I’m pleased to report that Mental Health was a major theme at the inaugural UKSAR Conference, which was attended by the Duke of Cambridge. The momentum, which gathered during various workshops, has led to a National Working Group being set up within UKSAR to move forward and coordinate a strategy to tackle this issue within all our rescue organisations. We’ve met already and aim to present our progress and structured plan at the Emergency Services Show (September 2018 at the NEC).
I want to share here some of my own experiences from a career in the ambulance service, search and rescue, as a paramedic in Afghanistan and caring for and losing close family members during normal twenty-first century life. I hope to show that talking to someone about how you feel about traumatic events can help you to feel better, move on and maintain good mental health. The key takeaway from my own experience is ‘It’s OK to talk’.
I believe we have made progress with mental health awareness in the last few years, thanks to celebrities such as Stephen Fry, Ruby Wax, Carrie Fisher, and the Duke and Duchess of Cambridge. Charities such as Mind Blue Light, Heads Together, Calm and PTSD999 have started to make a difference too, and most of all I think the stigma has been cracked in our work environment by many individual 999 services personnel coming forward to tell their story. However, there is still a lot of stigma to break down in our ‘can-do, crack-on’ culture and many of our organisations do not have enough structured support networks in place when someone does have the courage to raise a hand and ask for help.
We have more resources than ever before to educate and reduce the stigma around mental health issues, but we still are reading headlines like these: ‘One in four police officers who died in Devon and Cornwall since 2009 took their own lives’ (The Herald) and ‘Paramedics more at risk of PTSD than soldiers’ (www.heart.co.uk).
Mental health is difficult to understand, especially if you’ve not experienced it I recommend two books to introduce you to this subject, if you’ve a desire to understand more in order to help colleagues and yourself. ‘Trauma is Really Strange’ is a great comic, pitched at a winchman level, which explains how it is normal to have strong feelings and emotions after traumatic events, which are common in UKSAR. The quirky illustrations and simple language really get the message across well on a level we can all make sense of.
Secondly, ‘Save-My-Life-School’ by Natalie Harris, a paramedic from Toronto, who developed PTSD after attending a call when she had to treat a murderer in the same room as two of his victims. This is a page turner of a book from an individual on the frontline. This will help you understand depression especially, but also PTSD, turning to alcohol to cope and the recovery process after someone tries to end her own life.
I love my job. As Jim Fox writes, ‘Find a job you love and you’ll never work another day in your life’. This was how I felt in my early years in SAR. Each day was an amazing adventure. I’d seen lots of traumatic incidents already and been fine, so mental health was something other people had to worry about, not me.
Until one day, I rescued a patient with a serious head injury from an off-shore rig. He vomited into my eyes and mouth and his vomit contained blood. I realised after this incident that there was so much I was not in control of, as I had previously thought. Suddenly I was seriously worried for my own health and the long term implications due to the potential risk of infection.
Because of the blood tests, my GP was involved and he offered me the chance to see a psychiatrist. This worried me at first — did he think I was mad? What would the lads back at work say, if I said I had been to see the ‘shrink’? Was I going crazy? Was I not able to cope? Was I a failure? Was this the end of my dream job?
I chose to get an appointment, despite the stigma, as I knew I needed some help to get over the fear I had about my future health and about clipping onto the winch again and going to rescue someone — a job I really loved and didn’t want to stop doing.
Thankfully, the psychiatrist was brilliant and not at all the stereotype I was worried about. He put me at ease immediately, we had a chat and he explained it was perfectly normal to feel like this after such an incident. Fantastic — after only a few minutes I felt like my old self again, ready to get back to work and be winched. This session was so easy and so helpful, why did it work so well?
Three key things made it work and they are a great guide to help you listen, when someone feels they want to talk:
• Create safety and trust
• Listen carefully
• Don’t judge.
I continued to serve with RAF SAR, completed a tour of Afghanistan as a paramedic on the battlefield rescue helicopter and joined Coastguard SAR. Life was good and I never looked back.
About five years after Afghanistan, I was on holiday in France with my wife and I ducked into the shower one morning before we headed out. Suddenly, I was in an upturned Land Rover with a trapped patient in Afghanistan. (This was a job I had done out there). It felt claustrophobic and I could feel the 50-degree heat of the day. I could feel the sand on my skin and the weight of my body armour. I could see the patient in front of me and I could feel the pressure I was under to give best care, extricate him and the danger I felt to my own life.
I closed my eyes and I could still see the patient and when I turned the shower to cold, I could still feel the heat of the day. No matter how hard I scrubbed, I could not get rid of the feeling of sand on my skin. This was a very frightening experience and the best way I can describe it is like having a nightmare when you are awake.
When I got out of the shower and came through to my wife, I must have looked terrible because straight away she was very concerned for me and asked what was wrong.
I was so scared now — had I got PTSD? I didn’t want to admit this to myself, let alone my wife. How could this happen out of the blue, five years on? What was wrong with me?
Very quickly I decided I would tell her what I’d experienced in the shower. Immediately, I felt a little better and gradually things got back to normal for me. I could continue with our plans for the day and I haven’t had another flashback since. It took me a couple of days to get back in the shower though! My wife saved my life that day because she:
• Created safety and trust
• Listened carefully
• Didn’t judge.
