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Education and Employment References Committee
31/07/2018
Mental health conditions experienced by first responders, emergency service workers and volunteers

FYFE, Mr Scott, Private capacity

JONES, Ms Sally, Private capacity

Evidence from Mr Fyfe was taken via teleconference—

ACTING CHAIR: Welcome. I understand that information on parliamentary privilege and the protection of witnesses and evidence has been provided to you.

Ms Jones : Yes

ACTING CHAIR: Do you have any comments about the capacity in which you appear?

Mr Fyfe : I'm a paramedic with 35 years experience in both Victoria and Tasmania.

Ms Jones : I also am a paramedic with Ambulance Tasmania.

ACTING CHAIR: I now invite you each to make a short opening statement if you wish, and at the conclusion of your remarks I will invite members of the committee to ask questions. Mr Fyfe, do you wish to make an opening statement?

Mr Fyfe : I will make a very brief one, if that's okay. First off, thanks for the opportunity to present to the Senate committee. From a person who has been around and seen a lot of changes it is a fairly momentous step to actually have a voice to express some of our concerns, or certainly my concerns. These views are my own, and I'm not representing any organisation.

Paramedics, or ambulance officers as we used to be known, have changed considerably over the years. When I first started post-traumatic stress was not acknowledged as a problem, nor were the challenges of the job discussed. Thankfully, times have changed significantly. We now acknowledge that PTS is real and an issue for all workers who are exposed to traumatic events. However, what has not previously been discussed, particularly by emergency services, is the effect that cumulative exposure has on workers and how it impacts on their health and their family network. There is potential in some services where they are beginning to act towards recognising that this is a problem. However, I don't really believe they fully understand how large the problem is. It's in its infancy, and I don't thing organisations are well prepared for the ongoing commitment to the rehabilitation of current and, specifically, retired paramedics and volunteers. Governments need to accept, in my view, that cumulative exposure to traumatic events is a known reason for PTSD for its workers, and this should be presumptive in workers compensation legislation. Unfortunately, I have known many colleagues who have suicided throughout my career, and it's sad for me to know that there will be many more to follow. Thank you.

ACTING CHAIR: Thank you Mr Fife. Ms Jones.

Ms Jones : Thank you for inviting me today. I just wanted to shed some light on the volunteer first-responder workforce, because I believe a lot of information has been shared in relation to paid salary officers, but not a lot on first responders. More specifically, I'll focus on ambulance volunteers because that's the industry that I know best. I know there's been some research done on SES and fire volunteers, but the stresses and trauma that ambulance volunteers are exposed to is different. Although we come under the same umbrella of emergency services, it's quite different to the stress and trauma experienced by the other volunteer organisations. My proposal is about opening up conversations in that space and shedding some light on some of the issues that the volunteers face in their role as emergency responders and how we can better support their mental health and wellbeing to keep them going.

There are a lot of statistics on suicide, particularly, around Australia. What we know about suicide in emergency services is that is eight times greater than it is in the general population. When we compare the three services—ambulance, fire and police—it's higher in ambulance services. But I wonder how we measure suicide statistics in our volunteer workforce, because, technically, if we were to list what their occupation is it might be 'retired'. It could be they were known as their previous profession, but do they actually record: 'I'm a volunteer first responder'? So how do we measure that statistic? How do we know what impact it is that we've been having on their mental health and wellbeing? And how can we better address their needs?

In Tasmania the volunteer workforce is two-thirds that of the paid salary workforce. They contribute, in financial terms, billions of dollars across Australia in the hours that they volunteer. In Tasmania it's in the high millions that they contribute. They give that of their own free will, out of their own free time. They have no real expectations. In statistics and research that has been done as to why volunteers volunteer it's shown that they want to help the community. That's what they're there for. They don't sign up to be injured, but we are injuring them I think. A part of that is that we're also taking in injured people as volunteers, because of financial constraints in running the health system and the ambulance service as a whole. To service the rural and remote areas, we rely on the volunteers. There's been research in the volunteer area, but it's mostly around how we sustain and maintain a volunteer workforce. We're not actually looking too deeply into the mental health effects of the volunteer workforce. We need to do more research in that area to see what we can do to improve the services, because without them here in Tasmania the ambulance service would be in dire straits.

Senator URQUHART: Thank you, Ms Jones and Mr Fyfe. Ms Jones, we heard earlier from a representative from the volunteer ambulance service, and he talked about the lack of training. I asked him about how Ambulance Tasmania goes about recruiting volunteers, and he identified that that was a very difficult way. It was generally left up to the paramedics in a community or in fact to the volunteers who are already volunteering in that community. Is that generally your experience?

