Ambulance staff contemplate suicide due to poor mental health

Project M (1)‘It started to manifest itself after a failed resuscitation attempt on a child several years ago. While there were low-level symptoms over the years, and there were certain calls that would affect me more than others, there was much more severe recurrence after witnessing the aftermath of a plane crash over a year ago.’

Aryeh Myers, 39, is a paramedic for Magen David Adom, Israel’s national ambulance service. Before that he worked for London Ambulance Service NHS Trust for almost 10 years, as both an emergency medical technician (EMT) and paramedic. He was diagnosed with post-traumatic stress disorder (PTSD) just over a year ago.

Myers is one of an alarming number of paramedics whose mental health has suffered directly as a result of working for the ambulance service.

Recent figures published by mental health charity Mind revealed a third of ambulance staff surveyed contemplated taking their own lives due to stress and poor mental health. The results, taken from the responses of 1 600 emergency services staff and volunteers, including 308 in the ambulance service, also showed that 67% of ambulance staff contemplated leaving their job or voluntary role because of stress or poor mental health. A huge 93% reported experiencing stress, low mood and poor mental health at some point while working for the emergency services.

The figures also highlighted how 57% of ambulance staff took time off due to stress, low mood or poor mental health. These results reaffirm those published by The Observer that revealed over 40 000 days were lost by ambulance staff in 2014 due to mental health problems.

For Myers, he recalls how he took a month off work to begin treatment, including several sessions with a counsellor who taught him how to recognise triggers, how to partially ward them off, and particularly how to deal with the thoughts and reactions that those triggers bring.

‘It helped to a certain degree,’ he says. ‘At least I was able to go back to work. But there is, from what I’ve experienced, no way to completely get rid of PTSD, and certainly not if you continue working in the field where it was caused in the first place.’

Blue Light Programme

In October 2014, Mind was awarded LIBOR funding to deliver a programme to provide mental health support for emergency services staff and volunteers from police, fire, ambulance and search and rescue services across England up until 31 March 2016.

The Blue Light Programme focused on five main areas: tackling stigma and discrimination, embedding workplace wellbeing, building resilience of staff, providing information and support, and improving support pathways.

So far the programme has seen 250 000 information resources disseminated, 5 000 managers participate in line manager training, over 400 emergency services staff register to be ‘Blue Light Champions’, and 54 blue light employers and 9 national associations sign the Blue Light Time to Change pledge—a commitment to raising awareness of mental health, tackling stigma and helping enable staff and volunteers to talk more openly about their mental health at work. Currently, all ambulance services in England except East of England Ambulance Service NHS Trust have signed the pledge.

Funds have been allocated for Mind to continue to deliver the programme on a smaller scale throughout 2016/17.

Esmail Rifai, 50, is a clinical safety officer for North West Ambulance Service NHS Trust, who recently returned to work following a long period of work-related anxiety and depression. He lost a work colleague and friend to suicide.

‘My colleague taking his own life had a devastating effect on me at a time when I was coming to terms with my own mental health,’ he says.

‘At work I often take on more than time permits, which inevitably takes its toll and ultimately ends up with my own mental health deteriorating.’

Rifai is a ‘Blue Light Champion’ and has found the experience helpful in coming to terms with his own mental health issues. ‘Being involved with the Blue Light Programme has also given me some solace,’ he says. ‘Knowing that I’m helping others in itself makes me feel good—a sense of achievement.’

Exposure to shocking events

Project M (3)Dan Farnworth is an EMT for North West Ambulance Service NHS Trust who has also suffered from PTSD.

‘My mental health issues started about a year and a half ago,’ he says. ‘We went to a job that involved child abuse. It was awful. We did everything that we could, but unfortunately we weren’t able to save the child.’

While Farnworth understandably felt low after the job, it wasn’t until 24 hours later that he found himself unable to shake the image of the child from his head.

‘At work I wasn’t acting like myself anymore; I wasn’t socialising as much with colleagues, and generally not interacting with people.’

In addition to his work, he found the event had begun to affect his life at home as well.

‘It made me a grumpier person, and my patience was a lot shorter. It even started to affect my sleep, and I found myself having nightmares about it.

‘I’d often find myself just sat there, not really doing anything but thinking about the job, and thinking about whether there was anything else I could have done.’

The nature of work undertaken by ambulance services means there are times when paramedics find themselves turning up at the scene of a shocking or upsetting event.

