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Education and Employment References Committee
25/09/2018
Mental health conditions experienced by first responders, emergency service workers and volunteers

KASTELAN, Mr Christopher, President, Australian Paramedics Association New South Wales

PEARCE, Mr Stephen, Secretary, Australian Paramedics Association New South Wales

Committee met at 08:59

ACTING CHAIR ( Senator Brockman ): I declare open this hearing of the Senate Education and Employment References Committee inquiry into the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers. I welcome you all here today. This is a public hearing, and a Hansard transcript of the proceedings is being made. The hearing is also being broadcast via the Australian Parliament House website.

Before the committee starts taking evidence, I wish to remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to a committee, and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to a committee. The committee generally prefers evidence to be given in public, but, under the Senate resolutions, witnesses have the right to request to be heard in private session. If a witness objects to answering a question, the witness should state the grounds upon which the objection is taken, and the committee will determine whether it will insist on an answer having regard to the ground on which it is claimed. If the committee determines to insist on an answer, the witness may request that the answer be given in camera. Such a request may, of course, also be made at any other time.

I now welcome representatives from the Australian Paramedics Association of New South Wales. I understand that information on parliamentary privilege, and the protection of witnesses and evidence has been provided to you. Could you confirm that?

Mr Pearce : Yes.

ACTING CHAIR: I now invite you to make a short opening statement, and then we will ask you some questions.

Mr Kastelan : Good morning and thanks for having us here at this inquiry. I'm an on-road operational paramedic with 22 years of experience, generally a mix between the metropolitan area here in Western Sydney and now the Central Coast. With regard to the Paramedics Association, we're a registered trade union that represents the interests of paramedic and paramedic support staff employed by New South Wales Ambulance only. The union is routinely involved in matters where there is an exacerbation of mental health conditions, and we robustly advocate on behalf of our members. Our submission to the inquiry is generally limited to paramedics and paramedics support staff. Our submission is based on the feedback of our membership—we've recently did a survey of our membership in 2017—and also on our union's experiences in advocating for employees with mental health issues.

I just want to highlight a few factors that came out of that survey. The survey was directly related to their experiences of bullying and harassment in the workplace, which obviously has a significant effect on the mental health and psychological wellbeing of paramedics performing their tasks, and also their home and family life. Our respondents said that 73 per cent had faced bullying and harassment within the workplace. Seventy nine per cent of complainants indicated they did not feel that their complaint was taken seriously by New South Wales Ambulance management, and 59 per cent of complainants indicated that their complaint was left totally unresolved by New South Wales Ambulance management. This would indicate that processes in place to deal with aspects and triggers of psychological wellbeing are not functioning well within the workplace and that paramedics believe they are being left to manage these items on their own.

ACTING CHAIR: Could I just jump in there and ask a quick question. Did you determine whether that bullying and harassment was external to the workplace, for example, was it by someone one of your officers picked up off the side of the road, or internal to the workplace? Did you differentiate those two things at all?

Mr Kastelan : I believe this survey relates to the paramedics' experience with other workers and line managers within the workplace. Is that correct?

Mr Pearce : That's correct.

Mr Kastelan : There's a heap of statistics we can provide from union initiated surveys, but I think that will probably be pretty boring, and we can provide that information to you in writing at the end of this.

Our position is that this takes place within the workplace; it's prevalent within the workplace, and the structures around managing it with the paramedics within the workplace are substandard. We understand that there are systems currently in place, and being looked at and implemented, for paramedics within the workplace, but we're concerned that the organisational culture within the workplace isn't complementary to change at a fast pace in an expeditious manner. Did you have something to mention there, Steve?

Mr Pearce : As the president mentioned, those figures came out of evidence that we submitted to the parliamentary inquiry into bullying and harassment last year in September, and here we are 12 months later and I can certainly update this forum with regard to our submission. That update is pretty much up to today. So, it's the association's position that mental health injury within New South Wales is significant, growing and New South Wales EMS are mired in departmental bureaucracy, attempting to catch up. The good news is that New South Wales a mbulance have acknowledged the problem, unlike our Queensland counterparts, and have begun implementing measures to combat this workplace hazard. The progress, however, is frustratingly slow. Our members are still reporting that their mental health injury has been exacerbated by New South Wales ambulance managers—and that's bullying or non-empathetic behaviours and/or feeling isolated while New South Wales ambulance look into what they can do while they are not fit for suitable duties. So, this can go on for months, while the paramedic is either at home or waiting for meaningful work in the workplace and watching his or her peers go about their duties.