Ms Jones : I think recruiting for volunteers as a whole across Australia, no matter what the organisation, is difficult. Here in Tasmania we're no exception to the rule. The process of recruiting is that there is a recruitment truck that goes around, and we try to do recruitment drives, but it's difficult. People in the rural and remote communities are already committing themselves for many things. We find that our volunteers are not just volunteering for ambulance; they're also probably fire volunteers, SES volunteers or other community group volunteers. They do a lot, so it's difficult to recruit for volunteers. Because, I guess, we need them, there is a bit of a culture in my own experience where we're just taking on whoever applies. There's no great screening process. I believe we need a screening process not just for volunteers but for our salaried officers as well so that we're not taking on people who are injured. People out there who have military experience or have had volunteer experience in other organisations join the ambulance service, and they're probably already coming in with PTSD, and we're not picking that up. They're just being accepted because it's kind of bums on seats and we need the volunteers. If we don't have them in the regions, they're underserviced, and that has a knock-on effect to the urban areas and our urban resources are stretched. Our officers are becoming fatigued and they're getting burnt out. It's a never-ending cycle, really.

Senator URQUHART: I was in WA a couple of weeks ago, and I spoke via videolink to an employed paramedic down in the bottom South West of WA. She talked about being the only paramedic stationed in a particular station and then heavily relying on volunteers within that region and the difficulty of that not just for her but for the volunteers as well. Are there any specific examples across the state here where volunteer stations are under too much pressure?

Ms Jones : Probably each volunteer station. We have a range of volunteer stations. There are those that are paired up with a qualified paramedic, and then we have the volunteer-only stations, and we have what we call CERTs, which are community emergency response teams. They respond in a sedan. All of them are under strain and stress. At times they will respond by themselves. Even those at the branches that have a salaried officer with them will respond to a case. They're on call. They'll get a page, and it can be, 'Jump in your car and go and meet the paramedic en route.' So it's a toss up in the air as to who arrives first and what experiences they're facing there.

Senator URQUHART: We heard earlier today that there's no mental health support for volunteers. Do you think a compulsory debrief system would work?

Ms Jones : I would present a different argument to that. There is support for volunteers. They are also entitled to our EAP services, just like all salaried officers. They can access our EAP. That's four paid sessions, and they can reapply for more if necessary.

There is the peer support program that was rolled out last year. I had a large role in getting that program up and running. I just came in at the end of the last session and heard that the volunteers were missed in that area. I actually ran the recruitment drive on it, and I can guarantee you they were not missed. I worked closely with one of the committee members of the volunteer association to say, 'How can we get more volunteers to apply for the peer support course?' It was on their vGate, which is their intranet service that they can access. It was advertised. It was put out to all the stations. We just didn't get a big response. Over 30 people sent in expressions of interest across the state for the peer support program. I think about 22 actually applied in writing. There were 18 taken to interview. There were nine taken on the final selection process, which was a five-day induction course. So there was quite a large selection process to get through, and the five-day induction course was a big one.

ACTING CHAIR: But those numbers are the total of paid staff and volunteers that applied, are they?

Ms Jones : Anyone could have applied for that. Some volunteers applied, but they weren't taken through. They weren't listed as high enough merit-wise to progress in the interview stages.

ACTING CHAIR: Can you explain to us a bit about what that means—that they weren't high enough merit-wise.

Ms Jones : Everyone's merit listed. There were selection criteria to address. Everybody who applied to be a peer support officer had five selection criteria to address in their written application, as with any job interview. From those written applications, those that rated high enough went to interview.

ACTING CHAIR: But no volunteers?

Ms Jones : Out of the volunteers who put in a written application, there were some that identified that they had PTSD, so we had a duty of care to have a look at that a little bit more closely and not take them on board and risk retraumatising people or exposing them to more stress. Also, with the way that their application was put together, it just didn't rate high enough to progress. It doesn't mean that, because they're a volunteer, they didn't progress. It just means they were assessed in the same way as anybody else who applied, just like a job application, and then they just didn't get through.

ACTING CHAIR: Mr Fyfe, you talked about the cumulative exposure in your opening statement and you talked about the presumptive legislation. Can you just talk a little bit about what specialised support you would like to see for first responders.

Mr Fyfe : As an example, Victoria's probably moving to a model that I think is close to what I would have thought would be a good model. That is almost like a tune-up or a check-up that you have on a yearly basis on mental health. Essentially, at this point it's up to the individual to raise an issue that they are not coping with, or alternatively it's raised by an action from, let's say, the duty manager from communications, who actually raises an issue where a significant event has occurred, and then the system is enacted. But the long-term accumulation is not really dealt with and it's not really addressed until that person feels they're not managing or not coping, rather than having preventative management. That would mean maybe a yearly or biyearly check-up where we'd confirm that people are travelling all right, to really try to prevent the long term issues that most of us who have been around a long time currently have.