‘As a paramedic there is no way to avoid seeing sights that are difficult,’ says Myers. ‘It may be one shocking call, or it may be a build up over time, but I believe we are all affected in some way by the things we see, by the emotion we experience but are forced to contain while dealing with our job. Showing any sign of emotion is still perceived as a weakness rather than an outlet, and this is one of the things that needs to change.’

Kevin Sibley is an EMT for East of England Ambulance Service NHS Trust who served 8 years within the army. A year of that time was spent in Northern Ireland where he witnessed a number of harrowing events. He remains unconvinced at the prevalence of mental health problems suffered by ambulance staff.

‘I have known people who have left the ambo service and have come back 6 months later after querying suffering mental problems,’ he says.

‘Unfortunately I think lots of people use the mental health card in the ambo. PTSD in the military is not an excuse, it’s because your mates who will die for you are killed in a horrible situation. Unfortunately I can’t compare this to the ambo service as we join to help people in road traffic collisions (RTC) etc. You [can] walk in to a hanging, RTC or decapitation.’

Sibley is of the opinion that some paramedics are quick to associate distressing events with potential mental health issues, with some reaching for the latest buzz word to explain how they are feeling.

‘I don’t mean to belittle people with issues but we were unwell,’ he says. ‘Not dealing with it, then stress, then depression. People looked for a new thing, a new name, and grabbed PTSD.’

Support for ambulance staff

Currently, ambulance services have internal debriefing support services, and through occupational health staff have access to professional counselling services. Additionally, support is provided to ambulance service staff and their families by The Ambulance Services Charity (TASC).

‘Most people will normally feel some levels of stress throughout their day—the fight or flight model enables us to cope with difficult situations,’ says Jean Hayes, director of support services for TASC. ‘However, prolonged levels of stress can sometimes have a negative impact on health and wellbeing. For some ambulance personnel, constant and increasing exposure to difficult situations may result in poor health.’

Hayes explains how since its launch in March 2015, TASC have been approached by a number of ambulance personnel suffering from low mood, stress-related illness and undiagnosed PTSD, many of whom remain in work providing a dedicated service to the general public.

As a result, the charity is currently developing a programme of support for individuals, working with a leading psychologist, which will enable ambulance personnel to recognise their own symptoms and develop strategies to help manage poor mental health.

‘Subject to funding, TASC aim to roll out this programme of work nationwide,’ says Hayes. ‘Along with other support services, TASC are here to support those working in the UK ambulance services, whenever they are facing unexpected difficulties, crisis or are in need.’

The College of Paramedics has been working closely with Mind over recent months, and is an active participant in the blue light mental health agenda nationally, along with the Association of Ambulance Chief Executives (AACE).

According to David Davis, paramedic and fellow of the College of Paramedics, the College has recognised the importance of the mental health and wellbeing of paramedics and other ambulance and pre-hospital professionals for a number of years. These include significant concerns around what many feel is an unachievable retirement age of 68, significant changes in working practices and increased workloads resulting in increased isolation of practitioners, as well as concerns over violence and aggression towards emergency services workers.

‘The research undertaken by Mind, as part of the Blue Light Programme, has reinforced anecdote with real meaningful data about the level of problems, and importantly revealed that many frontline staff were not keen on being open about mental ill health and stress for fear of either embarrassment or adverse consequences from employers or otherwise,’ says Davis.

‘The most recent data was very worrying indeed,’ he adds. ‘Particularly that 35% of those ambulance staff completing the online survey had contemplated taking their own lives.

‘There is increasing awareness of the risk of suicide among paramedics and other emergency ambulance service personnel that simply cannot be ignored, and the recent data from the Mind survey tells us that actions must be taken now to support and protect this important group of public servants.’

Davis, who is spokesperson on mental health for the College of Paramedics, goes on to highlight that the recent College of Paramedics conference revealed a clearly expressed mandate to make mental health of the membership a priority and to support the Mind programme.

‘A single suicide of one of the brave men or women who I am proud to call my colleagues is a tragedy too many,’ says Davis. ‘We must work together to tackle the issues of mental ill health, whether they be stress, depression, anxiety or post-traumatic stress disorder.’

The AACE is one of the national associations signed up to the Mind Blue Light Time to Change pledge and were fully engaged in the Blue Light Programme throughout its initial duration. According to Anna Parry, national programme manager for the AACE, the association is continuing to benefit from the work undertaken by Mind, with the Time to Change Programme Manager contributing to ongoing work the AACE is overseeing to promote and enhance the mental health and wellbeing of staff. At the national level, the AACE is collating information and data in this area to better understand what more can be done to support ambulance service staff.

