{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T02:18:00Z","timestamp":1785377880778,"version":"3.55.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>A substantial portion of the 20 million calls that emergency medical services (EMS) personnel respond to each year are considered preventable, including more than 1.5 million behavioral health calls. Despite goals of preventing behavioral health crises and reducing the burden on patients and EMS personnel, little is known about how demographic and community characteristics influence behavioral health calls. Using nationwide 2021 EMS call data, we identified counties with high behavioral health calls and examined their demographic and community characteristics. Low-income and racially diverse counties had a higher incidence of behavioral health EMS calls, while politically conservative counties had a lower incidence of behavioral health EMS calls. To better meet the emergency behavioral health needs of communities, policy and decision-makers should consider strategies that increase access to and awareness of alternative behavioral health crisis services (eg, 988 Suicide and Crisis Lifeline).<\/jats:p>","DOI":"10.1093\/haschl\/qxaf054","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T07:25:06Z","timestamp":1741937106000},"source":"Crossref","is-referenced-by-count":1,"title":["County characteristics associated with behavioral health emergency medical services calls"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7256-9421","authenticated-orcid":false,"given":"Ashlyn","family":"Burns","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Indiana University School of Medicine , Indianapolis, IN 46202, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9859-2926","authenticated-orcid":false,"given":"Haleigh","family":"Kampman","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health , Indianapolis, IN 46202 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3411-2700","authenticated-orcid":false,"given":"Nir","family":"Menachemi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health , Indianapolis, IN 46202 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"issue":"6","key":"2025040414262667700_qxaf054-B1","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1136\/emj.16.6.464-a","article-title":"Life in the balance: emergency medicine and the quest to reverse sudden death","volume":"16","author":"Foex","year":"1999","journal-title":"Emerg Med J."},{"issue":"2","key":"2025040414262667700_qxaf054-B2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1093\/jhmas\/jrr053","article-title":"Transporting lazarus: physicians, the state, and the creation of the modern paramedic and ambulance, 1955-73","volume":"68","author":"Simpson","year":"2013","journal-title":"J Hist Med Allied Sci"},{"issue":"3","key":"2025040414262667700_qxaf054-B3","doi-asserted-by":"publisher","first-page":"414","DOI":"10.2105\/AJPH.2004.048793","article-title":"The formation of the emergency medical services system","volume":"96","author":"Shah","year":"2006","journal-title":"Am J Public Health"},{"issue":"4","key":"2025040414262667700_qxaf054-B4","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1016\/J.JEMERMED.2023.01.002","article-title":"Association between primary care availability and emergency medical services utilization","volume":"64","author":"Jasani","year":"2023","journal-title":"J Emerg Med"},{"issue":"10","key":"2025040414262667700_qxaf054-B5","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1197\/J.AEM.2006.07.011","article-title":"IOM report: the future of emergency care in the United States health system","volume":"13","author":"Institute of Medicine","year":"2006","journal-title":"Acad Emerg Med."},{"issue":"3","key":"2025040414262667700_qxaf054-B6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.12927\/hcpol.2016.24535","article-title":"Inappropriate ambulance use: a qualitative study of paramedics' views","volume":"11","author":"Dejean","year":"2016","journal-title":"Healthc Policy."},{"issue":"3","key":"2025040414262667700_qxaf054-B7","doi-asserted-by":"publisher","first-page":"329","DOI":"10.3109\/10903127.2012.670688","article-title":"Factors associated with ambulance use among patients with low-acuity conditions","volume":"16","author":"Durant","year":"2012","journal-title":"Prehosp Emerg Care."