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Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics
  1. Terence V McCann1,
  2. Michael Savic2,3,
  3. Nyssa Ferguson2,
  4. Alison Cheetham2,3,
  5. Katrina Witt2,3,
  6. Kate Emond4,
  7. Emma Bosley5,
  8. Karen Smith6,
  9. Louise Roberts7,
  10. Dan I Lubman2,3
  1. 1 Department of Nursing and Midwifery, Institute of Health and Sport, Victoria University, Melbourne, Victoria, Australia
  2. 2 Turning Point, Eastern Health, Melbourne, Victoria, Australia
  3. 3 Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  4. 4 Department of Rural Nursing and Midwifery, College of Health, Science and Engineering, La Trobe University, Bendigo, Victoria, Australia
  5. 5 Queensland Ambulance Service, Brisbane, Victoria, Australia
  6. 6 Ambulance Victoria, Melbourne, Victoria, Australia
  7. 7 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  1. Correspondence to Dr Terence V McCann; terence.mccann{at}


Objective Continuing stigma towards mental health problems means that many individuals—especially men—will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics’ ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems.

Methods A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems.

Results Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems.

Conclusions Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems.

  • mental health
  • adult psychiatry
  • substance misuse
  • paramedics
  • attitudes
  • survey

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  • Contributors DIL, TVMC, MS, KE, EB, LR and KS designed the study. NF and KE collected the data. AC and KW analysed the data. All authors participated actively in the writing of the manuscript and approved the final draft.

  • Funding This work was supported by a grant from Beyondblue (, using donations from the Movember Foundation (, grant number AN: CLT:7156.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval to conduct the study was obtained from local human research ethics committees across Australian states and territories (including the committees for Eastern Health (Victoria), South Australia Department for Health and Ageing, South Eastern Sydney Local Health District, Flinders University (South Australia)). The remaining states and territories accepted ethics approval from another jurisdiction. Approval was also obtained from each ambulance service research committee or structure.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All relevant data are contained in the paper.