Answering the call: mental health needs of first responders highlighted

By Dr John Bates. This article first appeared in Issue One 2019 of Fire Australia. 

Pioneering Australian research into the mental health and wellbeing of police and emergency service staff and volunteers has been released as part of a collaboration between Beyond Blue and the Bushfire and Natural Hazards CRC.

Professor David Lawrence (University of Western Australia) led the research, titled Answering the Call, with the findings released at the Melbourne Convention and Exhibition Centre on 29 November 2018.

Extensive anecdotal evidence has shown that police and emergency services personnel are at a greater risk of experiencing a mental health condition than those in less stressful jobs. The lack of comprehensive, national data has created challenges in understanding the true extent of mental health issues in the sector, and in advocating for genuine reform and change.

This landmark research now provides a detailed and accurate picture of mental health issues across Australia. The results have established national baseline measures of wellbeing, mental health conditions and suicide risk among police and emergency services personnel. They also provide evidence about the issues affecting their health, and the best ways to provide support.

The survey, conducted from October 2017 to March 2018, involved current employees (operational and non-operational) and volunteers, as well as former and retired employees working in ambulance, fire, police, and state emergency service agencies in each Australian state and territory.

Of the 36 agencies in the sector, 33participated in Answering the Call, with 14,868 employees and 5,485 volunteers surveyed. In addition, 661 former employees were recruited through associations of former employees and related groups. In total, the survey engaged with 21,014 respondents, measuring across nine survey themes:

• prevalence of mental health and wellbeing
• suicidal thoughts and behaviours
• individual risk and protective factors
• substance use
• risk and protective factors associated with the working environment
• stigma
• seeking support
• workers’ compensation
• former employees.

The main results from the survey in each of these areas are summarised below.

Prevalence of mental health and wellbeing

Ten percent of employees had probable post-traumatic stress disorder (PTSD). Rates of PTSD ranged from 6% in the state emergency services (SES) sector to 9% in fire agencies. In comparison, the prevalence of PTSD has been estimated at 4% in adults in Australia and 8% in the Australian Defence Force.

Twenty-one percent of employees had high psychological distress and 8% had very high psychological distress—much higher than the 9% and 4%, respectively, among all Australian adults. Volunteers showed lower levels of psychological distress and probable PTSD and higher levels of positive wellbeing, with 4% of ambulance volunteers, 5% of fire volunteers and 6% of SES volunteers having probable PTSD.

Suicidal thoughts and behaviours

Suicidal thoughts and planning were twice as high than with the Australian population, while rates of suicide attempts were comparable. Employees with higher levels of social support and resilience reported lower levels of suicidal thoughts and behaviours, even if they had experienced traumatic events that deeply affected them in their work or were likely to have PTSD.

Individual risk and protective factors

Employees and volunteers that had started their career in the previous two years had high levels of mental wellbeing and very low levels of psychological distress, probable PTSD and suicidal thoughts. Higher rates of psychological distress and probable PTSD were associated with greater length of service, low levels of social support and more exposure to traumatic events that deeply affected individuals.

More than 80% of employees and 90% of volunteers reported providing high levels of social support to others, as well as receiving similar support.

Substance use

Many police and emergency services employees reported high rates of alcohol consumption, which may indicate its use for coping with stress or other symptoms of poor mental health.

Almost 50% of employees’ alcohol consumption exceeded National Health and Medical Research Council guidelines. Sixteen percent of employees drank five or more drinks in a single session at least weekly, and 17% consumed ten or more drinks in a single session during the past month.

Rates of illicit drug use were comparatively low. About 5% of employees reported having used illicit drugs within the past year, although 13% of employees with probable PTSD reported having done so. In comparison, 16% of Australians aged 14 and over reported using illicit drugs over a 12-month period.

Risk and protective factors associated with the working environment

The workplace environment, particularly poor team culture and workplace stress factors—such as inadequate resources and unpaid overtime—had significant impacts on employee mental health. In agencies with higher levels of resilience, more employees were able to take time off after experiencing a traumatic event at work, and employees more frequently had debriefings and reported that work did not drain too much energy that it affected their private life.

Stigma

Employees and volunteers tended to believe that others in the workplace held negative beliefs towards those with a mental health condition, or a low commitment to support those with mental health conditions.

Employees held notable levels of stigma surrounding their own mental health. Thirty-three percent of respondents felt shame about their mental health condition and 61% said they would avoid telling people about it. Despite these figures, most employees and volunteers reported they would support any colleague who experienced a mental health condition.

Seeking support

Comparatively, more people in the police and emergency services sector seek support when they need it for a mental health condition than in the Australian population overall. Barriers to seeking support commonly cited, for employees and volunteers alike, included wanting to deal with it themselves, concerns about being treated differently, and being perceived as weak.

Nearly half of employees believed they had received sufficient support for their needs. While this may seem low, it is comparable with the general population.

Workers’ compensation

Most respondents making workers’ compensation claims found the process to be unsupportive and stressful, and reported that it had a negative impact on their recovery. Among employees of employees had probable PTSD who made a claim, 75% felt it had a negative impact on their recovery, with only 8% reporting a positive impact. More than half (52%) felt that they were not supported at all during the claims experience, and 63% reported that they found the claims experience to be very or extremely stressful.

Former employees

Twenty-eight percent of former employees had seriously thought about taking their own life. Of those, 66% felt this way while still working in the police and emergency services sector and 62% felt this way after leaving the sector.

Former employees had lower resilience and were much less likely to receive high levels of social support than current employees, particularly those former employees currently having probable PTSD or high rates of psychological distress.

How the research is being used

A major recommendation of this research is that agencies review their existing health and wellbeing strategies. This will ensure that they have a comprehensive workplace mental health and wellbeing strategy that is a fully integrated element of their core business. The research is also being translated into action as part of the third phase of the project.

The research provides an opportunity for police and emergency service agencies to develop, refine and implement strategies and programs that can minimise the long-term mental health impacts for future employees and volunteers—the future workforce for providing essential emergency services to our communities.

 To read the full report, visit www.beyondblue.org.au/pesresearch