It’s Not All In The Mind
This article was first published in Social Work Helper 4 years ago. I wrote it with the aim of enhancing an understanding of mental health of first responders among helping professionals. It remains relevant today as too many helping professionals, health promotion workers and advocates still focus on mental health as “something in the individual’s mind” without considering external factors that impact on wellbeing.
Our police, paramedics, firefighters and rescue personnel help keep our communities safe. However, the general public does not view this population group as vulnerable. While in the mental health field, doctors, psychologists and social workers are seeing a very different picture with alarming suicide rates and a high incidence of Post Traumatic Stress Disorder (PTSD). Emergency services responders are trained to look after others, but not themselves. It’s a global issue, one that is being increasingly brought to light by the courage of those who suffer and their supporters speaking out.
With many helping professionals working from a traditional medical model, mental health issues among first responders tend to be identified primarily as a response to attending traumatic incidents. Treatment is inclined to be focused on therapies such as Cognitive Behaviour Therapy, Dialectical Behaviour Therapy, EMDR and Mindfulness. These approaches focus on individual change and evidence certainly suggests that these types of treatments are invaluable in terms of strengthening the individual’s coping and resilience skills.
However, we must be mindful how the systems in which the individual functions will also have an impact on their mental health. When working with emergency services responders and their families, it is vital that therapists and health promotion workers understand ALL the factors which impact wellbeing, not just in response to mental health issues but also in developing prevention strategies.
So, what are some of these “other” factors, or determinants warranting attention when dealing with emergency services wellbeing?
1) Emergency Services Culture
Historically emergency services culture has fostered the ‘toughen up’ attitude, deeming the admission of mental health issues as a ‘weakness’ . Admitting this weakness not only reflects on the individual but also on the ‘brotherhood’ which values pride and strength.
2) Organisational Culture
Whilst changes are being made in some organisations, there are ingrained fears (real or perceived) from responders that any admission of mental health issues will either deem them unfit for work, or will stop them from getting promoted.
3) Workplace Stigma
There are real and perceived fears of work colleagues judging a responder as ‘weak’, particularly if a number of them have been to the same call outs, but only one speaks out about struggling. A lack of understanding of stress responses and the individuality of conditions such as depression, anxiety and PTSD leads to judgement and alienation of the individual affected, rather than what is needed – support.
4) Societal Expectations
Let’s face it, we all grew up thinking of police, firefighters and paramedics as heroes. They’re the people who protect us, and save our lives! We’ve been taught to listen to their instructions, trust their judgement in crisis and look to them for guidance when in danger. Somehow it doesn’t make sense to acknowledge that these ’heroes’ are human just like us!
5) Lifestyle Changes
Whether the responder is full time, part time or a volunteer, from the moment of recruitment personal and family lifestyle require changes. Inconvenient rosters, critical incidents, unexpected call outs and changes in household roles and routines are just some of the challenges faced by emergency services responders and their families.
6) Family Support
Families of first responders have unique stresses and unique expectations. But it’s difficult to discuss these stresses and expectations outside emergency services circles. Firstly there is this feeling that the general public won’t understand. More significantly, divulging that their responder family member is suffering in some way feels like they’re breaching an unwritten ‘confidentiality code’ such as don’t embarrass the organisation, the crew or the individual by speaking about individual or family mental health issues. What happens on the job stays on the job which extends to family members.
There is also the old belief that telling your family about any incidents affecting you will adversely impact that family member’s mental health. Organisational confidentiality regulations support that notion – yet talking about and processing traumatic incidents is critical in any recovery process.
7) Relevent Social Support
When responders experience work related stress, they have a number of barriers to disclosing struggles to friends who are not part of the emergency services culture. One barrier is confidentiality – they are not supposed to discuss the details of their work with anyone from the general public.
Secondly, there is the notion (real or perceived) that those who haven’t done the job could not possibly understand what they’ve experienced.
Thirdly, there is the reluctance to ‘burden’ civilians with the graphic details of incidents for fear they may end up suffering vicariously as a result of the disclosures.
8) Workplace Injury Processes
Theoretically when a first responder needs to take time off duty to heal, there are systems in place to support recovery and return to work, or to support a dignified exit from the service with support to utilise their skills in another field.
Unfortunately – as evidenced by numerous government inquiries- this is rarely the reality. Psychological injuries are often exacerbated in this space and it is vital for helping professionals to familiarize themselves with (and lobby for change to) common practices and their impact – including surveillance, isolation from colleagues, breach of trust, stressful appointments and interview techniques and inappropriate work placement referrals.
What Advice Can Those In The Helping Professions Take From This?
If you treat an emergency services person with depression, anxiety or PTSD without understanding the context in which their illness or injury occurred, then you are not only doing your client a disservice, but you could in fact be damaging their potential for an effective recovery. It is vital that you have a genuine understanding of emergency services culture both today and historically.
Secondly, should we as professionals not be advocating on behalf of this group? In Australia alone there are over 400,000 paid, part time and volunteer emergency services responders – add their family members and that’s a huge population group affected by unique stresses! To advocate effectively, helping professionals need to understand the systems their lives function in, and systems which impact on wellbeing and recovery.
Thirdly, there is a strong need to focus on prevention – on a global level the media are telling us there is a “mental health crisis among emergency services workers.” We’ve seen these sorts of reports for years. What is actually happening to prevent mental health issues among emergency services responders? What sorts of consultations are happening? Who is invited to these consultations? Who is the information from these consultations being disseminated to? And what are the results of these consultations “on the frontline”?
No matter what field of practice you are in, I urge you to educate yourself on ALL the factors impacting the mental health of those who keep us, our families and our communities safe.