of ambulance services have introduced specific mental health training programmes in an attempt to prepare their workforce to meet and fulfil their legislative responsibilities. In spite of this, the role of paramedics in the care and management of the mentally ill has attracted limited attention in the research literature. This article examines the role of the paramedic with respect to mental illness, what is known about paramedics' clinical decision-making practices, and the opportunities for future development of their scope of practice. It identifies the need for further research to explore the clinical decision-making processes are used by paramedics when fulfilling their mental health legislative responsibilities.

The changes in mental health services in Australia during the early 1980s, which included the resettlement of long-term residential mental health patients into the community, had a profound impact on the roles and responsibilities of different frontline services (Australian Institute of Health and Welfare (AIHW), 2004). These reforms significantly altered the means by which mentally ill and mentally disordered patients come to access and receive ambulatory and emergency mental health care. The consequence of these changes has been the marked increase in mental health related presentations that paramedics are required to manage and treat (Shaban, 2004; Roberts and Henderson, 2009; Townsend and Luck, 2009).

In Australia, mental health legislation varies from each state and territory, and while thes e laws promote the same fundamental principles, differences do exist in relation to the persons authorized to detain a person as an involuntary patient on the grounds of being mentally ill or mentally disordered. The extension of emergency provisions to paramedics in some Australian states and territories (New South Wales, Queensland, Northern Territory and Victoria) has meant that authorized paramedics are now being called to fulfil a role previously restricted to police officers or other accredited persons.

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