Indicios de mentira

While the systematic review identified wellbeing and mental health issues that have been identified in the published research literature, the landscape review sought to identify what these issues are perceived to be in practice. There is a general perception in the media that those working in ER roles suffer frequently from occupationally induced trauma13_{. Our internet searches showed that PTSD} is an issue that many charities and non-profit

organisations are providing support for (see section 4.3). However our interviews found that PTSD was not the main issue of need in ER populations. Whist some interviewees acknowledged that ER roles involved exposure to traumatic situations and suggested that some ERs did suffer as a direct result of this, it was not the main cause for concern in most cases. Instead, most interviewees stated that ERs predominantly needed help for mental health or wellbeing issues that arose from more general problems at home or in the workplace, such as relationship difficulties and unreasonable job demands. Table 3 highlights the main wellbeing issues that were identified by the interviews.

Table 3 - Quotes illustrating commonly mentioned wellbeing issues amongst Emergency Services

Highlighted Issues

General life issues (e.g. marriage/ relationship

breakdowns, debt or financial issues)

Rapidly increasing and unreasonable job demands with little/ no recognition

Quotes

“It tends to be the everyday trials I guess of life... marriage breakdown or problems with management or falling out with friends on station, not getting enough sleep, financial problems... family bereavements, parents for example or caring responsibilities. But it tends to be daily struggles for firefighters experiencing mental ill health rather than the actual operational incidents” (ID 21, Fire)

“The bulk of mental health issues I see within the police are nothing to do with what people have seen or experienced in their role as a police officer. It’s because their wife’s left them, they’re drinking too much, they’ve got too much bad debt, absolutely; all the other reasons why people in the general population would have a mental health problem. I don’t see nearly as much PTSD-type problems as people sometimes imagine” (ID 4, Police)

“999 calls are at the highest level that we’ve ever seen... the demand on the police service has gone up. It’s not that crime’s gone up” (ID 10, Police) “They just feel a little bit just undervalued… it really starts to grate.” (ID 3, Fire)

Table 3 - Continued Highlighted Issues Reinforced trauma Investigation anxiety Issues relating to an ageing workforce Physical wellbeing Quotes

“You get a lot of ex-service personnel come into the service. And they bring their trauma in with them” (ID 26, Coastguard)

“The resurrection of incidents that they’ve seen prior to joining” (ID 12, Mountain Rescue)

“When staff are under investigation. We’re trying to tighten up over that, I think. That’s a high-risk area for lots of forces and there’s been some quite notable cases in the press over the years of senior officers who’ve committed suicide at that point... staff who are suspended over misconduct, we now do a mandatory referral to occupational health within 30 days” (ID 11, Police) “Because they’ve changed the pension age for firefighters to 60... we now have to deal with a whole load of issues that we haven’t had to deal with before” (ID 27, Fire)

“What we’re finding at the moment, there is a trend that we are seeing here in our service is that people who have been working for us for a long time, that cumulative effect is starting to manifest itself in a mental health issue” (ID 32, Fire)

“12% of the sample size, they self-reported having three times the level of cardiovascular disease and twice the level of gastrointestinal problems and also autoimmune conditions, so things like, whether it’s arthritis or IBS, a whole range of other conditions are triggered” (ID 9, Police)

“A question that we get asked quite a bit in terms of is there any budget to support classes around Pilates, yoga and this type of thing. So it would be quite good to focus on physical wellbeing as well” (ID 37, Ambulance)

Thus, while PTSD is likely to be a problem in this cohort, it is not necessarily the only issue that needs resource or focus. From interviews it is rarely the high- stress events ERs deal with that cause a reduction in their mental health, rather it is the pressures of life and work which negatively impact upon their wellbeing. Furthermore, interviewees felt that whilst it was important to recognise that there may be elevated levels of CMD or other wellbeing issues in ERs, this

“People automatically pathologize and think about the worst cause of trauma that they can imagine. And it’s actually not that, predominantly the fire and rescue services, the police certainly and ambulance certainly have higher levels of occupational stress... but actually they’re quite a healthy, resilient bunch” (ID2, Fire)

KEY HIGHLIGHTS

• Interviewees acknowledged that exposure to traumatic situations may result in PTSD, however this was not their main cause for concern in terms of ER wellbeing.

• Interviewees reported that mental health or wellbeing issues more often occurred as a result of more general life issues (rather than trauma), including relationship problems, financial difficulties, increasing job demands, and poor work/life balance.

RECOMMENDATION

• Research and support should assess

organisational stressors and broader mental health and wellbeing outcomes in addition to trauma and PTSD to ensure research and support is reflective of ERs experiences.

3.6 Summary discussion - strengths and