More specifically, I can report systemic mechanisms are still failing. Technology, such as the IIMS system , or the Incident Information Management System, is acknowledged as dysfunctional by New South Wales ambulance, but is still in use as there's been no improvement to replace it as yet. That's the process whereby paramedics can make note and document any particular hazard they meet in their workplace. So, when significant events occur, there's no consistent follow-up or debriefing process. Managers feel underskilled in dealing with someone who has a mental health injury or is mentally unhealthy, and more training really needs to empower them to intervene early and definitively.

Staff psychology services are advertised to be available to paramedics in New South Wales. In reality though, there's no framework to deal with complex or significant mental health injury outside the workers compensation process. So, more work is urgently needed for New South Wales ambulance to make their claim of having staff psychology services in good faith.

Stigma surrounding self-reporting is still high. We believe there's still significant under-reporting as reporting that you need help is seen as an admission that you're no longer safe to work , and that's a significant thing for paramedics. Managers, identified as serial bullies over decades, continue to practice such behaviours, despite executive leadership team knowing who they are. That's also significantly concerning for our membership. And, of course, as you mentioned earlier, we'd like to be able to offer some further confidential submissions or in camera evidence as that's the only way that these members are comfortable to do so.

Paramedics are leaving the workplace in despair and have even taken their own li ves as they see no other option. It's a significant concern. The p eer - support process is still under-resourced , and there's still concern that this places more mental stress on these officers and that they're unable to get the training and use the time in a way that they feel confident to carry out that role.

EAP—is the committee aware of what that is? Yes. They continue to be undervalued by paramedics as the service doesn't really meet a caller's needs, as mentioned in our submission. Indeed, some paramedics have had to console the other party after relating accounts of their trauma.

New South Wales ambulance chaplaincy service has been bolstered in funding and resources on the ground, which is a very good thing. The Australian Paramedics Association New South Wales has been advised that there is frustration , though, between that work group and higher level management in implementing the assistance that they've promised when it's actually a real case and not just a training scenario. There's a disconnect there. There's one in-house clinical psychologist available to paramedics across New South Wales. That is a new implementation and part of a more wide-ranging implementation across ambul ance for mental health and well being. New South Wales ambulan ce are advertising for more, and there's to be a total of five sometime in the future. APA members have utilised this resource and have had value from the experience. That experience also clarified that there's no fr amework behind this experience.

New South Wales ambulance are not confident in allowing the paramedic to engage in suitable duties once they identify through this channel a s a psychologist role can't diagnose it but can give strategies and counsel. T he injured worker finds hims elf in a position where they're referred back to their general practitioner to facilitate a certificate of capacity and document suitable duties. The general practitioner then refers them to another psychologist, and this delays the injured worker ' s path to resolution of their injuries. With this being the case, the worker is funnelled into that worker s ' compensation system by default, and we think that New South Wales has a real opportunity to improve that outcome . Obviously , one psychologist is a beginning but it's not enough . J udging by our limited observation of that person's activity so far, we've real doubts that five will be enough. In any case, this resource base needs to be disbursed across the state and available to paramedics as soon as possible. We r eally do feel— and we've expressed it to ambulance managers directly that if they build it, they will come. There is a significant need for this.

The actual workers ' compensation/suitable duties pathway continues to be a difficult one for paramedics to deal with. The real danger here is the increased isolation and lack of meaningful work for that injured worker, which then exacerbates their injury. This happens as New South Wales ambulance has not evidenced action in providing a broader scope of work for the injured worker , which then exacerbates their injury. T hat broader scope of work has also already been cleared by their nominating treating doctor. This work needs to be meaningful. An example of that could be an activity that the worker has experience in outside of his or her paramedical expertise or even some accelerated training in another role. Also, there's pressure brought to bear—I don't know that it's overt —when the injured worker is expected to try to do things that may also exacerbate their injury in order to meet the conditions of a return-to- work plan , even if that activ ity doesn't appear on the plan.

In summation , New South Wales a mbulance , in our view , is still lagging significantly in implementing the measures it ha s flagged will change , and paramedics continue to suffer as a result. The Australian Paramedics Association New South Wales will continue to consult in this process but have real fears that budgets are prioritised higher than paramedic welfare. W e welcome your questions.