Senator URQUHART: Do you want to expand on the presumptive legislation that you talked about and why you think that's necessary and advantageous for people with mental health issues?

Mr Fyfe : Certainly. I'll talk from my direct example. As I said in my submission, I've been around a long time, 30 years. I've seen more trauma than, I think, the average person. Other paramedics of the same vintage would have the same sort of exposure rate. I've seen more trauma and death than I really want to remember. You can't do this job and not—

ACTING CHAIR: We have lost Mr Fyfe. We might just continue with some questions to Ms Jones while we get Mr Fyfe back on the line.

Senator O'NEILL: I want to ask one clarifying question on the back of that last question. Would declaring that you have PTSD automatically exclude you from becoming a peer support person?

Ms Jones : No. What we're looking at now in our approach to mental health in the workplace is that, yes, there are people who have PTSD—that's unavoidable at the moment; that's the nature of what's happened—but it depends on how they're managing that. For anyone who has post-traumatic stress, we look at moving them towards a space of post-traumatic growth. That's looking at building resilience and seeing: have they managed to get some growth from their experiences? It happens. If I can give a parallel example, when someone goes through that kind of stress, it's a bit like when cities—like Christchurch, with the disasters over there—have been demolished. Their whole system has been demolished. What happens is that they rebuild, and they rebuild stronger and better. That's where we get post-traumatic growth. If somebody has experienced post-traumatic stress and if they are not functioning in a healthy manner then that's a concern. If they're functioning okay, then—

ACTING CHAIR: I think Senator O'Neill's question was in regard to peer support. Would it exclude you from being a peer support person?

Ms Jones : It depends on if they're healthy or unhealthy.

Senator O'NEILL: Who makes that assessment and determination?

Ms Jones : A psychologist.

Senator O'NEILL: Is it because that is part of the process?

Ms Jones : Yes.

Senator O'NEILL: And that's an independent person outside.

Ms Jones : Yes.

Senator O'NEILL: What is the status of any report that would be generated in those circumstances?

Ms Jones : It would be fed back to the chief executive if there were concerns over somebody's mental health, and we would see what the chief executive would want to do.

Senator O'NEILL: So it's not a confidential assessment for the person to help them decide.

Ms Jones : The contents of the report are confidential. If there are issues that need to be identified to keep that person safe and okay then that's addressed accordingly.

Senator O'NEILL: I can see that being a structural problem for people choosing to participate or not.

ACTING CHAIR: We have Mr Fyfe back on the line, so Senator Urquhart can continue for the next few minutes.

Senator URQUHART: Thanks. I wanted you, My Fyfe, to give a bit of an overview about how you think the presumptive legislation would be advantageous.

Mr Fyfe : As I was saying before about people who do this role for a significant amount of time—and it's not just ambulance; it's any first responder, whether they are professionals or volunteers—you're exposed to far greater trauma than most people would experience in a year, let alone a lifetime. It's only just been acknowledged by organisations that it is a problem. Presumptive legislation would mean that the challenge of going through a workers compensation—the trials and tribulations that many paramedics I know have had to go through—is almost too difficult for them to consider, so they would prefer not to. I certainly know of a couple of colleagues who have not done that because they found it too hard, to adversarial, to actually go through it all. That is probably the single biggest thing that would change about how we address mental health, certainly within ambulances across Australia.

Senator URQUHART: It's about not having that combative process at the beginning.

Mr Fyfe : Correct. Ambulance, particularly, manages the initial event—something that occurred today, for example—fairly well. We have systems in place for that, but it's the cumulative exposure that we don't manage well.

Senator PATRICK: I have a question that relates to what has been referred to this morning as 'the bucket'. Noting your tenure in the service, you said in your opening statement that, when you joined the service, PTSD and mental health issues didn't exist. They weren't a problem and have somehow been discovered along the pathway. I presume the bucket metaphor was used back then, or is that also relatively new to the service?

Mr Fyfe : It wasn't discussed. It didn't exist, so no-one discussed it. You would probably find, historically, if you go back to those years, an awful lot of emergency service workers had alcohol problems because that was one of their coping mechanisms. As far as the 'bucket' goes, I use that term all the time. Only recently I had to see a psychologist about a particular issue that had occurred. They said everyone has one or two events in their career and their lives. I just stood there and I was quite dumbfounded that my bucket's always 95 per cent full because of the number of events and the types of events I have been to over the years. Everyone's bucket, even back when I started, was full of coping mechanisms and alcohol. People used to finish night shift and they would go and have a breakfast down in the parks in Melbourne or go out for breakfast and it would be almost an alcohol breakfast. And that was part of their coping mechanism. Thankfully, that doesn't happen anymore but it just wasn't discussed.

Senator PATRICK: I was trying to get to the point where you said that the mental health issues weren't discussed. Was the bucket metaphor used? Because obviously in some sense we're talking about whether it's discussed formally and openly versus in the corridors or hallways of a hospital or the ambulance station.

