BACKGROUND:Mental illness is a recognised global health issue and is a major burden of disease that health systems have failed to adequately address. National reforms in Australia to improve mental health service delivery propose building the knowledge and skills of service providers, such as paramedics, to ensure that they appropriately respond to the needs of people experiencing mental health issues. There is a paucity of literature on the role of paramedics in managing mental health presentations despite becoming an increasingly significant part of mental health care in the pre-hospital context. AIMS:This scoping review examined the available literature on the paramedic management of mental health related presentations. METHODS:The five stages of Arksey and O'Malley's methodological framework was used: (1) identifying the research question; (2) identifying relevant studies; (3) study section; (4) charting the data; and (5) collating, summarizing and reporting of results. Relevant databases were searched. RESULTS:Fourteen peer-reviewed articles met the inclusion criteria. Three themes were identified and structured the findings. These were education and training, organizational factors, and clinical decision making. CONCLUSION:The authors recommend that future research address these areas, as high quality evidence will support planning in this complex area of health care delivery.