ACTING CHAIR: Thank you very much. I'm a relative newcomer to this inquiry , so I'm probably go ing ask you some very basic , fundamental questions before I hand over to others who are more experienced in this topic because we are reaching the end of our public hearings. I have I guess a ' chicken and the egg ' question . Y ou talked about the cultural component of some of the problems your members are facing in terms of the culture of the organisation. I t's o bviously also a high-stress environment where you're dealing with very confronting situations , which is also a source of mental trauma for your members. A re you contending that the cultural issues are exacerbating the problems that are coming from the nature of the work or are they a so urce of a problem in themselves?

Mr Kastelan : I t's interesting you mentioned the chicken and the egg ; it's hard to work out which one comes first sometimes . A s a paramedic who may either f orthrightly or reluctantly self- identify that they're suffering from mental fatigue , the recognition within the workplace that it's a significant problem is concerning because it actually takes quite a great deal of mental trauma to come to the point where you believe you do need to self- identify . Sometimes those paramedics are then sent straight back into the operational duties, even after they've self-identified—whether it's the psychological trauma emergency services experience then being managed poorly by the manager to whom they've identified or whether the managers are identifying a problem and are not dealing with it in an appropriate manner, as Steve's just mentioned, in regards to the return-to-work plans and the exacerbation of psychological stress due to the lack of meaningful return-to-work or pre-return-to-work operational duties. To answer your questions, it comes not only from the operational trauma of dealing with the type of work that we do but also from the lack of understanding from managers to work within an appropriate framework to set sail the paramedic to psychological wellbeing.

ACTING CHAIR: I don't know how much good evidence there is around this, but how much preconditioning or preparatory work is there in terms of the training that's given to paramedics by New South Wales ambulance or by the union? Can you build resilience prior to things becoming a problem and is that work being done?

Mr Pearce : In the last couple of years, there have been significant increases on that very subject. New South Wales ambulance acknowledged that there needs to be more effort taken to attempt to prepare trainee paramedics for what they're likely to see and experience. I certainly acknowledge that. It is the kind of role, though, that you have to do. I neglected to tell you my background; I started as a paramedic in 1989. There really isn't anything that can prepare you for what you do. However, there are support programs in place now when you begin whereas they really didn't exist way back then. That's a very good thing. Managing the staff's resilience is a subject of work that New South Wales ambulance started a couple of years ago with this health and wellbeing initiative—and that's a great thing—it's just that we see it as moving along very slowly. We are really hoping that some of the bureaucracies will fall away with the higher prerogative of putting that in place so that people can work in a safe way.

Mr Kastelan : There's also a hope, aspirations, that student clinicians through their university studies are being forewarned of the type of intense workload and psychologically challenging work they're about to enter into. They do get ride-along sessions with operational paramedics reasonably regularly. I'm hoping that paramedics go into it with eyes wide open. Unfortunately, the rigours of operational workload and the variability of a dynamic working environment can sometimes be significantly challenging to process psychologically. What some people may seem to think are going to be the most psychologically damaging jobs as a paramedic can sometimes be the least damaging. Every individual has different trigger mechanisms of what's going to provide the psychological stress that's going to precipitate a mental health condition over time. I think that's a real concern for us—that those little triggers aren't being picked up on as they take place because operational workload dictates how much time a manager can spend with somebody who is ticking a box that says they're not well.

Senator URQUHART: At the outset, throughout your submission, you are sometimes quite critical of the process of New South Wales ambulance. What's your relationship like with New South Wales ambulance? Part of the reason I ask that is because they were invited today and they actually decided not to come, which I'm very concerned about because I feel as if they care about their workers and they should've come along to answer questions. Can you tell me what your relationship is like with New South Wales ambulance?

Mr Pearce : Of course. The Australian Paramedics Association was born out of a need to have an industrial voice and an advocate for paramedics. We have a really robust relationship with ambulance. We're very respectful, but we never shy away from the fact that, when our members bring concerns to us, we want to be the shield that allows that communication to take place so that the paramedics don't need to. There's been such a long history of difficulties when paramedics go to their managers for help that there just isn't the confidence for them to do that. We like to think that we are very, very much on the front foot in terms of advocating for our members, and it is difficult for New South Wales ambulance at times because we really don't pull punches. We're respectful about it, but we don't cushion what we see as a really significant problem. Whilst mental health injury within New South Wales ambulance of course is related to the nature of the work that we do, the culture and the lack of ability to change over time has significantly contributed to it. We've advocated for many of our members in the past five years purely because of that. They report to us again and again that, yes, it's a tough job, but being left out in the cold and uncared for by their employers is even more difficult. And in other situations they're actually given a hard time by their managers because they say: 'You just need to suck it up and get moving. We've got work to do, and it's a really important job, and we've only got finite resources.'

