999--My Life on the Frontline of the Ambulance Service

by Dan Farnworth

  I’ve heard that some emergency service staff who attended the Manchester bombing were still off work with PTSD more than a year after the event. Maybe some never returned. It’s perhaps not appropriate to talk about silver linings where terrorist attacks are concerned, but they did at least succeed in focusing minds on the vital importance of providing staff with sufficient psychological support, as well as the right knowledge and equipment. My chief executive said to me, ‘If it wasn’t for the work you were doing prior to this, I don’t think we would have delivered support in the way we have.’ With another atrocity inevitable, the consensus seemed to be that 999 staff needed to be mentally prepared. The penny seemed to have dropped that support shouldn’t just be offered in the wake of an atrocity, it should be on tap. There were lots of meetings, events and bold pronouncements. Change seemed to be afoot.

  As part of the NHS’s seventieth birthday celebrations, me and Rich received a public tribute and a Points of Light award (which are for outstanding volunteers making a change in their community) from Theresa May (though I couldn’t attend 10 Downing Street because I knackered my back the week before). And at the 2018 NHS Heroes Awards in London, me and Rich received the Mental Health Champion honour. In a line-up for the Duchess of Cornwall (Camilla to me and you), I was stood next to Tito Jackson. When everyone was shushing each other and getting giddy about the arrival of Camilla, I was more interested in having a chinwag with Tito about The Jackson 5.

  The award was presented to us by the actor Michael Sheen, and there was also a lovely video message from Prince William, who is a former colleague, having been an air ambulance pilot for a couple of years. And as I was stood on the stage, I thought about that policeman who had written me off as a kid, the one who told my head-teacher that I was a bad person and destined to end up in prison. I so hoped he was watching.

  Also at the NHS Heroes Awards, I met a girl called Freya Lewis, who survived the Manchester bombing. Freya was only fourteen at the time, and just a few metres away from the explosion. Tragically, her best friend died. Freya was in hospital for six weeks, underwent seventy hours of surgery and had to learn to walk again. But she was back at school just four months after the attack and has raised tens of thousands of pounds for various causes since. Freya was one of the most incredible people I’d ever met, a force of nature. She still has scars, both outside and inside, but she just keeps ploughing on regardless.

  Freya confirmed what I already suspected, that there are amazing people out there who are able to turn suffering into something positive. And she made me think of Roger, my wonderful counsellor who had set me on a similar path. I’d always wanted to tell Roger what a positive effect he’d had on me, and so many others by extension. Everything that had happened to me since getting back on my feet, and the changes I’d been able to effect, stemmed from him. But when I next visited my GP surgery with one of my kids, I noticed a book of condolences in the waiting room. Roger had died of cancer, which meant I never got to tell him how much he’d helped me. When you want to say something, don’t delay. Otherwise, you might leave it too late.

  21

  DOING BETTER

  You can’t see what we see and deal with what we deal with without it having an adverse effect on you. Pretty much every one of my colleagues will have been haunted by difficult memories or nightmares related to the job at some point. I’ve seen quite a few of them seek solace in alcohol. And I’ve seen relationships fall apart – including mine.

  All the while I was receiving plaudits for raising awareness of mental illness, my marriage was grinding to its end. Our once stable relationship was unable to withstand the collapse of my mental wellbeing. You need the different tracks of your life to run parallel, but my PTSD was like an explosion going off. When that side of the track became bent and tangled, all the weight fell on my marriage. And eventually the marriage couldn’t stand the strain and toppled sideways.

  It was very difficult for Amy, because I became an arsehole overnight. One minute, I was a loving husband, the next I didn’t seem to care less about anything. I’m reassured I was a good father throughout, but I didn’t think I was. I didn’t think I was attentive enough, but maybe that was related to the guilt of being unwell and thinking that everything I touched turned to dust.

  My wife was a better person than me, wanted to talk things through and try to work things out, but I just wanted out of the situation and to focus on my campaigning. The relationship just wasn’t for me anymore, and I was as blasé as that. Through no fault of her own, I associated Amy with that terrible experience with the murdered child. She was part of the package. I needed a fresh start in life, a total clear-out. So I let the relationship dwindle and die. Me and Amy still have a healthy friendship, and a beautiful boy who is at the centre of everything we do. But I like my new-found freedom.

  Of late, I’ve seen colleagues who started out in the job full of beans crumble before my eyes. It’s not just that I’m now better equipped to see the signs, it’s just a lot more obvious. The stresses and strains have become so great that some people just aren’t able to hide it. Most people can do the job with the right support. But there isn’t enough of it.

  Even now, a colleague will suddenly disappear and people will say, ‘Oh, I hear Joe Bloggs has left.’ And someone will reply, ‘Yeah, I think he just didn’t fancy it anymore.’ People still don’t put two and two together and think that maybe the reason Joe Bloggs ‘didn’t fancy it any more’ was because of the crushing workload and the terrible things he’d seen.

