Revelations from a Groundbreaking NZ Study on Mental Health Ambulance Callouts

A recent study published in the New Zealand Medical Journal has shone a spotlight on the escalating reliance on ambulance services for mental health crises across Aotearoa New Zealand. Analyzing data from 26,847 mental health-related callouts between July 2022 and June 2023, researchers from the University of Auckland and Auckland University of Technology (AUT) uncovered stark patterns of unmet needs, particularly in deprived communities. These callouts represented 5.7% of the total 468,930 ambulance incidents handled by Hato Hone St John (covering 90% of the country) and Wellington Free Ambulance during that period. The findings highlight how ambulance clinicians often serve as the first—and sometimes only—point of contact for individuals in distress, underscoring systemic gaps in community-based mental health support.

The study's lead author, Gabrielle Harding, a paramedicine lecturer at AUT and practicing paramedic with Hato Hone St John, emphasized that many of these incidents signal deeper issues: "People ring 111 when they are at a crisis point or in distress." This research marks the first comprehensive Aotearoa-specific analysis of such callouts, filling a critical gap in local data amid rising national ambulance demands, which hit a record 706,194 emergency 111 calls in 2025.

Understanding the Scale: Low-Urgency Callouts Dominate

Nearly 90% (89.8%) of the mental health callouts were classified as low acuity—status three or four on the ambulance urgency scale—indicating they could have been managed outside emergency settings. Only 67.2% of patients were transported to hospital, leaving 32.8% treated on scene or referred elsewhere. Among ethnic groups, low-acuity rates were similarly high: 89.3% for Māori, 92.1% for Pacific peoples, and 89.9% for non-Māori non-Pacific peoples (NMNPP).

Repeat callouts affected 15.8% of cases, with 9.8% involving two incidents, 2.8% three, and 3.2% four or more within the year. This pattern points to fragmented care, where individuals cycle back into crisis without sustained support. Peak demographics skewed younger, with 22.4% under 25 years old—a figure rising to 31.9% for Māori and 29.3% for Pacific peoples—highlighting vulnerabilities among youth in these groups.

Deprived Communities Bear the Brunt: NZDep Insights

The New Zealand Deprivation Index (NZDep), a tool measuring socioeconomic disadvantage across 10 quintiles (1 least deprived, 10 most), revealed profound inequities. A staggering 30.8% of callouts originated from the most deprived quintiles (9 and 10), far exceeding expectations based on population distribution. For Māori, this jumped to 47.7%, and for Pacific peoples to 49.9%, compared to 24.5% for NMNPP—a statistically significant disparity (p<0.001).

NZDep incorporates factors like income, home ownership, employment, qualifications, and single-parent households, painting a picture of how poverty amplifies mental health stressors such as financial strain, unemployment, and housing instability. In these areas, ambulance services become a default safety net when primary care or community mental health options falter. Researchers argue this reflects "unmet health needs," urging policies to tackle upstream determinants like racism and access barriers.

Ethnic Disparities: Māori and Pacific Peoples Over-Represented

Māori comprised 22.1% of callouts (5,920 cases), Pacific peoples 4.6% (1,228), despite their population shares of around 17% and 8%, respectively. Females dominated across groups (over 50%), but younger Māori and Pacific individuals faced disproportionate burdens. These patterns align with broader trends: Māori experience higher undiagnosed rates, hospital admissions, and poorer outcomes, while Pacific peoples report elevated conditions but lower service access.

Cultural safety emerges as key; the study calls for Māori-led services per Te Tiriti o Waitangi principles, especially post-disbanding of Te Aka Whai Ora. For those exploring careers in culturally responsive health, opportunities abound in New Zealand's universities and paramedicine programs. Check out higher ed jobs in health sciences or NZ academic positions to contribute to equity-focused research.

In deprived areas, these disparities intensify, linking to historical inequities and ongoing stressors. A 2023/24 Health Survey showed 19.1% of adults with moderate distress and 13% high/very high, with ethnic gaps persisting.

Photo by micheile henderson on Unsplash

Ambulance Services: The Frontline of a National Crisis

Hato Hone St John and Wellington Free Ambulance clinicians follow unified Clinical Procedures, offering medications, GP referrals, or ED transport. Yet, with mental health callouts rising—up 10% in 2019 alone—and total 111 calls surging 30% over five years, services strain under non-urgent volumes. Police are withdrawing from these responses, amplifying ambulance roles.

• Clinicians code impressions like anxiety, self-harm, or suicide attempts via SNOMED CT for standardized data.
• Data from electronic Patient Report Forms feeds the ANZPaCC database, enabling this analysis.
• Training gaps noted; enhanced paramedic education on mental health could bridge them.

AUT's paramedicine program, where lead researcher Harding lectures, exemplifies how universities train the next generation. Aspiring professionals can find guidance at higher ed career advice.

Government Reforms: From Crisis to Community Focus

The 2018 He Ara Oranga inquiry decried the "ambulance at the bottom of the cliff" model, advocating early intervention and equity. Recent moves include Health NZ's Access and Choice (1m+ sessions since 2020), 557 new mental health FTEs since 2023, and Budget 2025's $61.6m for crisis cafés and peer support.

January 2026 saw co-response teams launch in four regions (Tairāwhiti, Counties Manukau, Waitematā, and others), pairing police/ambulance with mental health experts for repeat callers.Learn more on government rollout. Telehealth expansions and a $10m Innovation Fund support peer-led initiatives like Ki tua o Matariki for young mothers.

Promising Solutions: Co-Response and Crisis Cafés

Wellington City Mission's 24/7 Crisis Café diverted 750+ in 11 months, reducing 111 repeats via peer support for panic or suicidal ideation. Minister Matt Doocey praises co-teams for personalized responses to loneliness or housing stress.

• Co-response models: Proven in Wellington (2020-21 eval), lowering ED transports.
• Peer-led cafés: Community alternatives to clinical EDs.
• Referral pathways: Linking ambulances to GPs/telehealth.
• Workforce growth: Specialist services for youth.

Study authors advocate ambulance data monitoring, culturally safe care, and socioeconomic interventions. For full study, see NZMJ publication.

University Research Driving Change

AUT and University of Auckland researchers, including Harding (AUT Paramedicine) and UoA's Sarah Fortune and Rodrigo Ramalho (Population Health), leveraged ANZPaCC data ethically approved by Northern B Ethics Committee. This interdisciplinary work informs paramedicine curricula, emphasizing cultural competency and data analytics.

Universities like AUT train paramedics for MH complexities, fostering careers in research and practice. Explore university jobs or rate my professor for insights into programs shaping NZ's health workforce.

Photo by Sumaid pal Singh Bakshi on Unsplash

Future Outlook: Toward Equitable Mental Health Care

With ambulance demands climbing and disparities entrenched, sustained investment in community alternatives is vital. Policymakers must prioritize Māori/Pacific-led services, upstream prevention, and ambulance upskilling. Ongoing data from Hato Hone St John could track progress.

Optimism lies in reforms: co-teams, telehealth, and peer support promise relief. For professionals, this underscores demand in paramedicine and public health. Visit higher ed jobs, career advice, rate my professor, and university jobs to join the response. Detailed RNZ coverage: read here.