},{"issue":"1","key":"2025040414262667700_qxaf054-B8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3109\/10903127.2012.722178","article-title":"National characteristics of emergency medical services responses in the United States","volume":"17","author":"Wang","year":"2013","journal-title":"Prehosp Emerg Care."},{"issue":"12","key":"2025040414262667700_qxaf054-B9","doi-asserted-by":"publisher","first-page":"2142","DOI":"10.1377\/HLTHAFF.2013.0741","article-title":"Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings","volume":"32","author":"Alpert","year":"2013","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"2025040414262667700_qxaf054-B10","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1080\/10903127.2021.1973626","article-title":"Public health surveillance of behavioral health emergencies through emergency medical services data","volume":"26","author":"Rivard","year":"2021","journal-title":"Prehosp Emerg Care."},{"issue":"10","key":"2025040414262667700_qxaf054-B11","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1377\/HLTHAFF.2013.0133","article-title":"Access and cost barriers to mental health care, by insurance status, 1999\u20132010","volume":"32","author":"Rowan","year":"2017","journal-title":"Health Aff (Millwood)"},{"issue":"S1","key":"2025040414262667700_qxaf054-B12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/1475-6773.13475","article-title":"Community-based models to improve service access: rethinking behavioral health crisis response pathways","volume":"55","author":"Sirkin","year":"2020","journal-title":"Health Serv Res"},{"issue":"1","key":"2025040414262667700_qxaf054-B13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1017\/S1121189X00002621","article-title":"Stigma and discrimination limit access to mental health care","volume":"17","author":"Thornicroft","year":"2008","journal-title":"Epidemiol Psichiatr Soc"},{"issue":"1","key":"2025040414262667700_qxaf054-B14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1176\/APPI.PS.201500453","article-title":"Trends in racial-ethnic disparities in access to mental health care, 2004\u20132012","volume":"68","author":"Cook","year":"2017","journal-title":"Psychiatr Serv"},{"issue":"10","key":"2025040414262667700_qxaf054-B15","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1176\/appi.ps.60.10.1376","article-title":"Effect of racial and ethnic composition of neighborhoods in San Francisco on rates of mental-health related 911 calls","volume":"60","author":"Kessell","year":"2009","journal-title":"Psychiatr Serv"},{"issue":"11","key":"2025040414262667700_qxaf054-B16","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1111\/ACEM.12253","article-title":"Patient demographic and health factors associated with frequent use of emergency medical services in a midsized city","volume":"20","author":"Knowlton","year":"2013","journal-title":"Acad Emerg Med."},{"issue":"5","key":"2025040414262667700_qxaf054-B17","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1080\/10903127.2019.1566423","article-title":"Pediatric behavioral health-related EMS encounters: a statewide analysis","volume":"23","author":"Fishe","year":"2019","journal-title":"Prehosp Emerg Care."},{"issue":"6","key":"2025040414262667700_qxaf054-B18","doi-asserted-by":"publisher","first-page":"365","DOI":"10.15171\/IJHPM.2019.15","article-title":"Political ideology and stigmatizing attitudes toward depression: the Swedish case","volume":"8","author":"L\u00f6ve","year":"2019","journal-title":"Int J Health Policy Manag"},{"issue":"1","key":"2025040414262667700_qxaf054-B19","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1177\/0020764015589131","article-title":"Managing the terror of a dangerous world: political attitudes as predictors of mental health stigma","volume":"62","author":"DeLuca","year":"2015","journal-title":"Int J Soc Psychiatry"},{"key":"2025040414262667700_qxaf054-B20","doi-asserted-by":"publisher","first-page":"102914","DOI":"10.1016\/J.PMEDR.2024.102914","article-title":"Demographic variation in preferred sources for suicide prevention and mental health crisis services among U.S. adults","volume":"47","author":"Purtle","year":"2024","journal-title":"Prev Med Rep"},{"issue":"2","key":"2025040414262667700_qxaf054-B21","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/j.1556-6678.2008.tb00491.x","article-title":"The stigma of mental illness","volume":"86","author":"Overton","year":"2008","journal-title":"J Couns Dev."