Paramedics and emergency medical services are on the front line of the nation’s behavioral healthcare crisis, responding to more than 1.5 million behavioral health-related calls each year in the U.S — a figure that does not include the rising number of calls, texts and chats sent to the 988 Suicide and Crisis Lifeline.
“A big gap that EMS has a bird’s eye view to is our mental health and substance use crisis,” Barry Geller, MD, associate chief medical director and chair of the emergency department at Northwell’s Phelps Hospital in Sleepy Hollow, N.Y., and medical adviser for the Westchester, N.Y., community paramedicine program told Becker’s. “A disproportionate number of people who use the 911 system are those that have mental health issues, they have substance use issues, and are unable to get care in other types of settings.”
Northwell’s Phelps Hospital launched the program in early 2024 in partnership with the Ossining (N.Y.) Volunteer Ambulance Corps, with the goal of keeping patients home and out of the emergency department. In its first full year from October 2024 through September 2025, the program served 339 patients across 1,081 encounters and helped 454 patients avoid unnecessary ED visits.
The traditional response — transport to the ED — is not always the correct one, especially for behavioral health crises, Dr. Geller said Community paramedicine offers a different pathway. Rather than defaulting to the ED, a community paramedic can assess the patient, coordinate a virtual consultation with a psychiatrist, connect them to social case management or arrange transportation directly to a mental health clinic or detox center — bypassing the emergency department entirely, he added.
“The paramedics are really trained clinicians. They’re capable of comprehensive patient assessment and on-scene treatment, and they’re also able to navigate the patient to appropriate care settings, which is not always the emergency department,” Dr. Geller said. “And that can be an urgent care center, it can be a detox center, it can be a mental health facility.”
Fragmented care is a particular problem for this population — patients who move in and out of crisis without a consistent thread connecting their episodes of care. Dr. Geller sees community paramedics as uniquely positioned to address that fragmentation, precisely because they are in the home, seeing the full picture of a patient’s life in a way that a clinician in a clinical setting cannot.
“Fragmented care occurs because there is at times lack of coordination, and there’s also lack of the understanding of what factors prevent this coordination,” he said. “By going into the patient’s home, they can form a relationship with the patient, which will really help to engage the patient. That’ll increase the likelihood of making them more compliant, and they’ll also be able to educate them on specific gaps in their knowledge.”
That ground-level visibility — combined with the ability to connect patients to social workers, facilitate virtual psychiatric consults and help patients stay connected to care between crises — is what Dr. Geller believes makes community paramedicine a meaningful intervention in a behavioral health system that has long struggled with continuity.
Despite the outcomes, community paramedicine still collides with structural barriers: A reimbursement model that rewards transportation, not care. Paramedics are classified as suppliers under Medicare Part B, meaning they get paid only when they move a patient — an incentive that works against the very care this population needs.
Some legislative progress has been made on reimbursement for treatment-in-place, but Dr. Geller said the industry is far from where it needs to be.
“Once the government and private payers understand the tremendous value in community paramedicine, I think we’ll see a much greater adaptation to it,” he said. “But we need to do a much better job within the EMS community to really make people understand all the advantages that come about from having a robust community paramedicine program.”
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