Tuesday, 21 February 2012

Mental Health in an Ambulance......

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.
I could go on for hours. The reason I mentioned the above jobs was apart from the first one, we weren't stood down for any. We were expected to carry on as if nothing had happened. No follow up support. Nothing. It is of no surprise that PTSD is so common amongst staff when so little compassion and understanding is shown. We aren't robots. These things DO affect us.

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?'.


  1. manchester ambulance man21 February 2012 at 14:34

    Well, what can i say. A damn good post, and very very true. After I dealt with a kiddy resp arrest, cleared at a+e and were just sent another job with out even a " are you ok ". I was livid and angry for the next week or so. We get no de-briefs after bad jobs. Its even worse when ur on the rrv as you dont even have a crew mate to talk to. You sit there and talk to yourself basicly.
    Keep up the good work luv

  2. Once again excellent blog. What interests me is the figures. We ve all had at least one of the signs/symptoms given. Are these figures recent also are they taken from UK EMS or USA/Worldwide. Management need to know we are not machines/automatons. When our vehicle /equipment is broke it is taken off the road to be fixed. We usually are left to our own coping devices. MORE NEEDS TO BE DONE

    1. Thanks for you comment, the sources were varied, all through google scholar, stupidely I didn't save all of the sources but hear are a few I have re-found!

      Emergency Medicine Journal 2004 - http://emj.bmj.com/content/21/2/235.full

      Occupational and Environmental Journal 2004 - http://oem.bmj.com/content/61/6/553.full

      European Working Conditions Observatory 2008 - Can only find the abstract now

      Traumatology 2011 - http://tmt.sagepub.com/content/17/4/17.abstract

      King's College London 2008 - http://www.iop.kcl.ac.uk/news/default.aspx?id=257

      The Royal College of Psychiatrists 2012 - Can't find the bloody page!

      There were more but I can't find them now! All were UK facts generally within the last 5 years. Most were published in the BMJ and only 1 European. None were USA either. You're right, more does need to be done!

  3. Another fantastic blog Ella. Having been to some tough jobs with no/minimal support from management afterwards, I can relate to a lot of what you said. I think management need to understand that we are not just a pin number/call sign , we are human and to effectively encourage us to not speak out about jobs/stress only causes increased sickness/early retirement in the long term.

  4. Never had longer than an hour stood down after a job except for when our colleague arrested 5 hours after the last of 4 night shifts. We got the rest of the shift off then.

    I'm personally on a cheeky wee 25mg Citalopram each day. I know plenty of other who have mild to serious mental health issues and most get some support from our immediate management.

    These days though we tell control that we are standing down and will get back to them when we are ready for the road rather than wait for down time to be offered.

  5. In my short time on the road I have already compiled a list of horrors similar to, but not quite as long as, yours. However, the worst thing for me (so far) was watching a 14 year old boy being told his Dad was dead. I made it back to the truck without crying, cleared from the job, and we were immediately sent on our next job, no questions. I struggled to compose myself in time for arrival on scene...because that's what we do. To what consequence??

  6. Love your blog, only found it today. I had experience of resus-ing a baby which we knew was a non-starter but did the basics because the hysterical mother had already started. I blued him in specifically as a non-viable resus to be met with a full paed team and an anaesthetist who went 'woah, woah, woah...HE'S DEAD' To which I didn't say the 'I know he is you stupid, inhuman bitch' part, but I did say 'yes, and THIS is his Mum' and promptly left resus with absolute rage inside me. I know they are anaesthetists because they have no people skills but really! So inappropriate. The rage and frustration (probably from not having a proper go at her but 'professionalism' stopped me) (or maybe it was just the fact that I like my job and probably would not have got out of that one!) made me cry rather than the dead child, and I think it was because I knew he had been dead before we were even called to help. And after all that? Another job. Because we'd already had a cuppa in A&E whilst they persuaded me not to put in a formal complaint about the anaesthetist. After all this time her attitude still makes me MAD!!

    1. Thanks for your comment! Totally agree with you. I wish some discretion would be shown but senior medical personel. They just don't understand emergency medicine and what we often have to do for the sake of the families!

  7. Ambulance drivers work for public and private agencies, as well as some municipal fire departments. Volunteering for a rural municipal ambulance service is an option for gaining valuable experience.

  8. They really don't give a s*** about the staff at the sharp end dealing with it all! I could rant, but as usual i'll keep it all to myself.

  9. I really commend your work, I could never be a paramedic. I wanted to be a SCBU nurse, but in all honesty with my history I doubt I would ever be strong enough and no mum in that place wants a weeping nurse rocking in the corner!


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