Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697644947517.pdf (Australia)
Submission to the Senate Inquiry into the mental health conditions experienced by first responders By the Australian Paramedics Association (NSW) ‘APA (NSW)’ a.

The nature and underlying causes of mental health conditions experienced by first responders, emergency service workers and volunteers; Mental health disorders that are work related are associated with mental stress.

They can include stress, anxiety, depression, nervous breakdown, and symptoms associated with ongoing exposure to traumatic events.
Mental health conditions experienced by emergency service workers are caused by:      exposure to traumatic events (with traumatic events compounding over time) exposure to workplace and occupational violence sexual harassment and bullying in the workplace poor management of identified issues at work other work pressures The increased mental stress that paramedics employed by NSWA face is primarily caused by excessive work pressures, conflict between individuals, significant work load and a lack of clear direction or support from NSWA managers about these issues.
This is exacerbated by a lack of support from colleagues and peers.
The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 2 of 13 Mental disorders related to work place stress include post-traumatic stress disorder, adjustment disorder, depression and anxiety, these can precipitate and/or be associated with many other conditions including but not limited to:     anxiety eating disorders gastric upset sleep disorders  mood swings      sexual impotence poor interpersonal relationships poor social skills isolation and despair acute and chronic medical issues Factors that bring on this workplace stress include high intensity workload and exposure to trauma.
The nature of the work paramedics do requires prolonged and repeated exposure to occupational hazards and traumatic situations.

Such an example described by paramedics is being responded to a private residence to treat a patient.

Upon arrival the patient or their family is acting erratically, in an intimidatory manner or threatening violence.

The expectation of the paramedic is to remain in this potentially dangerous environment to treat the patient until they can be transported.
This causes significant fear and anxiety for the paramedics which is then compounded over time as they experience further stressful or traumatic events.
There are many causes of occupational stress and can include but are not limited to:      poor communication low levels of support of professional and personal development lack of clarity regarding organisational objectives lack of clarity around role and scope of duties responsibility The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 3 of 13  career stagnation and uncertainty and lack of opportunities for promotion  wages           job insecurity, significant responsibility with minimal control over decision making and work social and physical isolation poor relationships with other workers and managers conflict in the workplace lack of support within the workplace bullying, harassment and sexual harassment within the workplace.
conflicting demands of work and home poor work life balance suitability and maintenance or repair of equipment and facilities In regard to work load people can feel:      overloaded or under loaded lack of control over the pacing of the work prolonged considerable time pressures inadequate times for rest and sustenance poor or totally absent feedback on performance b.
Research identifying linkages between first responder and emergency service occupations, and the incidence of mental health conditions; https://www.bnhcrc.com.au/news/2017/world-first-research-australian- police-and-emergency-services-personnel-s-mental-health c. Management of mental health conditions in first responder and emergency services organisations, factors that may impede adequate The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 4 of 13 management of mental health within the workplace and opportunities for improvement, including: i.
Reporting of mental health conditions There needs to be a modern approach to education of employees on mental health issues.

It is important to acknowledge the importance of mental health and mental health concepts within the workplace and to stress the importance of managing mental health conditions to staff and managers.

Mental health promotion and investment within the workplace is vital for paramedics.

Mental health conditions within the workplace are likely vastly underreported.
The reasons for this include but are not limited to: Inadequate reporting mechanisms NSWA does not have technology to enable the reporting of incidents in real time.

This leads to significant underreporting of critical incidents.

Furthermore, the technology provided to paramedics (such as EMRs) is often non-functional.

Better technology would enable paramedics to make notifications about significant events that may impact upon mental health.
The ability to have a mobile application to make notifications of workplace incidents would make reporting more common.

The current system makes it too onerous to report incidents.

However, even when a paramedic is able to report an incident this commonly does not lead to any follow up with the paramedic or any other further action.

Rigorous procedures for responding to an incident report need to be implemented and enforced.
The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 5 of 13 Stigma surrounding mental health NSWA has a workplace culture which categorises issues with mental health as inconsequential.

It is not uncommon for us to be informed a circumstance in which a paramedic has confided in peers or managers that they are struggling to cope.
This has been met with a lack of empathy and a suggestion akin to “suck it up, it is part of the job”.

ii.

Specialised occupational mental health support and treatment services, NSWA has recently started implementing new mental health support and treatment services.

