Reviewing Australian paramedic clinical practice guidelines for persons experiencing a mental health crisis

Changes in service delivery and Australian mental health legislation have expanded the role of paramedics in caring for persons experiencing a mental health crisis. The expanded role of paramedics is reflected in Clinical Practice Guidelines (CPGs) and varies across ambulance services. We examine Australian paramedic CPGs to identify guidelines for managing mental health crises, citations, assessment tools, treatment options (e.g. de-escalation, restraint), and recommendations. Mental health is outlined in a range of CPGs, but is most often associated with agitation and disturbed behaviour. Legislation and legal documents are frequently cited in the CPGs, reflecting the significant influence of legislation on paramedic practice. There are differences between ambulance services in their approaches to mental status assessment, de-escalation, and restraint; however, there are commonalities in the underlying principles. There is limited publicly available evidence to enable evaluation of CPG development. Care of persons experiencing a mental health crisis requires flexibility and clinical judgment on the part of the paramedic, making it a challenge to be prescriptive. Ambulance services operate under the current mental health legislation in their jurisdictions, resulting in variations in practice, as documented in the CPGs.