},{"issue":"10","key":"2025040414262667700_qxaf054-B22","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1176\/appi.ps.201300550","article-title":"Stigma and public support for parity and government spending on mental health: a 2013 national opinion survey","volume":"65","author":"Barry","year":"2014","journal-title":"Psychiatr Serv"},{"key":"2025040414262667700_qxaf054-B23","doi-asserted-by":"publisher","first-page":"469580241256822","DOI":"10.1177\/00469580241256822","article-title":"Market factors associated with comprehensive behavioral health crisis care availability: a resource dependence theory study","volume":"61","author":"Burns","year":"2024","journal-title":"Inquiry"},{"issue":"1","key":"2025040414262667700_qxaf054-B24","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1186\/S12889-021-11205-W\/TABLES\/3","article-title":"Race, ethnicity, poverty and the social determinants of the coronavirus divide: U.S. county-level disparities and risk factors","volume":"21","author":"Samuel","year":"2021","journal-title":"BMC Public Health"},{"issue":"4","key":"2025040414262667700_qxaf054-B25","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1177\/1077558716646898","article-title":"Assessing the individual, neighborhood, and policy predictors of disparities in mental health care","volume":"74","author":"Cook","year":"2017","journal-title":"Med Care Res Rev"},{"key":"2025040414262667700_qxaf054-B26","doi-asserted-by":"crossref","unstructured":"Ehlers J, Fisher B, Peterson S, et al \u00a0Description of the 2020 NEMSIS public-release research dataset. Prehosp Emerg Care. \u00a02023;27(4):473\u2013481. 10.1080\/10903127.2022.2079779","DOI":"10.1080\/10903127.2022.2079779"},{"key":"2025040414262667700_qxaf054-B27","article-title":"County health rankings & roadmaps","author":"University of Wisconsin Population Health Institute"},{"key":"2025040414262667700_qxaf054-B28","article-title":"Rural urban commuting area","author":"United States Department of Agriculture"},{"issue":"1","key":"2025040414262667700_qxaf054-B29","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/HMR.0b013e3182826624","article-title":"Using resource dependency theory to measure the environment in health care organizational studies: a systematic review of the literature","volume":"39","author":"Yeager","year":"2014","journal-title":"Health Care Manage Rev"},{"issue":"3","key":"2025040414262667700_qxaf054-B30","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/HMR.0000000000000113","article-title":"Contextual factors associated with hospitals' decision to operate freestanding emergency departments","volume":"42","author":"Patidar","year":"2017","journal-title":"Health Care Manage Rev"},{"issue":"4","key":"2025040414262667700_qxaf054-B31","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1037\/cdp0000047","article-title":"Ethnicity as a moderator of how parents' attitudes and perceived stigma influence intentions to seek child mental health services","volume":"21","author":"Turner","year":"2015","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"issue":"1","key":"2025040414262667700_qxaf054-B32","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1472-6963-7-15","article-title":"Cultural competence in mental health care: a review of model evaluations","volume":"7","author":"Bhui","year":"2007","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"2025040414262667700_qxaf054-B33","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1097\/PHH.0000000000002050","article-title":"Mental health and mental health care utilization across political affiliation in U.S. adults","volume":"31","author":"Ettman","year":"2024","journal-title":"J Public Health Manag Pract"},{"issue":"11","key":"2025040414262667700_qxaf054-B34","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1176\/PS.2008.59.11.1264","article-title":"Disparity in depression treatment among racial and ethnic minority populations in the United States","volume":"59","author":"Alegr\u00eda","year":"2008","journal-title":"Psychiatr Serv"},{"key":"2025040414262667700_qxaf054-B35","doi-asserted-by":"publisher","first-page":"114442","DOI":"10.1016\/J.PSYCHRES.2022.114442","article-title":"Racial and demographic disparities in emergency department utilization for mental health concerns before and during the COVID-19 