This is a new strategy and direction for NSWA and there are concerns regarding the appropriateness of the specialists engaged to provide these services.
Mental health conditions in paramedics are largely focussed around the trauma, violence and exceptional levels of stress they are exposed to daily.

It is vital that the professionals who are employed to aid are suitably qualified and specialised in mental health and more specifically trauma.

If we are looking for specialists to deal with trauma, occupational violence, and bullying and harassment NSWA needs to look beyond currently employed staff and uniformed paramedics into the broader community.
Staff currently employed by NSWA who have typically been used to run these services lack the relevant expertise.

Having internal staff and managers facilitating these services also creates a lack of confidence in these services from those that need them.

Previously the APA has raised significant concerns around some of the programs implemented to emotionally support paramedics and the staff the have been employed to support these programs.
The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 6 of 13 Peer support officers This has been seen as a beneficial program by some paramedics however has still not gained confidence amongst the workforce more broadly.
The reasons for this include:    the appropriateness and inadequacy of training and re- certification the process of selecting peer support officers (and the suitability of the people being appointed to these roles) accessibility of peer support officers  whether the intentions of some peer support officers was altruistic or career motivated There have recently been great improvements in the recruitment of support officers in regard to the numbers of officers and the quality of the training content.
It would be beneficial for all paramedics and support staff to complete the peer support officer course.

This would provide all paramedics a means to support their colleagues and develop a greater understanding of mental health.

Employee Assistance Program This program has been mired with concerning controversy for many years.

The APA has received feedback from many members regarding it not being fit for purpose.
There have been significant concerns from paramedics who have accessed this program regarding the suitability of the professionals who are providing advice to emergency services.
The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 7 of 13 On many occasions paramedics have informed APA (NSW) that they got no value out of the counselling sessions and that in many cases they left the sessions having actually traumatised the counsellors and feeling worse off themselves.
Many concerns have also been raised about confidentiality and discretion, timeliness and availability of counselling sessions and the value of telephone counselling.

This program should be reviewed in full with a specific emphasis on the suitability of using EAP to provide counselling on trauma.

Chaplaincy services Chaplaincy services are part of employee support.

Chaplains are sought from many denominations.


The uptake of these services tends to be mixed and varied across the sectors with some stating significant success and engagement whilst others have never seen an Ambulance Chaplain within the workplace in a supportive role.

Resourcing has been spent recently on expanding this service and it is the hope of APA that this program fulfils its requirements.
Clinical psychologists There has recently been recruitment of a chief psychologist and there will be further recruitment of subsequent clinical psychologists to provide psychological support for employees.

The best methodology for dispersing these services through the state is yet to be determined.

There are some concerns that these services will only be provided within the Sydney Metropolitan area and leave out rural New South Wales.
Appropriate emergency services and trauma counsellors should be engaged in as many key locations as possible around the state to The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 8 of 13 provide generalised access for all paramedics.

Avoiding phone consults where possible would be preferable as paramedics have reported that these are less effective than face to face.

iii.
iii.

Workers’ compensation There appears to be an ongoing discourse with workers compensation claims, and the relationship between the insurer and the injured worker.

Concerns revolve around engagement between the parties, difficulty attaining information, overreaching by the insurer into the confidential nature of some of the injured workers details.

Paramedics report being bounced around from one case worker to another with poor ongoing engagement and support leading to delays in returning to work.
NSWA does a poor job of providing meaningful alternate duties where paramedics are given tasks of no meaning.

Paramedics have reported that this increases their feelings of isolation while rehabilitating.

The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 9 of 13 iv.
Workplace culture and management practices, Whilst poor workplace culture can come in many forms, a common approach needs to be successfully employed to turn the tide on improving organisational culture in NSWA.

Planned organisational interventions, to improve organisational culture can make positive steps to reduce the stresses that come from unsatisfactory managerial activities.
The improvement of workplace culture must be underpinned by relevant and recent policies and guidelines that are implemented and enforced.

NSWA has policies which aim to improve the culture of the workplace but while these policies are not uniformly applied and enforced the culture will not change.

There are many examples of policies and procedures not being applied consistently by and to managers.
A commitment to enforce policies designed to improve workplace culture (such as managing misconduct policies) uniformly is crucial to improving workplace.

The workforce cannot have faith in such policies while they are seen to only apply to some of the workforce.
Some methods to improve these issues include:      assessing organisational wide culture emphasising workplace civility and staff engagement teamwork building inclusive of crew resource management leadership training anti-bullying programs and guidelines  mindfulness and stress reduction programs  burnout coaching and training The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 10 of 13 v. Occupational function and return-to-work arrangements, Return to work arrangements are at best sporadic.
Staff who have the opportunity to undertake meaningful alternate duties while working towards returning to full operational duties report greater satisfaction and less negative feelings while on workers compensation.