Senator URQUHART: In your submission you talked about New South Wales ambulance acknowledging the issues around mental health but that there was no follow up. Did I understand that correctly?

Mr Pearce : Yes, it's acknowledged that it's a significant problem, and we're really happy about that, but the on the ground, at the coalface, our members are reporting and we are seeing no great follow up. I can give you an example that's really relevant. If a paramedic crew go to an extremely traumatic case, there's no consistent debriefing or even picking up that it's even occurred. The lack of ownership around who does that and how that system works is something we see as being managed quite easily. In fact, it is managed easily in other emergency services, but, again, we're lagging behind and our members suffer. Unfortunately, when there's another job to go to, paramedics compartmentalise that and go and do the other job.

Senator URQUHART: Is that lack of acknowledgement or lack of assistance from the top down? Where does it actually come from? We've heard time and time again throughout these inquiries—and I've spent some time talking to paramedics—that the blockages seem to be at the middle management level. Again, I'm really concerned that the New South Wales ambulance chief is not here today, and I'll probably say to every witness. I'm really annoyed that they haven't bothered to show up to tell us how good or bad they are because I think everyone—the paramedics out there on the beat—deserve to hear from their employer about what they're doing to overcome some of the issues. Do you find that it's at a middle management level or at a higher level? Quite often, if it's driven from the top down and the people at the bottom want to make a difference, there's stoppage in the middle. Is that where you're finding the problems are?

Mr Kastelan : I would suggest that you're on the right track in that regard. I'd also say that as a paramedic I'd be disappointed to hear that our chief executive or representative wasn't presenting today. I think there may be some relevance in how mental health might be dealt with in the organisation just by that lack of appearance and I say that on behalf of all the paramedics across the state who would not be aware that was the fact but who I think I would be disappointed that a representative of the senior leadership team isn't here.

Senator URQUHART: And this is the only state so far where we've not had somebody from the chief of ambulance turn up.

Mr Kastelan : I can't comment further on why that's the case so I'll move on to the next point you discussed—that helicopter view looking down. I do believe that the discussions and strategies coming out of the senior leadership team appear to be well founded and the targets could hit the mark. I know that paramedics are extremely enthusiastic about having some of these strategies that allow them to have better psychological health and wellbeing. I've always said, in my meetings with senior management, that I love, conceptually, the strategies that come out of head office; it's just that there's no possible way for it to hit the ground running when there is that disconnect in middle management. Why is that the case? Middle managers have a lot of competing requirements of their workforce, not least the legislated need to provide a service to the community. How do you pull somebody aside and acknowledge they are having some problems when you have five cases backed up and you have KPIs that need to be met? I think you have hit a key aspect there.

Anecdotally, we were talking to a senior manager in the last week or so and it was highlighted that this was a real blockage in the system for allowing good, sound strategies to hit the ground running and we asked why that was the case. One of the reasons was that, in private enterprise, it would be much easier to move somebody aside; in the public service, it is a little bit difficult—and hands went up in the air. Is that good enough for a workforce of 3,000 or 4,000 front-line paramedics who are relying on decisions being made on their behalf? I would put it to the committee that that probably isn't good enough. Paramedics, for their future wellbeing and psychological health, should be looking to have a more robust set of systems in place to ensure that they are managed better.

Senator URQUHART: Are you aware of any training and support that is provided to middle management to improve their ability to support staff who might be suffering from mental health issues? Or is it more about the competing challenges and there just aren't enough people to do it?

Mr Pearce : No. All of those strategies that have recently been conceptualised are in their infancy—they have either just started or haven't started yet—because we recognise that managers need further assistance and skills in this. So, no, in terms of actual work being done that allows these managers to feel confident and empowered to do those extra skills, they are not there yet. But they have conceptualised and put together programs they want to roll out. But, again, here we are, a couple of years since funding was made available, and still we are having the same complaints from our members because those things haven't happened yet.

