Mental Health in the Emergency Services

On 20th June 2018, I attended the first Emergency Services #MentalHealthMatters conference at St George’s hospital in Tooting. The conference was a student lead event (students from the Paramedic Sciences degree programme), with funding from Mind and the Ambulance Staff Charity.

Along with my colleague and friend, Sarah Golding (PhD student and Health Psychology trainee at the University of Surrey), I had been invited to co-present research exploring the stresses experienced by Emergency Operations Centre (EOC) staff.

An estimated 137.3 million working days were lost due to sickness or injury in the UK in 2016…
Office for National Statistics

According to the Office for National Statistics (ONS), approximately 11.5% of sickness absence in 2016 was due to mental illnesses, such as stress, depression and anxiety. This amounts to about 15.8million days, although I suspect this number may be higher – stigma towards mental illness persists, discouraging workers from disclosing mental ill-health to their employers. Note-worthy in the ONS report is that 4.5% of sickness absence came under the category “prefers not to give details”.

Working in emergency medicine is inherently stressful, with exposure to trauma, long shifts, and time pressures being quite literally a matter of life or death. However, with the sickness absence rate for emergency medical staff (EMS) at nearly three times the national average, more needs to be done to support the wellbeing of these professionals.

Stress experienced by frontline emergency staff (i.e. paramedics and ambulance technicians) is a known issue and has received much international research attention. However, staff working in Emergency Operations Centres (EOCs) (i.e. dispatchers and call handlers) don’t have direct physical contact with the public, and as such have been largely overlooked and under-researched. Without a clearer understanding of the unique experiences of EOC staff, it is challenging to offer guidance on how best to reduce sickness absence rates and ultimately improve wellbeing for these staff.

Stress in Emergency Medical Dispatch Staff

For my Masters dissertation (conducted at the University of Surrey as part of my Masters in Health Psychology), I conducted a qualitative study to explore the lived experiences of ambulance dispatch personnel at an EOC in the south of England. Through interviews with nine dispatchers (out of a population of 36), I developed three key themes – these were “how dispatch is perceived by others”, “what dispatch really involves” and “dealing with the stresses of dispatch”.

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What does this mean for the staff?

Although aware of the inherently stressful nature of their role, the dispatchers interviewed in this study saw the value and importance in the work they did, and took pride in their role. Some of the key sources of stress they identified are common across all emergency services, including the stressful situations staff have to manage, the long shifts, and a lack of appropriate resources due to tightened budgets.

However, their stress was worsened by poor-shift recovery – staff didn’t always “switch off” effectively after their shifts, but often went home dwelling about the events from their shifts. Without effective recovery, this stress is compounded, leading to what is known as “allostatic load”, and staff are at risk of fatigue and burnout.

Training and supervision should be an opportunity to develop staff skills and address any ongoing issues staff face, but the participants in this study felt the current training was often irrelevant to their work, and that their time could be used more effectively. Supervision was rare and brief.

Finally, negative interactions with other staff groups was a significant source of stress for the dispatchers. Particularly with the ambulance crews, who were seen as doing “the important work”, dispatchers often felt as though they were expected to be a sounding board for their stress, being shouted at in difficult situations. Dispatchers saw the importance of fostering good working relationships, and made efforts to improve these, but there was increasing resentment as they felt their efforts were one-sided.

How can the situation be improved?

Despite all of these stressors, dispatchers remain in their role for years, and on the whole state that they enjoy and find value in their work – this promotional video from the South Central Ambulance Service exemplifies this well:

 

So what can we do to improve dispatcher wellbeing? Firstly, effective post-shift recovery should be supported and encouraged. Training could be better utilised to educate staff about allostatic load, and the importance of developing routines to unwind after work. Although dispatchers are allocated a certain number of breaks during their shift, the majority chose not to take these as they felt the impact it had on “work flow” was detrimental. The impact that not taking breaks has on worker wellbeing is significant, and breaks should be better monitored and encouraged.

Encouraging better interactions between staff groups is also an important area for focus – all staff members have a role to play in improving the way they interact with each other. This could be facilitated by encouraging regular work shadowing (with effort made by both sides of the divide). Multidisciplinary team training, when used effectively, is an excellent opportunity for team building, and senior staff should emphasise and educate around the benefits of team cohesion.

Finally, and most simply: we all have a role to play in recognising individual achievements. Working in emergency medicine is stressful but vitally important. It takes very little to thank a staff member for their efforts, but regularly showing gratitude and appreciation can have important, cumulative benefits for individuals and the wider team as a whole.

You can read a published version of this research at BMJ Emergency Medicine.

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Further Reading

 

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