The first participants in a two-year study being led by the University of New England (UNE) have described psychological distress arising from repeated exposure to traumatic incidents, which they say is complicated by their geographic and social isolation, staff shortages, high workloads and limited anonymity.
And, sadly, this cumulative trauma is increasing the mental ill-health, burnout and staff turnover among police, paramedic, SES and fire and rescue personnel who cannot access the support they need.
One respondent reported “the further out you are the more compounded those things become. Because it’s up you or no one else … there aren’t other services. There aren’t other units. So, yeah, you have that feeling of burden of responsibility so you can’t take your own self-care seriously. Then that’s where the burnout happens”.
Interviews with serving and retired first responders in NSW and Queensland confirmed that the impact of repeated traumatic experiences on rural workers may be more pronounced than for their urban counterparts. Rural and regional staff commonly have a higher scope of practice, working longer hours and respond to incidents involving people they know.
In such small teams, participants described feeling guilty if they took leave to seek mental health support, seeing it as an abandonment of their over-worked colleagues and community.
“Psychological distress is exacerbated by workplace cultures that expect stoicism and celebrate heroes, who are expected to remain endlessly available, emotionally contained and strong,” said coordinator of the two-year study, UNE’s Professor of Nursing Rikki Jones.
“Participants also identified barriers to seeking help, including limited access to trauma-informed and first responder-specific supports in rural areas, concerns around privacy and confidentiality when accessing services, and fear that it will impact their career.
“So they don’t get the support they need – if it is available – until they’re in crisis.
“What all this means is that if we don’t start to take the mental health of our first responders in rural areas seriously, we risk losing them from these communities. They and their families also risk untold heartache from the acute or chronic mental health symptoms and conditions that can develop, like anxiety, depression, PTSD, panic disorders, substance misuse disorders and suicidal ideation.”
The research team has found that frontline organisations sometimes view mental health as a check-box activity, rather than a work health and safety concern requiring structured interventions. And these interventions must extend beyond individual resilience-building to include organisational reform, cultural change and improved access to tailored mental health services in rural and remote areas.
The interviews are the first stage of research aimed at identifying the key mental health issues – and solutions – for first responders working in rural and regional Australia. It engages the Black Dog Institute and researchers and mentors from UNE, Charles Sturt University, Sydney University and Griffith University, supported by an advisory group comprising first responders and healthcare clinicians.
This is thought to be the first paper in Australia outlining the lived mental health experience of rural first responders. It has already inspired the development of a personal safety check-in (akin to an equipment check) to normalise mental health discussions and help-seeking, and will inform future guidelines and interventions for frontline organisations.
The full report is available at http://dx.doi.org/10.1111/inm.70349