Mr Kastelan : There is a capable leader program being rolled out for middle and senior line managers, but it was 2018 before that was initiated. I have been in the job 22 years. It is a massive concern that, 22 years after I commenced, they start thinking about human resources issues in a middle supervisor's role. Again, there is a level of concern that a representative of that organisation isn't here to answer that question for you.

Senator URQUHART: I note that the New South Wales government has adopted a wellbeing strategy for first responder organisations. Can you comment on the effectiveness and implementation of that, and what are the key areas for improvement?

Mr Kastelan : New South Wales Ambulance is looking at four strategies to ensure that the workforce, as a whole, is well. It comes down to 'capable leader, safe paramedic, well paramedic—and I can't think of the fourth one of my head. As I said, it has only recently been implemented. I sit on the working committee of that—it met this morning—at this point in time. I would suggest that the ambulance services would be hoping that they are providing their workforce with an ability to become more resilient and bounce back after the organisational and operational issues that impact upon paramedics and senior leaders. Again, it is to be complemented; it is fantastic; we think there is great merit in that. As industrial advocates ourselves, in these meetings, we constantly see the attempted cost-shifting of operational costs to the budgets of the wellbeing groups. We are really concerned about that; we push back very harshly on that. Even today, they are putting together proposals where basic clinical equipment is being put into this programs. That is not what the money was put aside for; it was put aside for resilience training and psychological help of its workforce. That can come in a huge range of strategies. We are working through those, but it can appear to be at a snail's pace at times.

Senator URQUHART: Do you know how many workers in New South Wales have died as a result of suicide, from a paramedic perspective?

Mr Kastelan : I couldn't give you the exact answer at this point in time.

Senator URQUHART: You don't keep track of that?

Mr Kastelan : I don't have that information just now.

ACTING CHAIR: I am happy for you to take that on notice.

Senator URQUHART: Yes, you can take it on notice. This is something we have seen over and over again—paramedics and first responders taking their own life. There is always a question mark about whether it was related to the job; coincidentally, more often than not it is. But there doesn't seem to be a clear correlation between the two. If there was, I would hope that things would happen a lot quicker within an organisation to try and help those people.

Mr Pearce : We are aware of a few that we can come to you with further definition on. But, again, there is an issue with under-reporting.

Senator URQUHART: I just happened to be watching a bit of TV in a motel room the other night and saw a British program about first responders. I noticed during the ads for that program that New South Wales Ambulance is doing the same sort of show on commercial TV. In that television program—we are talking about commercial TV, and they cut and snip bits out of it—are we going to see what is really like in New South Wales Ambulance or is it going to be a glorified version of what people want to see and what the shows want to rate things at? One of the reasons for this inquiry is to get information out, to get people to talk about their issues and to reduce some of the stigma about mental health so that we can actually help people, but to also shake up some of the organisations to make sure they look after their workers. I am really concerned about your members. Are they participating in this program freely, or are they being told that they have to participate in this program?

Mr Pearce : The short answer is that we don't know. But what I can say is that every facet of operational ambulance has a significant mental health issue. You mentioned that ad. I saw the same ad. I have no knowledge of the show.

Senator URQUHART: I don't think it has started yet.

Mr Pearce : No. The footage in the ad shows our control centre and operational paramedics going to cases. Both of those facets of ambulance have significant mental health problems within them that are documented, and we have advocated for members in both parts of that space. I am sorry I can't give you a definitive answer on what that show will look like, but I can certainly tell you that—

Senator URQUHART: That's fine. I'm more interested in whether your members have been asked to be part of that or whether it is just a requirement for a TV show.

Mr Kastelan : I believe there is an expression of interest process for people who are interested in that aspect of it. I am sure the show will be tasteful and have appropriate discretion in regard to patient confidentiality, as required, and some paramedic input as well.

Senator URQUHART: I just hope it shines a light on some of the issues paramedics are facing.

Senator LINES: How long has your association been registered?

Mr Pearce : We became registered in 2013. Prior to that, we were acting as an association for some five years.

Senator LINES: I think you said there was some work being done with trainee paramedics to let them know what the job is about. Are there any studies or analysis that shows how that helps with mental health? What is the purpose of that?

Mr Pearce : I think your question would be better directed to New South Wales Ambulance. I haven't participated in what they do at a trainee level. However, I think they have a presentation about health and wellbeing and the assistance that the organisation provides currently.