Paramedics who are given suitable duties which are meaningful are typically located closer to the Sydney metropolitan area.

This unfortunately leaves rural paramedics (and many in metro) spending their rehabilitation undertaking a role which has no meaning or purpose.
This makes the rehabilitation process much more frustrating and emotionally difficult for paramedics.

A lack of opportunities for paramedics exacerbates mental health issues.

Paramedics on workers compensation report that the suitable duties they are given are basic, irrelevant and drain their motivation towards engaging in pre-operational duties.
Further investigation should occur into redeploying paramedic staff into other areas of health inclusive of local area health districts, and if this is also not available redeployment into other government business units to allow some cross training.

The ability to complete suitable duties remotely has allowed paramedics to complete meaningful suitable duties without geographical restriction.

The viability of offering more projects for paramedics to complete remotely should be investigated.
This would assist paramedics on workers compensation with maintaining meaning and keeping motivated to return to full duties.

Injured workers with mental health issues may need extra support to get back into the workforce.
These workers need to be engaged with The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 11 of 13 by many professionals in order to assess the individual’s progression and ability to undertake appropriate and meaningful suitable duties.

Key personnel should engage the injured worker regularly and in a meaningful way whilst acknowledging any personal discretion required from the worker.
This will allow the worker to retain their identity whilst dealing with mental health issues that are prohibiting them from returning to meaningful duties and as such will engage them with members of staff that they have previously had contact with and have attained a level of trust.

This will ensure their transition from injured back to operational is smooth.

vi.

Collaboration between first responder and emergency services organisations, APA (NSW) does not have any submissions on this part.

vii.
vii.

Post-retirement mental health support services, Following retirement some emergency service workers struggle with a lack of identity and purpose.

This can lead to depression while they try to cope with the reality away from their workplace and colleagues.

Emergency services workers leaving their profession need to invest time in planning for the end of career and be mindful that this may occur before they expect due to illness or injury.
The high rates of injury that paramedics face mean that a paramedics career may end unexpectedly either voluntary or involuntary.

The transition can vary from one person to another, but the loss of identity is a major issue.

The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 12 of 13 Recognising the early warning signs for mental health issues is crucial for individuals and their wider support network.
A legacy coordinator has only recently been appointed to NSWA and this is a welcome addition.

However further time needs to be spent helping paramedics close to reaching retirement.

There needs to be a specific focus on tackling the loss of identity and associated mental health issues that revolve around pre and post retirement from a long and distinguished service career.
In addition, there needs to be an acknowledgement of mental health issues that an individual may experience after spending a large part of their life experiencing trauma.

viii.

Resource allocation Not enough resources are allocated to assisting individuals who are suffering from mental health issues.

There has also historically been little investment in strategies and programs to assist paramedics in maintaining mental wellness.
This has changed as of late with a pool of funding being provided to address paramedic wellbeing.

APA (NSW) is hopeful that this will make inroads to improving paramedic wellbeing.

The success of the program will be measured in individual resilience, health, and wellbeing.

It will also be critiqued by paramedics as the strategies are implemented and the courses are undertaken.
Importantly paramedic wellbeing will be directly impacted by the energy and resources put into improving workplace culture and by making a genuine attempt to weed out bullying and harassment.

Resourcing should be dispersed amongst all areas of service delivery not only psychological support.
Many paramedics report that their mental wellbeing is adversely affected by staffing issues, equipment The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44 Page 13 of 13 allocation, access to breaks and fatigue as these issues add to their stressors at work.

d. any other related matters Literature that was used to inform this submission has been included below.
1. http://www.springboard.health.nsw.gov.au/content/uploads/2014/08/FI NAL-Workplace-Culture-Lit-Review.pdf 2. https://stand.uow.edu.au/after-the-game/ 3. https://www.beyondblue.org.au/get-support/online-forums/staying- well/excellent-way-to-beat-post-retirement-depression 4. https://www.safeworkaustralia.gov.au/system/files/documents/1702/w orkrelated_mental_disorders_australia.pdf 5. https://www.bnhcrc.com.au/news/2017/world-first-research-australian- police-and-emergency-services-personnel-s-mental-health The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 44