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Low-income and racially diverse US counties experience a higher incidence of behavioral health EMS calls, according to a recently published study.

Low-income and racially diverse US counties exhibit a significantly greater incidence of behavioral health–related emergency medical services (EMS) calls, whereas politically conservative jurisdictions demonstrate a notably lower incidence, according to a recent study published online in Health Affairs Scholar.

“Despite goals of preventing behavioral health crises and reducing the burden on patients and EMS personnel, little is known about how demographic and community characteristics influence behavioral health calls,” wrote corresponding author Ashlyn Burns, PhD, MPH, of Indiana University Richard M. Fairbanks School of Public Health, and colleagues. “The purpose of this study is to examine whether county characteristics are associated with behavioral health EMS calls.”

Characterizing EMS Calls

The investigators performed a comprehensive, cross‑sectional analysis of the 2021 National EMS Information System dataset, identifying EMS calls related to a behavioral health condition using the primary reason assigned to the patient record.

Of the 36.8 million calls included in the analysis, 6.7% were for a behavioral health need, according to the study. Behavioral health calls due to a psychoactive substance were most common (39%), followed by calls related to unspecified mental disorders (30%) and anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders (22%).

Next, the researchers aggregated the calls to identify counties with high rates of behavioral health EMS calls and examined their demographic and community characteristics.

Findings showed high rates of behavioral health calls were more likely to occur in counties with more mental health providers per capita, a higher percentage of insured residents, and a larger population of racial and ethnic minorities (P<0.001). In addition, high behavioral health EMS calls were more likely to occur in metropolitan counties (P < 0.001) and less likely to occur in counties where a higher percent of the population voted Republican (P < 0.001).

Alleviating the EMS Burden

“Understanding what types of communities have high behavioral health EMS calls can help inform efforts to alleviate the burden of behavioral health crises on both patients and EMS personnel,” the authors concluded. “Therefore, efforts are needed to address underlying factors contributing to behavioral health crises and to ensure access to more appropriate, alternative services that can meet the unique needs of patients experiencing a behavioral health crisis in these communities.”