  According to the trade union GMB, 81,669 days of sick leave were taken by ambulance staff in England because of mental illness in 2016–18. According to the charity Mind, 91 per cent of ambulance staff have experienced mental health problems as a result of work, a figure that is significantly higher than in the general population. One in four ambulance workers will consider taking their own life at some point in their career, but they are less likely to take time off work or ask for help. I suspect that’s partly because of the macho culture – we’re supposed to come to the rescue, not the other way around – and the fear that admitting they’re struggling will lead colleagues to think they’re nuts.

  But it’s also because ambulance workers don’t know who to ask. And when we do ask, there is no clear support structure in place. The culture is changing and more ambulance workers are admitting they’re struggling, which is a good and a bad thing: good that they’re talking, bad that they’re being put under so much pressure that they’re having to ask for help.

  Another thing counting against ambulance staff is the lack of a single, coherent trade union. Firefighters have the Fire Brigades Union, which most uniformed staff are a member of. Police officers aren’t allowed to join a union by law, but they have the Police Federation looking out for their interests. Ambulance staff, however, have several unions, which dilutes our voice. They can be very good at representing you if you’re in trouble but when it comes to pay or the retirement age, they can be a bit weak.

  When you’re at the bargaining table with politicians, you’re far better off being represented by one booming voice, rather than a lot of shrill ones all arguing with each other. I’m not a militant man and would never dream of going on strike. How could I when it would mean people dying? But I would like a strong body that stands up for its staff. And part of standing up for your staff is making sure they have sufficient health and wellbeing provision. While the ambulance service might blame a lack of resources and time for the deficiency in its mental health provision, there are solutions to every problem. If they have to be cost-effective, then make them cost-effective. They have to want to find solutions, and they have a responsibility to find solutions. But the only people who can make them live up to that responsibility are politicians.

  In an ideal world, the HR department would say, ‘If we invest in the wellbeing of our staff, we will save money in sick leave and retention.’ But that’s long-term thinking, and ambulance service bosse
s, in common with bosses in all the emergency services, already have enough on their plates plugging holes, baling out water and keeping their respective ships afloat.

  The government has suggested that every workplace should have a mental health first aider. That’s great, but mental health first aid is like a sticking plaster. Ambulance people see and deal with terrible things on a weekly basis, so what works for an average work environment is unlikely to be sufficient for the ambulance service. What comes before physical first aid in the workplace? A robust health and safety policy, so that people don’t fall down stairs and off ladders in the first place. In the same way, mental health first aid should be superseded by a robust mental health and wellbeing policy.

  Like any workers, ambulance staff have yearly appraisals. But those appraisals are focused on the actual work, along with targets, box-ticking and form-filling. That’s all well and good, but appraisals should also be like spring cleans for employees’ minds, or mental MOTs, a root around under an employee’s bonnet to see if everything is working as it should be. If you owned a factory full of machines, you’d spend money making sure those machines were maintained. Because if they weren’t maintained, they would inevitably go wrong, not perform their jobs properly and your business would suffer.

  Frontline ambulance staff should be taught resilience building, or how best to cope with the stresses of the job. Resilience is a life skill, and it shouldn’t just be taught to ambulance staff, it should be taught to people working in every emergency service. In fact, it should be taught to everyone, including kids in schools.

  Many people don’t even have a concept of what mental health is, let alone how to maintain it. I gave a talk once, during which I said, ‘How many people in this room have mental health?’ A couple of hands went up. Then I said, ‘Actually, everyone in this room has mental health, just as we all have physical health. It’s one of the things that makes us human. And as long as you have mental health, you’re at risk of developing a mental health problem.’ There were one or two confused faces, but when I told my story, they understood the point I was making: only when you fully understand yourself and the potential problems you might face can you know when to seek help.

  People need to know how to recognise when they are okay and when they’re not. Your relationship might be misfunctioning. Your child might be unwell. You might be struggling financially. You might be struggling to sleep. You might be drinking too much and eating too much rubbish. Things add up, compact in your mind, and that one final straw might send you crashing through the floor.

  Some people don’t like the idea of speaking to a psychiatrist or counsellor, but they might like talking about work with their colleagues, whether it’s bitching about bosses or politics or the quality of the coffee in the vending machine. However banal those conversations might sound to people outside the group, they are important to those in it, because work plays such a big part in people’s lives. You become part of a brother-and sisterhood in the ambulance service, no different to being in the police force or the military. As such, I’m a big believer in using peer support to tackle mental health issues.

  There should be colleagues, whether current or former members of frontline ambulance staff, who people can talk to in a controlled environment, in absolute confidence. Some emergency services have introduced a tool called TRiM (Trauma Risk Management), which was born in the military in the 1990s. TRiM is about teaching people to assess colleagues’ responses to a specific traumatic event. If someone has dealt with something potentially traumatic, they can talk to a TRiM assessor (who is a colleague, not a medical professional), who is trained to identify whether they might need to be referred for counselling.

