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Violent encounters and safety concerns are common among paramedics attending to 911 emergency calls. These concerns are particularly salient for paramedics attending to mental health and substance use calls. This article draws on data from a qualitative case study. Findings include paramedics’ reported perceptions and experiences of violence experienced on mental health calls, success with de-escalation of those in distress, and paramedics challenging the notion that all individuals with mental distress are violent. The article explores tensions between attention to care providers’ and care recipients’ safety, the contexts in which this care takes place, and equity concerns related to appropriately managing mental health emergencies.