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Mental health and illness are global health priorities. International reforms of mental health care systems repeatedly call for increased participation of a wide range of health, welfare, and disability professionals and organisations in providing services to people with mental disorders. 1 There are increasing needs to improve mental health skills of all health-care professionals, improve coordination of services provided to consumers of mental health services and their and carers, and foster greater community interest and involvement in mental health issues. 1 Despite this, the roles of paramedics and contributions they can make to the care of the mentally ill in the wider continuum of health care have not been fully recognised. Traditionally, the work of paramedics has been limited to managing specific conditions such as suicide. The reasons for this are many and varied, but one consequence of it is that research into paramedic judgment and decision-making of mental illness is rare. This paper will present a review of key research examining mental health assessments in the emergency care context, with a specific focus on paramedics. It will examine the use of mental assessment tools or instruments by ambulance and emergency medical personnel and highlight the needs for future research into this important area of health-care. Central to global mental health reforms is the preparedness of health care professionals, including paramedics, to recognise, assess, and manage mental illness in everyday practice and the sufficiency of education and training programs, clinical standards, policy, and legislation to ensure quality and accountability in the care of the mentally ill. Mental Illness – The Great Pandemic of the 21st Century Mental illness is a global health crisis. It results in significant morbidity and is a major factor influencing the social determinants of health of individuals, families and communities. Approximately 450 million people worldwide are affected by mental, neurological, or behavioural problems at any time. 2 This group of illnesses account for 12 percent of the global burden of disease – a burden that far exceeds other diseases such as cancer; heart

Paramedics’ clinical judgment and mental health assessments in emergency contexts: Research, practice, and tools of the trade