I grew up in Northern Ireland during ‘The Troubles’, a very stressful and frightening time. My mother would talk about it, even when her brother was murdered by the IRA, but my father never did, choosing to bottle it all up. He was a police officer for 35 years and dealt with plenty of traumatic incidents and lost many friends and colleagues during this time. On reflection, I can see how my father was stressed by his lack of engagement at home sometimes and his bad moods. I just wish he could have talked about it and unloaded some of this weight. It’s important to note that often poor mental health and stress can build over a long cumulative period, rather than just from one traumatic incident.
In 2016, reports from the US stated that 22 veterans were dying by suicide each day. To increase awareness of PTSD and these shocking statistics, a social media campaign challenged individuals to post videos doing 22 press-ups for 22 days and then nominate others to also take up the challenge, thus spreading the awareness further.
I empathised with this cause, but thought I’d shift the focus to emergency services personnel. I believe there are many military charities and support, but none for UK emergency services personnel (many of whom are also veterans, like myself).
I also thought I could go one better than the videos in my daily newsfeed of middle-aged men struggling to do 22 press-ups alone! So, I decided to make more interesting videos using the SAR aircraft and featuring famous landmarks or events such as Cowes Week, Stanage Edge and Downtown Abbey. I started with a video of the helicopter trying to do press-ups with me (but not quite keeping up).
On the last day, I dreamed of all the emergency services in my area coming to my base and doing press-ups together with as many emergency vehicles and aircraft as possible. To spread the word and recruit others to the cause, I travelled the UK making press-up videos with other emergency services. A highlight was at Tower of London after being transported by the RNLI along the Thames, escorted by police and fire service launches.
I soon realised there was a culture of silence, of bottling up many mental health issues regarding traumatic incidents at work. Yet as soon as many people were alone with me, they confided they too had suffered or knew someone close to them who had. I heard stories of friends and colleagues who had died by suicide from this issue.
At this time in the UK, suicide was reported as the No 1 killer of men under 45 years old. I adopted the message from another campaign that #itsoktotalk (with thanks to #andysmanclub). The simple message is that we should talk about the intense feelings and emotions we have after traumatic events, which are often part of our normal working life in search and rescue.
On the final day, everyone turned up as promised, we had three aircraft and lots of emergency vehicles and boats — see the video at www.big22.org.
It was a great day and two keys things came out to me. Firstly, I heard a member of the public say, ‘I thought this only happened to the military’ — which totally illustrates how under-reported these issues are for our emergency services. Secondly, one of the guys who did press-ups with us gathered the courage to ask for help and was diagnosed with PTSD. We ensured he received prompt treatment through ‘PTSD999’ and he returned to work in a short period. This shows that getting the message out there and breaking down the stigma saves lives. Although PTSD is treatable, it’s much better to catch and treat the early symptoms by talking in an open and supporting environment following our exposure to traumatic incidents.
We are working with Mind Blue Light as a partner to explore how we can set up a similar structure to the Peer Trauma Support (PTS) network in Bristow UKSAR. The initiative provides support to colleagues through a network of volunteers, who are trained in accordance with industry best practices and NICE guidelines.
During my PTS training, I realised I was showing symptoms of grief, burn-out or stress. This presented primarily by not sleeping well over an extended period. I knew it was good to talk, so I spoke to one of the trainers and we had a chat to explore my issues. These stemmed from an intense three-year period of caring for and losing my father and my mother-in-law, moving house, setting up a company, changing job, lots of travelling and getting a promotion in UKSAR.
Immediately I started to feel better, just by talking, because my listener:
• Created safety and trust
• Listened carefully
• Didn’t judge.
When he suggested to me that, as well as grieving, I might have temporary depression, I realised that, despite my own campaigning for mental health, I still carried a stigma for mental health myself. He asked me what was so terrible about admitting I might have temporary depression. I couldn’t think of anything and after a short time, agreed it was possible and there was nothing bad about admitting this. This illustrated to me how deeply instilled the stigma can be, even in someone who would consider himself a mental health campaigner.
Since then, I haven’t looked back. I feel much better, am sleeping well again and tackling life as I did before. I look after myself better as I go. Mindfulness has been an incredible help to think clearly, have a focus and sleep consistently. Try it and you will be amazed how much better you can feel for a simple investment in yourself for a few minutes a day. I recommend trying an app such as ‘Calm’.
This last example of how my mental health was affected by normal life doesn’t involve a traumatic incident — it’s just the cumulative effect of ‘normal’ life. I’ve included it to show the importance of looking after yourself, your colleagues and friends by noticing if they are not their normal selves. I hope you also now have a simple 3-point plan of how to listen when someone wants to talk about something that is bothering them.
Having the courage to talk about my perceived weaknesses and problems in these three instances in my career has made me a stronger and healthier individual in the long term, but it wasn’t easy. I’m still doing a job I love and that’s why I’m recommending that whatever is bothering you, don’t bottle it up. Find someone you trust and tell them about it.
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