  TRiM is a good idea in theory, except ambulance workers don’t work on the frontline of a warzone (not technically, anyway), where the provision of on-the-spot counselling is naturally less practical. We should be able to speak to professionals whenever we need to, not have to rely on the well-meaning guesswork of colleagues. Some services do have counsellors you can call free of charge, but often this involves a few weeks’ wait to speak to somebody.

  I like to use the analogy of a building site. Until fairly recently, health and safety on building sites was negligible. It was common to see labourers working without hard hats well into the 1980s. Someone wearing ear defenders and a high-vis jacket would have been a total laughing stock. But back in 1974, the government passed the Health and Safety at Work Act. It didn’t improve the situation immediately, but accidents and deaths reduced slowly but surely.

  In 1981, the fatality rate for construction workers was 7.9 per 100,000 – four times higher than the rate across the general workforce. In 2016, it was 1.9 per 100,000. Now there is barely a building site in the country that doesn’t adhere to the health and safety rules and regulations, and any boss of a construction company who is caught flouting health and safety rules and regulations is seen as a cowboy at best and a criminal at worst.

  My hope is that at some point in the near future, we’ll look back at the ambulance service’s mental health provision and be appalled at how inadequate it was. Sending staff out to deal with traumatic situations without providing sufficient support is every bit as negligent as allowing people to climb ladders minus hard hats and without anyone holding the bottom.

  The situation isn’t all doom and gloom. Ambulance people are a band of brothers and sisters and we try to look out for each other. But we can all do better. We don’t engage our instincts and listen for signs. We walk into a room and say, ‘Morning. You okay?’ And most people will reply, ‘Yeah, all good, mate’, or something along those lines. But someone might say, ‘No, I’ve had a bit of a shit morning actually.’ That person might be trying to tell you something. They might be tentatively reaching out for help, which might only consist of a chat. But too often when we ask someone if they’re okay, we don’t listen to their answer. And the uncomfortable truth is, too many people roll their eyes and think, What a miserable sod.

  And I’m not just talking about the ambulance service. The same can be said for most work and social environments. I’ve heard professional footballers talk about wanting to cry in the dressing room before a game, while knowing they’ll be mocked if they show as much as a flicker of emotion. But if you notice even the smallest of signs – a friend being unusually quiet or irritable, falling out of love with former interests, expressing negative thoughts – maybe ask if everything is okay. And if they say yes, ask them again.

  22

  ANOTHER WAY

  In 2018, I was awarded a Churchill Fellowship to research mental health and wellbeing in the American and Canadian emergency services. Fellows are given a grant by the Winston Churchill Memorial Trust and sent off to learn how people in other countries deal with issues we have encountered in our lives. It’s a brilliantly simple idea, empowering people to learn from the world for the benefit of the UK.

  I already knew from my research that people in America and Canada had done extensive work in the field and had world-class support structures in place. So I was tremendously excited about what ideas I might bring home with me. I felt like a Victorian explorer setting off for an exotic land with a butterfly net.

  First stop was New York and the 9/11 Memorial & Museum. I couldn’t even begin to imagine what the city’s first responders went through the day the World Trade Center came crashing down, but the museum does a very good job of telling their story. Clearly, one of the museum’s aims was to ensure those emergency workers and the people they tried to save would never be forgotten, which made me think about how the UK’s emergency workers are viewed. America is very good at lionising those who put their lives and wellbeing on the line for their country, whether it be their soldiers, firefighters or ambulance workers. The UK, not so much. Too often, the police are portrayed as prejudiced and bent and firefighters as lazy. Ambulance workers might as well be invisible.

  I spent a week with the Las Vegas Metropolitan Police Department, l
eading up to the first anniversary of the Mandalay Bay massacre, in which fifty-eight people were killed. I wanted to see how they had supported their staff in the wake of the shooting, and what I found out amazed me. They had a whole department of former police officers whose job was to provide non-judgemental mental health peer support. These were people who knew what it was to be on the frontline and had received tailored training, rather than counsellors who could only guess. They were housed in a secluded, non-descript building away from the police station, so that an officer in need wouldn’t feel nervous about being seen entering. This peer support department also provided a pathway for older members of staff who otherwise might have retired and ended up feeling bereft and forgotten by the service.

  Any Las Vegas police officer involved in a fatal shooting has to be referred to a counsellor, with the recommendation that that relationship be maintained for at least six months. When they offered to show me the board with the names of coppers who’d shot people and were receiving treatment, I expected there to be two or three. In fact, the whole board was covered. While it was shocking to see just how prevalent gun deaths are in America, it was also heart-warming to know that all those people were being unconditionally supported. Also on the menu was musculoskeletal treatment and a range of alternative therapies. It made health and wellbeing provision in the UK ambulance service look medieval.

  At Louisiana State University in Baton Rouge, they were doing amazing things to support their students’ mental health, which I thought could be applied to people doing paramedic degrees in the UK. There was a lot of emphasis on building resilience, including the importance of leading a healthy lifestyle, exercising, eating well and looking after your finances. And what struck me most about their support network was its openness. If a student had a problem of any description, whether it be a drink, drugs or gambling addiction, they were safe in the knowledge that they could reach out for help without being judged or censured.