Last month’s Dashboard was by far the most engaged post we’ve had since we started this project. EMS provider mental health issues may be the single biggest issue facing our profession right now. This month, we have another submission from a provider who, despite being early in their career, is already carrying some of the weight of bad calls:
“The stigma of mental health and wellness in EMS needs to be crushed. I’m a 24 year old Paramedic working well over 90 hours a week and not once has anyone asked ‘Are you okay’ after a bad call. If only you’d ask I’d tell you – No, I’m not okay.
I just told a mother that I did everything I possibly could to save her daughter (nearly my age) but unfortunately she passed away. I just worked tirelessly on a 6 month old baby who choked on a piece of clay. The mom kept saying over and over again “I just left him for a few seconds.. a few seconds!” Listening to those heartbroken cries turn into fits of rage. They say never take work home with you, but this baggage hands over you, everyday and every night when you get off shift and take off that uniform.
Ask the questions… it’s okay to not be okay.. I know I’m not.”
Christen Kishel, Ph.D. commented on last month’s submission, and given the response that we received, I’ve asked her to give us her thoughts again this month:
I want to start by offering a sincere thank you to paramedic who has shouldered more trauma and tragedy early in his career than many people will experience in their lifetimes, and for making the clear and true statement that our culture HAS to change. Emails like his help to move the culture in the right direction.
When I read this email, I immediately thought of the 2015 article in JEMS Magazine that provided many in the field with a wakeup call long before we began seeing daily posts on social media reminding us that we lose more medics and other emergency responders to suicide than to line of duty deaths. The following is taken directly from the article:
The results showed that 3,447 (86%) of the 4,022 respondents experienced critical stress [defined as “the stress we undergo either as a result of a single critical incident that had a significant impact upon you, or the accumulation of stress over a period of time. This stress has a strong emotional impact on providers, regardless of their years of service”], but the shocking discovery was that 1,383 (37%) of the respondents had contemplated suicide and 225 (6.6%) had actually tried to take their own life.
The rates of suicide contemplation and suicide attempts significantly decrease when a field provider has the support of their peers and is encouraged to utilize the formal support institutions in place: A supportive and encouraging environment cut suicide contemplation rates in half and attempt rates by 66%.
There were two critiques prevalent in the responses, regardless of what type of support they utilized: the support was either not accessible or the provider felt discouraged from using the support. Some comments from the survey that illustrate these critiques include:
• “Fear of being fired. We’re not allowed CISM at our service.”
• “I asked for help and ended up losing my 22-year career.”
• “Asked for help and was laughed at.”
• “Was told to get back to work. Was told I signed up for it so deal with it.”
• “It wasn’t offered even though we all thought it should be. One co-worker stated it didn’t even bother him. A different co-worker who heard about it made comments about me being ‘mentally fit enough to be on a truck’ because the kid’s death bothered me.”
The survey results revealed that 1,592 (40%) of the respondents had access to support but didn’t seek help.
Suicide is of course only one of the many possible outcomes for medics who do are not offered and accept mental health support. Post-Traumatic Stress Disorder, Depression, Substance Abuse, serious health conditions, and family problems (including divorce and domestic violence) are only some of the other consequences. When organizations and the people who work within them respond to requests for help with shaming, feigned ignorance, complete lack of response, and/or disciplinary action rather than support, the field loses their most valuable providers, and I have indeed seen all of these responses in my work. I often think to myself, who would I want working for me or responding to a call for a member of my family? I would want a provider who is supported by their peers and supports their peers, takes sick leave when needed to obtain mental health treatment, or uses coverage to get more intensive inpatient treatment services, maybe takes an antidepressant to enhance their brain’s ability to practice healthy coping skills and maintain stability in times of stress. I would much prefer that over a provider who has been discouraged from doing these things, afraid of stigma, afraid to lose their job, afraid they will lose respect or a promotion and instead suffers from sleepless nights, hangovers, illness, anger, and general malaise.
In the right set of supportive conditions, I have seen the difference it can make, especially when the people working to change a culture are persistent and consistent over time. It takes around 5-7 years to really change a culture, and it always starts with one person. That one person (or small group) will almost always feel like they are pushing a boulder uphill, and having personally helped to start peer support teams, I know just how taxing it can be. Most support systems start from the bottom up, and those grassroots movements often take time to gain momentum. For those reading this who are part of one of those movements, know that there are thousands of others all over the country who are doing the same. They are your invisible supports, and if you start to feel discouraged, make sure to attend conferences through the ICISF, the IAFF, the Rosecrance Florian program, the First Responder Network, or others. You’ll meet others who have been where you are and revive your passion for mental wellness programs and peer support.
So where to start? Support from leadership to provide education to their crews about trauma, burnout, and resilience. Leaders need to know where to refer people who identify themselves as struggling and make it easy to access mental health services by getting HR to start the medical leave process, getting coverage for appointment times, and making connections with the mental health providers to make it easy for a person to get an evaluation and referral to inpatient treatment if necessary. Disciplinary action or stigmatizing should never occur as a result of someone seeking help to prevent any harm to themselves, their team, or the community. Disciplinary action may be needed for actual actionable offenses, but if in the process of investigation, a mental health concern is identified, consider offering treatment resources as part of the process to assist in preventing future offenses rather than losing a valuable asset. When both labor and management show strong and public support for peer support programs, those programs flourish. And most importantly, even when leadership fails to provide formal supports, peers need to support each other. And it starts with the simplest of gestures, as the medic who submitted the email said – just ask! Even if the person does not say, “terrible, thanks for asking”, they will always remember that you asked, and that makes all the difference. Be well out there and take good care of each other!
Not every EMS Dashboard Confessional will be related to provider mental health issues, but we are happy to provide a forum for getting these issues off your chest, and providing constructive resources on how to handle them.
Use the link here to tell us about a decision or action that you wish you had handled differently.