Psychiatric emergencies without psychiatric preparation: A contemporary challenge for Emergency Medical Services

Mental health emergencies now constitute a routine part of prehospital emergency care. Yet Emergency Medical Services (EMS) systems remain structurally organised around somatic interventions. We argue that this persistent imbalance reflects a structural design failure in contemporary EMS systems, leaving clinicians inadequately prepared for one of the most common and complex patient groups they encounter. Drawing on Swedish EMS as an illustrative case, we argue that this gap is not an individual competence issue but a structural design problem. We propose educational reform, guideline redesign and stronger feedback systems to reposition mental health competence as a core requirement for safe and equitable prehospital nursing practice.