‘The sector feels that there is more that could and should be done to fight mental health stigma and discrimination and to enhance the supports that are available to staff in this area,’ says Parry.

‘The mental health and wellbeing of staff subsequently features in the AACEs 2016–17 strategic priorities; these are identified and progressed by ambulance services nationally,’ she adds.

Removing the stigma

Project M (4)Farnworth believes that with ever increasing demand on the ambulance service, there is not as much opportunity for discussion and reflection between jobs anymore.

‘When staff attend a particularly traumatic job, they are offered some “time out” but many staff don’t take this up when they know there are patients out there waiting for our help,’ he says.

‘As much as we look out for each other, there is still a bravado or “stigma” attached with this job; we all like to think we are infallible. We are there to support the public in [their] time of need, but we tend to not ask for help ourselves.’

‘Talking to my peers has also been a massive help,’ says Farnworth. ‘It helps me realise that what I’m going through is normal, and that many people experience things like this from time to time.’

This sentiment is something that Myers finds he can also relate to:

‘The first piece of advice I would give would be “do not be ashamed”. It took me a long time to admit both to myself and to those around me that there was something wrong. There is still a stigma attached to mental health issues, particularly PTSD, in a field where it is expected that you just get on with the job, that prevents people from seeking help. A first-line defence must be to talk, be it to a colleague, a friend or a relative, or, if the need arises, to a medical professional who will be able to give guidance with reference to the right course of treatment if required.

‘Don’t be afraid to seek help. Because the subject up until very recently was taboo, it was not well known how and where to seek help, but I believe that it’s slowly improving.’

Rifai also believes that stigma surrounding mental health should be removed: ‘There is no shame or stigma attached to experiencing mental health problems, it’s just the same as breaking a bone, except no one can see that you are suffering. We are not super humans and we are just as prone to illness as anyone else, if not more.’

Blue Light Walk

To help raise awareness of mental health problems within the blue light community and get emergency service personnel talking, Farnworth has teamed up with Richard Morton, paramedic; Philip Baggaley, senior paramedic; and Gill Despard, paramedic lecturer practitioner, to walk from Scarborough RNLI to Blackpool RNLI stopping at fire, police and ambulance stations along the way. They will be raising money for the Blue Light Programme.

The walk will take place from 26–30 September and they are inviting all emergency services, as well as the general public, to join them on the ‘last leg’ from Broughton ambulance station to Blackpool RNLI. Additionally, they are putting on a Blue Light Walk Charity Ball to celebrate the success of the walk on 1 October. If you would like to support their cause or join them then visit http://www.bluelightwalk.com.

Has your mental health been affected as a result of working for the ambulance service? If so, Journal of Paramedic Practice would like to hear from you. Email jpp@markallengroup.com

Taken from Journal of Paramedic Practice, published 6 May 2016.

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Improving mental health outcomes

Within our society there has been a long-standing lack of parity between mental and physical health, with those suffering from mental health issues often experiencing stigma and discrimination. Luckily this is beginning to change. In 2013, the Minister for Care Services, Norman Lamb, campaigned for parity of esteem between mental and physical health, following a report produced by the Royal College of Psychiatrists (Department of Health and The Rt Hon Norman Lamb, 2013). The report set out the rationale for a parity approach to mental and physical health, and made recommendations for how parity can be achieved, predominately in health and social care (Royal College of Psychiatrists, 2013). More recently, newly elected leader of the Labour party, Jeremy Corbyn, has created a dedicated Minister for Mental Health in his shadow cabinet. Liverpool Wavertree Labour MP, Luciana Berger, is the first to be appointed to this role. However, there is currently no equivalent position in the Conservative party.

Around 20% of the world’s population have mental disorders or experience mental health problems, with half of mental disorders beginning before the age of 14 years (World Health Organization (WHO), 2007). Additionally, it is estimated that around 800 000 deaths by suicide occur each year (WHO, 2014). However, it is argued that this is a conservative estimate due to the stigma associated with suicide, lack of reliable death recording procedures, and religious or legal sanctions against suicide in some countries (WHO, 2014). It is apparent that mental health forms a large portion of demand on health services worldwide, and should therefore be made a higher priority on the global public health agenda.

