Encounters between people with mental health and/or substance use problems and ambulance clinicians: a qualitative interview study in Norway

Abstract Background Interactions between ambulance clinicians and people with mental health and/or substance use problems are frequent, and international studies show that these encounters are often shaped by stigma, power dynamics and challenges to patient autonomy. However, there is limited research exploring patients’ experiences of ambulance services in the Norwegian context. This study addresses this knowledge gap. Methods This qualitative study was based on in-depth, semi-structured interviews with 23 people with mental health and/or substance use problems recruited from primary and specialized healthcare services and service user organizations. The data were analyzed using reflexive thematic analysis, with input from a multidisciplinary stakeholder group throughout the research process. Results Participants reported varied experiences in their encounters with ambulance clinicians. Prior interactions with other healthcare services strongly shaped their expectations of, and willingness to seek, emergency care. While some described professional and reassuring care, others experienced patronizing attitudes toward conditions perceived as self‑inflicted. Several participants also reported inadequate physical health assessments and treatment, and many felt excluded from decision‑making processes due to limited information, involvement, and respect. These experiences influenced their sense of safety, autonomy, and trust in emergency services. Conclusions In Norway, people with mental health and/or substance use problems described several challenges in their encounters with ambulance services, including stigma, patronizing attitudes, inadequate physical healthcare, and limited patient involvement. These findings highlight the need for improved competence in mental health and substance use and clearer communication practices to promote more equitable and respectful ambulance care.