Paramedic mental health literacy and psychiatric emergencies: A qualitative pilot study in Gauteng, South Africa

Abstract

Background: Paramedics in South Africa frequently respond to psychiatric emergencies in complex, high-risk pre-hospital environments. Their care is shaped by limited formal training, workplace cultures and varying mental health literacy, alongside legal, ethical and contextual constraints specific to emergency medical services. Despite these demands, little research has examined paramedics’ perceptions, attitudes and experiences of psychiatric emergencies in South Africa.
Aim: To explore paramedics’ perceptions, attitudes and experiences of psychiatric emergencies and how they influence assessment, communication and decision-making in the pre-hospital setting.
Setting: Paramedics working in private and public emergency medical services in Gauteng, South Africa.
Methods: An exploratory qualitative design was employed. Semi-structured interviews were conducted with eight paramedics across Basic, Intermediate and Advanced Life Support levels. Data were analysed using inductive thematic analysis to identify patterns across participants’ accounts.
Results: Five themes were identified. Participants described limited formal training in psychiatric emergency care, resulting in reliance on experiential learning and peer modelling. Communication and de-escalation were viewed as essential but inconsistently supported by training and resources. Workplace humour, stigma and emotional distancing were commonly described as coping responses, with divergent views regarding their impact on patient care. Ethical and legal uncertainty shaped conservative or coercive decision-making around consent, restraint and sedation. Cultural, linguistic and environmental factors complicated assessment and engagement.
Conclusion: Despite commitment to supporting psychiatric patients, significant educational and structural gaps constrained effective care. Enhanced training, reflective supervision and context-sensitive guidance may improve patient experiences and paramedic decision-making.
Contribution: This study contributes to understanding how South African paramedics perceive and manage psychiatric emergencies in pre-hospital settings, highlighting educational, ethical, and contextual challenges influencing care.