In March, NHS England launched an independent taskforce whose role was to develop a 5-year national strategy to improve mental health outcomes across the NHS. The subsequent strategy interim report, published in September, set out how national bodies will work together between now and 2021 to help people have good mental health and make sure they can access evidence-based treatment rapidly when they need it. In the report it was recognised that parity between physical and mental health is necessary but not sufficient, and that the huge variation in access to services between different groups of people must also be tackled (Mental Health Taskforce, 2015).

World Mental Health Day is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilising efforts in support of mental health. This year the theme is ‘Dignity in Mental Health’. For more information, or to find out how to get involved, visit: http://tinyurl.com/njlgnt6.

References

Department of Health, The Rt Hon Norman Lamb (2013) Achieving parity of esteem between mental and physical health. The Stationery Office, London

Mental Health Taskforce (2015) The Five Year Forward View Mental Health Taskforce: public engagement findings. http://tinyurl.com/nf2laqg (accessed 27 September 2015)

Royal College of Psychiatrists (2013) Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health. Summary. RCPsych, London

World Health Organization (2007) 10 facts on Mental Health. WHO, Geneva. http://tinyurl.com/kzy8usv (accessed 28 September 2015)

World Health Organization (2014) Preventing suicide: A global imperative. WHO, Geneva. http://tinyurl.com/ose3ser (accessed 28 September 2015)

Taken from Journal of Paramedic Practice, published 2 October 2015.

UNISON survey reveals stress among ambulance staff

Nine in ten ambulance workers are suffering from stress, according to a recent survey carried out by trade union UNISON.

The online survey, which was completed by 2,977 ambulance workers, revealed that causes of stress among staff were long hours (71%), staff shortages (65%), mental demands of the job (45%), target culture (52%), physical demand of the job (40%), bullying and harassment (25%), and abuse of violence at work (15%).

The survey also revealed that 74% suffer from sleep problems, 72% felt irritable as a result and experience mood swings, and 56% suffer from anxiety.

Additionally, 38% said they had to take time off sick because of work-related stress and 26% admitted they were close doing so.

UNISON, which represents 20,000 ambulance workers in the UK, have raised concerns that employers are not fulfilling their duty of care, as more than half of respondents said they were unaware of any steps being taken by their employer to remove or reduce stress.

UNISON head of health, Christina McAnea, said:

‘Working in emergency services is stressful but the pressure on ambulance staff is reaching dangerously high levels.

‘It is unacceptable that the current system doesn’t allow for proper breaks between shifts,’ she added. ‘Workers have told us they often work 14-hour shifts without a decent break.’

Emma Mamo, head of workplace wellbeing at mental health charity Mind, said:

‘This data reveals the worrying scale of stress among ambulance workers, and echoes our findings which revealed the extent of stress and mental health problems across all emergency services personnel.’

Last month, Mind launched its Blue Light Programme, a major new programme of mental health support for emergency services staff after being awarded £4 million of funding from the Cabinet Office.

The programme aims to focus on tackling stigma and discrimination, embedding workplace wellbeing, building resilience, and providing information and support.

Taken from Journal of Paramedic Practice, published 30 April 2015.

Street Triage Mental Health Scheme introduced to West Midlands

A pilot ‘street triage’ scheme from the Department of Health has been launched in the West Midlands to ensure people with mental health issues are kept out of custody and receive the right treatment.

The scheme will see paramedics from West Midlands Ambulance Service NHS Foundation Trust and nurses from Birmingham and Solihull Mental Health NHS Foundation Trust join forces with West Midlands Police to attend incidents involving people who require immediate mental health support.

The pilot follows similar schemes that have taken place elsewhere in the country, which have shown a reduction in the demands on police and ambulance time.

Dr Andy Carson, medical director for West Midlands Ambulance Service, said: ‘This is a fantastic and exciting opportunity for the Trust to work alongside partners to ensure the highest quality of care is delivered to some of the most vulnerable people from within our community. We welcome this opportunity and firmly believe this will ensure mental health provision will be amongst the best in the country.’

Jon Short, chief executive at Birmingham and Solihull Mental Health NHS Foundation, said: ‘There’s been a huge fuss in recent years over how much front-line police work deals with mental health issues.
‘Lots of their call-outs are to disturbances in the street or domestic issues. Police have limited powers in these issues, so the outcome is often an arrest.

‘The triage will allow trained paramedics and mental health nurses to assess people more thoroughly and to make police aware of the range of options available to them, such as if the person involved needs counselling or other care.’

Taken from Journal of Paramedic Practice, published 27 January 2014.