Mr Fyfe : You just didn't raise it. If you weren't coping, you didn't discuss it with anybody because it wasn't considered—

Senator PATRICK: Not even not even using the metaphor?

Mr Fyfe : No, not at all. You just cope with it, basically. That was it. There was something wrong with you—you're weak.

Senator PATRICK: How recently would you say that the ability to talk about it has occurred?

Mr Fyfe : I can't give an exact date. The start was probably in the late eighties, when Dr Robyn Robinson, a psychologist in Victoria, did a survey about mental health and she got a phenomenal response. I don't think anyone realised how bad it was. But really I would say that, particularly in the last 15 years, Victoria started to deal with things fairly well and it's getting more mature across the board. To be fair, probably during the last five years it's really becoming one of those things that is a risk within the organisation that I think is starting to be discussed, just like blood exposure where we use personal protective equipment to try to minimise the risk. But we're now only just having those discussions about how it's actually okay to raise an issue. And in fact, when it's a critical issue, the organisation is starting to take responsibility and say, 'This is an issue. This person potentially needs assistance.'

Senator PATRICK: Are you saying that it's been talked about for the last 15 years but we haven't really come far in dealing with it, except for the last couple of years?

Mr Fyfe : Over the last five years or so, it's become totally accepted for people say, 'Look, I'm not coping well.' Even 10 or 15 years ago, that probably wasn't something that was well received by your peers because it was considered a weakness whereas now it's actually everyone has those moments regardless. It's just that emergency service workers seem to have them an awful lot.

ACTING CHAIR: Thank you, Mr Fyfe and Ms Jones, for appearing today.

Ms Jones : Can I clarify that last question you had, Senator O'Neill ,about the peer support program and the psychological assessment. I heard you say just at the end there that that might be a deterrent for people applying for the course.

Senator O'NEILL: Yes, given the uncertainty about what would be done with any information that is generated.

Ms Jones : There's no actual psychological assessment done on anybody applying to be a peer support officer. The written application is just like a job interview—there's certain criteria to be met—so there's no assessment in that stage. The interview, again, is just to clarify what was written in the written application so there is no assessment done in that stage. Where they are observed is on the peer support induction course, which is also the final part of the selection process.

ACTING CHAIR: But, Ms Jones, you said that no volunteer ambulance officers were eligible because they stated that they had had PTSD in their applications.

Ms Jones : That was a contributing factor. If they were qualified, they would still go on to the course.

ACTING CHAIR: But did any go onto the course?

Ms Jones : They didn't, no. Due to the merit process on their written application and their actual interview, they just didn't rate high enough to go on—but they could have.

ACTING CHAIR: But they didn't even get to the first—just correct me if I'm wrong here. They started it in their application, and none of them got to the next level.

Ms Jones : Not all of them. That's a flag that goes up, and we just need to look at that. If they made it to the course, they would be watched and observed, along with everybody else, to see if they are coping.

ACTING CHAIR: But nobody did, though?

Ms Jones : Nobody got to that stage.

ACTING CHAIR: Nobody made it to the next level?

Ms Jones : No. In the future courses, there's no reason why they can't progress through. It's not a deterrent to say, 'You can't go through.' It's just a flag, with anyone, if they identified stress.

Senator O'NEILL: Would you be able to provide the committee with the observational criteria that were used to determine who was a fit person to proceed? It seems quite anomalous, given the scale of the volunteer workforce to the paid workforce, that not a single volunteer went through and the paid ones went through. If you determined that that was your course of action and you didn't invite anybody, that would be understandable. But if that became your course of action at some point during the process or if there is a discriminatory process in place, I would be very interested to see what your observers observed to determine if a person who declared PTSD was suitable or unsuitable for progressing to peer support training.

Ms Jones : I guess you could have the same argument for our patient transport department. They're paid officers who were also invited to be part of the process, and we didn't get enough applicants there either.

Senator O'NEILL: It's not the number of applications that I'm questioning. It's the quality of the process of discernment.

ACTING CHAIR: If they declared that they had PTSD.

Senator O'NEILL: If you could take on notice the details, if you can provide any, of the observational tools that were used to determine if a person was sufficiently recovered from a post-traumatic stress incident or illness to be eligible to train as a peer support worker. The committee will be in touch with you with that in detail.

Ms Jones : Can we just extend that out to everybody? It would be a mental health disorder, not just PTSD. It could be anxiety or depression as well.

Senator O'NEILL: Yes, I'm interested in seeing your processes.

ACTING CHAIR: Once again, thank you, Mr Fyfe and Ms Jones, for your time today. If there's anything else or any other information you would like to give us, besides the information Senator O'Neill has asked for, please feel free to send it to us.