Closing the Gap Between Need and Care: Predictors of Mental Health Service Use in EMS
Highlights Public health relevance—How does this work relate to a public health issue? EMS personnel represent a critical public health workforce; low utilization of mental health services in this population carries direct consequences for patient safety, workforce stability, and system capacity. Actual mental health service use—rather than intentions or attitudinal proxies—is the criterion in a statewide sample of 36,697 licensed Florida EMS professionals. Public health significance—Why is this work of significance to public health? Psychological symptoms, not stigma, are the strongest factor associated with help-seeking, reframing how barriers to care are prioritized in high-risk occupational populations. Peer support is the most actionable system-level factor associated with increased service utilization, with meaningful organizational and workforce benefits. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Findings are consistent with the potential value of routine symptom screening, proactive identification, and structured referral pathways within EMS agencies. Strengthening peer support infrastructure and confidential, occupationally competent clinical access offers a practical, scalable approach to improving workforce well-being and sustaining EMS system performance. Abstract Background: Emergency medical services (EMS) personnel experience high rates of psychological distress yet demonstrate low utilization of mental health services. Factors associated with actual service use—rather than intentions or attitudes—are not well understood. Methods: Using secondary data from 36,697 licensed Florida EMTs and paramedics collected during the 2022 licensure renewal process, logistic regression models evaluated the relative contributions of workplace factors, attitudinal variables, trauma exposure, and mental health symptoms in their association with service utilization. Results: Psychological symptoms, particularly anxiety and depression, were the strongest factors associated with help-seeking. Peer support emerged as one of the few system-level factors associated with increased service use, even after accounting for symptom presence. Stigma-related variables showed weaker and, in some cases, counterintuitive associations. Suicidality and substance use were modestly associated with help-seeking beyond core symptom variables. Findings were consistent among trauma-exposed personnel. Discussion: Results are consistent with the potential value of early identification, routine symptom screening, and integrated, system-level supports such as peer support and access to confidential, occupationally competent care.