This study aims to investigate how prehospital emergency medical personnel in Norway perceive their competence and manage encounters with patients who are experiencing mental health crises.

A qualitative descriptive design using content analysis was employed, following the Standards for Reporting Qualitative Research guidelines.

The study was conducted within four emergency medical care services in a Norwegian hospital trust, covering both urban and rural areas.

Individual interviews were conducted with 16 health professionals (9 men and 7 women), aged 24–55 years, with 1–18 years of service experience.

The results revealed one main theme—‘Balancing security and patient care’—with two subthemes—‘Increasing mental health-related assignments in prehospital care’ and ‘Challenges related to the lack of competence and resources in handling mental health crises’.

This study highlights the increasing complexity and frequency of mental health crises that are faced by prehospital emergency medical personnel in Norway. These personnel often feel unprepared due to a lack of competence and clear procedures, forcing them to rely on clinical experience. Police involvement, particularly in rural areas, underscores the need for better collaboration between law enforcement and healthcare services. To enhance the quality of care, it is essential to implement a standardised curriculum for paramedicine education and provide comprehensive mental health training for all prehospital emergency medical personnel, including emergency medical communication centre operators and other healthcare professionals involved in emergency care.