Introduction: Mental health presentations are a rapidly growing proportion of cases seen by paramedics, often at the frontline of care delivery. How paramedics perceive persons with mental illness is vital, as their experiences in providing care can significantly impact decision-making. This article investigates these experiences and how they may influence patient care. Methods: This qualitative descriptive research was conducted with two focus groups of six operational paramedics, and the data recorded and transcribed. The team closely examined the data using thematic analysis through a symbolic interactionist lens to identify, analyse, and interpret patterns of meaning within transcribed data. After thematic analysis, a model for future practice was generated, which pictorially demonstrates the overlap of common themes. Results: Five themes ultimately were identified that were profoundly important to the paramedics within the focus groups. Paramedics have varying experiences when caring for people with mental illness. They are empathetic towards the circumstances of the person with mental illness. They perceive that the stigmatisation of persons with mental illness occurs in some cases. Paramedics are also affected in their clinical decision-making by their training and education and by the profession’s cultural influences. Conclusion: The stigmatisation of people with mental illness is apparent in paramedic practice. Despite mental illness being a common presenting problem, paramedics feel underprepared and have difficulty treating those who need help. The patients’ behaviour can often be reflected in the conduct of paramedics. The impact of burnout due to high exposure to people with mental illness, especially in metropolitan areas, may lead to decreased levels of empathy and compassion.