The GWAAC Critical Care Team attend the most critically ill and injured patients across the region, which can impact on their mental health. On Time to Talk Day we hear from one of our trainee Specialist Paramedics in Critical Care, Pete, who discusses how we as an organisation try to manage mental health. This is what Pete had to say:
‘’I’ve been here for 18 months and previously was on the Hazardous Area Response Team, a part of the ambulance service. I don’t currently have a formal role for welfare in the unit but have some relevant experience (more of which later) and am working on an initiative for the GWAAC team to protect our mental well-being.
‘’I hold qualifications in counselling skills and was working towards my Diploma in Counselling but have stepped away from that to focus on some more proactive measures. Counselling is a reactive approach – you wait for people to come to you when they are already in crisis, and that’s not the most effective approach for our team. As I’ve learned more I’ve come to appreciate that putting in proactive measures for mental well-being would be a more effective way forward. If we can stop people reaching crisis point in the first place, then we should be able to reduce or avoid staff going through a mental health crisis.
‘’For the most part we do very well at managing mental health within GWAAC – although it’s amazing what can become ‘normal’. We get sent to the most critically ill and injured patients. People often say to me “oh, you must have seen some things” and that’s absolutely true – we do see things that are way outside of most people’s lived experience – but it’s very rarely the obvious things (the ‘blood and guts’ side of the job) that upset us.
Overwhelmingly we’re upset by the relational aspects of the job – how the incidents make us feel – rather than the physical. So it’s more about how we relate to the patient, whether that’s because they remind us of somebody, or they haven’t received the level of care we feel they should have, or we can’t do for them what we feel we should be able to. Those are the aspects that we’ll find upsetting.
For example, because we see the most critically ill patients around 25% of them will die in our care. We become used to death and it’s amazing what can become normal, but sometimes the way in which someone dies, for example if they live alone, or there was something that meant we couldn’t do what we wanted to as quickly as we wanted to, then there is the potential for that to upset us.
There’s also the risk of accumulated trauma if you are subjected to a run of busy shifts and don’t have time to process everything that has happened. One cardiac arrest is a fairly standard job for us and is usually easily managed, but once I attended five in three days and that was an emotionally exhausting experience.
‘’Internally, we have a number of processes to support people who need it. We have staff welfare leads who act as a point of contact for anyone with any kind of welfare issue. A huge amount of stress can be alleviated simply by having a chat with someone you know and trust, and often those conversations happen in the crew room or the kitchen on base, or while we restock after a job.
The first formal stage is the trauma risk management (TRiM) assessment. This is a process where we talk to an assessor who scores us on a matrix to see if we need more professional support. There’s an initial meeting 72 hours post incident (within the first 72 hours there is no such thing as a ‘normal’ response and emotions are still heightened, which makes assessment of any longer term effects inaccurate). You can be referred for further help immediately if required. Otherwise there is a second assessment at 28 days to see how the incident has settled.
We have a number of TRiM assessors in the unit who can do this and then we refer to external professional help when required. Beyond that there is a Staying Well service which is put in place by the ambulance service. This gives staff access to a range of services including physiotherapy and counselling.
‘’We’re currently looking at implementing a program of non-managerial supervision where staff sit down with a trained colleague on a regular basis and discuss their work and their reactions to it. This helps to ensure professional standards are met and support staff development, as well as discussing emotional reactions to the work and the thought processes around them. It’s aimed at being a proactive layer of protection.
As we grow up we learn from those around us a set of ‘rules’ as to how the world should work. When it feels like the world isn’t following those rules we get upset. Programs like supervision challenge how valid those rules really are and how we react when they’re ‘broken’. This allows us to see past these arbitrary rules and be more flexible in our approach to life.
‘’It can be really tricky to spot if someone is struggling with their mental health and everyone is different and will react differently. The key really is how well you know this person because what will show is behaviours that are out of character – so your normally bubbly friend becoming quiet and withdrawn could be a sign. It’s mostly about being able to spot something that’s outside of ‘normal’ – whatever normal means for that person.
‘’If you think someone is suffering then most people want to talk about this, they just don’t know how. They need to know that they have permission to talk about themselves and how they’re feeling and that they won’t be judged as being mad, bad or crazy. Mostly they just need someone to listen. Encourage them gently to talk, and if they can’t or won’t talk to you then suggest they talk to someone else. This is a process that you do ‘with’ someone, not ‘to’ them, so you can’t force it upon them. Just let them know that you’re there for them when they need you. Just be a good friend, and if the conversation turns to an area you can’t help in don’t be afraid to say “I don’t know, maybe we can find someone who can help”.
‘’My advice for anyone suffering with their mental health is to find Time to Talk. Find someone you can talk to and talk. We put ourselves through so much torture having imaginary conversations in our heads, beating ourselves up or talking ourselves down. As Seneca said “we suffer more often in imagination than reality”, so get outside of your own head and talk to someone. Once you take the first step of opening up you can really start moving back to health. There’s no one right or wrong way to do this – the way that feels right to you is the right way.’’