Paranoid schizophrenia calls 911 nearly every month due to thoughts of someone or something coming to get her.

A 45-year-old female with paranoid schizophrenia calls 911 nearly every month due to thoughts of someone or something coming to get her. She has no support system, and shortly after being discharged she inevitably goes off her medication and relapses.

A 30-year-old male is homeless and an alcoholic. He freely admits that he has no desire to change his lifestyle, and has had several short stays in jails and forced rehab centers. He rarely ever overdoses, but he is often discovered sleeping or wandering outside by PD, who calls for EMS.

Each patient has a problem, but does their different attitude affect how you perceive them? Obviously, our care cannot change based on our feelings, but does either one of them seem more or less at fault for their situation?

While we cannot refuse transport in either case, is there something that a street-level paramedic can do to help break these cycles?

Are these issues more of a single failure (either the patient, PD, or hospital) or a systemic breakdown? How and where might they be addressed?

If you were in a position of authority, how would you address issues like these?