I recently posted a guest blog by MentalHealthCop entitled Safe & Well? This was a joint venture between the two of us and my response to the same question was posted on his blog. As hoped, the posts threw up a lot of questions and commentary on the issue, but for me, one of the most poignant ones came from an anonymous reader.
Whilst you are dealing with patients with mental health problems, how is the mental health of the ambulance service employees handled and is the support there if it's needed?
A very good question indeed and one I decided to answer in full. Mental health is always a 'hush hush' subject when it comes to sick leave. The idea of someone going off with long term stress is not uncommon but is often made light of and even suggested it's just a way to get blag months off work. In all fairness, this has been the case with a number of people and I'm sure the system has been abused, but stress, amongst other mental disorders is a real issue that should be highlighted.
The job we do is stressful at times and for me personally, it is often a struggle to deal with some of what we see emotionally. We see a lot of acutely ill people and this itself is stressful due to the fact that invariably there will be bad outcomes. As a result of this, there is a distinct possibility of self-recrimination amongst ambulance staff and a likelihood of suffering intrusive thoughts for a prolonged period of time. A number of studies have been done on the prevalence of Post-Traumatic Stress Disorder (PTSD) amongst ambulance staff and it has shown as high as 20% of staff suffers with this condition with 65% thought to have shown some degree of psychiatric morbidity. Although a large proportion of our job is dealing with drunk people and time wasters, seeing dead children, mutilated bodies and neglect leaves an imprint in one's mind. Anyone who says they have never had a job that has affected them is a liar. We all have our coping mechanisms be it sharing, crying, laughing or writing. We do what we need to do to be able to go out again and do our job.
Below are a few facts and figures that I have compiled, from a number of studies, which highlight just how common these issues are within EMS:
- 22% reported probable clinical levels of anxiety.
- 20% are indicative of a diagnosis of PTSD.
- 10% had clinical levels of depression.
- 45% of respondents reported current troubling memories.
- 15% reported having had them in the past.
- 68% report suffering insomnia
- 21% of which consider it to be chronic insomnia
- 5% admitted to having had suicidal thoughts.
- Suicide rate in EMS is 1:3500 compared to 1:10000 amongst the general public.
Cheery stuff isn't it! A large proportion of instances of mental health issues can be attributed to the job we do, however, I feel it is perpetuated by the environment in which we work. Many staff feel overworked, undervalued and mis-treated by management. This isn't limited to my service; this is country wide and goes a long way to explain morale being at its lowest. Despite significant reforms staff still report a lack of respect and bullying tactics used to make the prospect of going off sick untenable. I have seen it first hand, the meetings, the letters, the phone calls, the home visits. It is bullying, make no bones about it. A welfare check always seems to have an undertone of mistrust about it. Whilst I appreciate that sickness needs to managed if you tell a manager you are off sick because you are stressed, not sleeping or you are depressed it's a black mark against your name; a black mark that will stay. You're considered to be 'pulling a fast one'. Mental health, despite the propaganda, is not taken seriously or respected within the ambulance service. Counselling is available but the system isn't trusted. There are LINC workers (internal councillors) who are rarely used due to confidences being breached and everything leads to people lying about the reasons they are off sick. In turn, this pushes mental health further under the carpet.
In a recent survey, 75% of ambulance staff felt they had been disrespected in the last 12 months by a manager. 52% felt they had been bullied and harassed. 83% said there was no concern for employees and 92% said there was a poor relationship between staff and management. 80% said stress wasn't managed effectively & 75% believe they have excessive workloads. Is it any surprise that mental health problems are so common? What amazed me was just how high these figures are. Obviously, sick leave costs money, but for anything to change there needs to be a change in the mindset. If someone says they are stressed it should be taken seriously. Being told to 'go and have a cuppa' after a baby has died in front of you simply isn't good enough. These feelings and images can last for months and I really don't think that this is appreciated and I don't think enough help or follow up support is offered. I have suffered anxiety, stress, intrusive thoughts and depression in the past but I have an outlet, a coping mechanism. Not everyone does. Some of the things we are subject too can be truly harrowing and it didn't take me long to compile a small list of jobs I've attended in the last 3 years that will stick with me forever:
- Doing CPR on a 7 year old girl after she drowned in her bath.
- Delivering a still born baby and having to tell the parents.
- Climbing under a train to find a man mutilated and twister around the wheels.
- Trying to revive a man you had fallen 60ft and landed face down.
- Trying to stop the arterial bleed of a man stabbed in the neck.
- Finding a man hanging in a park.
- Watching a woman get hit at speed by a car.
- Declaring a woman dead after being crushed by a bus.
- Seeing the remains of a man crushed by a JCV.
- Attending a family of 4 in an RTC. Parents dead. Children orphans.
- Finding a child, covered in excrement, left on her own.
- Seeing a man's chest cut open and heart massaged.
Clearly, mental health is a problem that is prevalent within the ambulance service but clearly what we see and what the management see are two different things. My hope is that as mental health is becoming more of a public concern, the acceptance of its severity within the service will trickle down to the managers. It is only when staff feel supported and valued that the true impact that mental health is having can really been seen.
To see how mental health affects our police officers check out MentalHealthCop new blog 'Who is protecting the protectors?'.