pandemic","volume":"310","author":"Penner","year":"2022","journal-title":"Psychiatry Res"},{"issue":"8","key":"2025040414262667700_qxaf054-B36","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1080\/10903127.2022.2142344","article-title":"Disparities in emergency medical services care delivery in the United States: a scoping review","volume":"27","author":"Farcas","year":"2022","journal-title":"Prehosp Emerg Care"},{"key":"2025040414262667700_qxaf054-B37","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-024-01368-0","article-title":"State policies associated with availability of mobile crisis teams [published online ahead of print March 18, 2024]","author":"Burns","journal-title":"Adm Policy Ment Health."},{"issue":"2","key":"2025040414262667700_qxaf054-B38","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1515\/FHEP-2021-0042\/MACHINEREADABLECITATION\/RIS","article-title":"Health outcomes, income and income inequality: revisiting the empirical relationship","volume":"24","author":"Alexiou","year":"2021","journal-title":"Forum Health Econ Policy"},{"issue":"3","key":"2025040414262667700_qxaf054-B39","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1016\/J.AMEPRE.2007.04.033\/ASSET\/88361B56-4681-495B-962E-3CA129766E94\/MAIN.ASSETS\/GR1.JPG","article-title":"Should health studies measure wealth? A systematic review","volume":"33","author":"Pollack","year":"2007","journal-title":"Am J Prev Med"},{"issue":"1","key":"2025040414262667700_qxaf054-B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12939-019-0942-1\/TABLES\/6","article-title":"Income gradient in health-related quality of life\u2014the role of social networking time","volume":"18","author":"Zhang","year":"2019","journal-title":"Int J Equity Health"},{"issue":"6","key":"2025040414262667700_qxaf054-B41","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1377\/hlthaff.2016.0029","article-title":"Removing obstacles to eliminating racial and ethnic disparities in behavioral health care","volume":"35","author":"Alegr\u00eda","year":"2016","journal-title":"Health Aff"},{"key":"2025040414262667700_qxaf054-B42","article-title":"Crisis services and the behavioral health workforce","author":"Pietras","year":"2021"},{"issue":"6","key":"2025040414262667700_qxaf054-B43","doi-asserted-by":"publisher","first-page":"e20173554","DOI":"10.1542\/PEDS.2017-3554\/-\/DCSUPPLEMENTAL","article-title":"Hospital-based quality measures for pediatric mental health care","volume":"141","author":"Bardach","year":"2018","journal-title":"Pediatrics"},{"key":"2025040414262667700_qxaf054-B44","volume-title":"Quality Measures for Behavioral Health Clinics: Technical Specifications and Resource Manual","author":"Substance Abuse and Mental Health Services Administration","year":"2024"},{"key":"2025040414262667700_qxaf054-B45","doi-asserted-by":"publisher","first-page":"105729","DOI":"10.1016\/J.CHILDYOUTH.2020.105729","article-title":"Outcomes, evidence-based treatments, and disparities in a statewide outpatient children's behavioral health system","volume":"120","author":"Lang","year":"2021","journal-title":"Child Youth Serv Rev"},{"issue":"10","key":"2025040414262667700_qxaf054-B46","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/J.JAAC.2013.07.012","article-title":"Dissemination and implementation of evidence-based practices for child and adolescent mental health: a systematic review","volume":"52","author":"Novins","year":"2013","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"2025040414262667700_qxaf054-B47","first-page":"37","article-title":"Adopting evidence-based medically assisted treatments in substance abuse treatment organizations: roles of leadership socialization and funding streams","volume":"37","author":"Blum","year":"2014","journal-title":"J Health Hum Serv Adm."}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxaf054\/62413340\/qxaf054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/3\/4\/qxaf054\/62413340\/qxaf054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/3\/4\/qxaf054\/62413340\/qxaf054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T19:01:57Z","timestamp":1743793317000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxaf054\/8078309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,14]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxaf054","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,14]]},"article-number":"qxaf054"}}