Background Paramedics are called on frequently to provide care to patients with mental health and/or and alcohol and other drug (AOD) problems, but may have mixed views about how this fits within their role. Aims To explore paramedics' experience of caring for patients with non-medical emergencyrelated mental health and/or AOD problems, understand their perceptions of their scope of practice in caring for these patients, and ascertain if their practice should be extended to incorporate education with these patients. Method A convenience sample of 73 paramedics from most Australian states and territories-recruited through an online survey-participated in individual audio-recorded, qualitative interviews, conducted by telephone. The interviews were part of a mixed method study comprising qualitative interviews and online survey. A Framework Method of analysis to analyse the qualitative data. Results Three themes and sub-themes were abstracted from the data about participants' experiences and, at times, opposing viewpoints about caring for patients with non-medical emergency-related mental health and/or AOD problems: Caring for these patients is a routine part of paramedics' work, contrasting perspectives about scope of practice in caring for this group of patients, competing perspectives about extending scope of practice to incorporate education with this cohort of patients. Conclusions Paramedics need more undergraduate and in-service education about the care of patients with mental health and/or AOD problems, and to address concerns about extending their scope of practice to include education with these patients. Thought should be given to introducing alternative models of paramedic practice, such as community paramedicine, with a focus on supporting people in the community with mental health and/or AOD problems. There is a need for a change in workplace and organisational culture about scope of practice in caring for patients with these problems. Extending paramedics' role could, potentially, benefit people with these problems by improving the quality of care, reducing the need for transportation to emergency departments, and decreasing clinicians' workloads in these departments.