Senator LINES: Okay. I thought it was more extensive than that. Do you have contact with other unions that cover ambulances across Australia?

Mr Pearce : Yes, we do.

Senator LINES: Thinking about New South Wales Ambulance, are there any other ambulance services, whether private or state run, that you think offer best practice in terms of dealing with mental health? Or do you think what you experience is fairly common across the country?

Mr Pearce : We have sister organisations in Victoria, Tasmania and Queensland. My view is that Victoria appears to be leading with some of the mental health and operational initiatives they have to support paramedics whilst they do their role. Other than that, I can't say much.

Senator LINES: That's fine. It is good for the committee to know.

Mr Kastelan : Ultimately, the concerns that operational paramedics have in New South Wales are based across the country. There are similar triggers for their workloads.

Senator LINES: Prior to being a senator, I was an elected official with United Voice, which covers the ambulance officers of Queensland, the Northern Territory and Western Australia.

Senator PATRICK: Culture is one way to look at this problem, and that is the empathetic way to do it. Another way is to look at it from a cost perspective. I imagine that you wouldn't classify putting ambulance operators out of the field any differently than making sure that the level of tyre wear on an ambulance is safe or that they have the proper radio equipment and so forth. I just wonder why it might be that we pay more attention to those sorts of details and are less strict in regard to officers who may be suffering mental illness.

Mr Pearce : One of the answers to that is that mental illness is significantly underreported. And there are lots of reasons for that. There is the stoicism of paramedics in the field to push through, because of the operational workload, at the peril of their own health and wellbeing. If there is work to be done, somebody to be looked after, they will go and do that before looking after themselves. Is that the right way to do things? Probably not. You need to look after yourself to be able to look after the people you want to care for, of course. But there are many competing interests that the organisation puts upon a paramedic. So, certainly, mental health issues are significantly underreported. The other concern is that, in terms of the structures to report, paramedics aren't able to complete them in real time. There is no apparatus or function within the ambulance service for me to do a job now and within five minutes be reporting it as a concern. I need to wait until the end of my shift and do it after I have signed off. And then I need to ask a manager whether I am able to stay on overtime to fill out an incident report—because there is no real-time capability with our information technology in our vehicles to provide that feedback to our managers appropriately.

The other thing that was discussed earlier was the Significant Events Register. It takes something to report something, or for somebody to understand that it has happened, for it to be put on the Significant Events Register. My understanding—and, again, New South Wales Ambulance will be able to clarify this—is that the Significant Events Register is discussed once a month. So if I have a difficulty today but the meeting was yesterday, I will probably need to wait three or four weeks before that is flagged on the system—unless I specifically flag it myself or another paramedic who is concerned about me flags it. So a lot of stuff flies under the radar at the peril of paramedic wellbeing. But I get what you are saying: logistically, it is very easy to see that there is an A service needed on a Mercedes ambulance next week, so we should take it off the road and do that to make sure it is roadworthy to do the job; but there's no hazard button or warning light that comes up on a paramedic when they're not well.

Senator PATRICK: I wonder whether anyone has done any analysis of what it would cost to take an ambulance officer off the road and service them, to make sure that we're not sending these people out into the field. Is that an inhibitor or is it simply a lack of awareness, a cultural issue? Does cost play a part in this?

Mr Kastelan : Cost has certainly played a part in it, as evidenced by the fact that we only commenced a wellness week for our operational paramedics with the injection of a significant amount of money, the recent wellness and resilience package that emergency services and ambulance got. If cost wasn't an issue, that would have been running for the last 20 years. But it wasn't; it only just started up this year when extra money was allocated for it.

Senator PATRICK: When an ambulance officer is assigned to a particular job, I presume that's actually recorded so that you would be able to go back through, post facto, and have a look at the sorts of incidents that someone has been involved in if they later turn up presenting as mentally unwell. Are you aware of anyone who has looked back through the records of people, from a study perspective, to extract from that what the causes are and whether there are particular types of operations that are much more distressing for people? Are you aware of that having been done anywhere?

Mr Pearce : I think there are international studies that have occurred. I couldn't tell you off the top of my head. I don't know that New South Wales Ambulance has done one. I would probably be concerned that they actually don't have the technology to do that. There have been several concerns around the database of workload that is within the control centre, which is called VisiCAD. It's had a number of incarnations, and some information has been lost or is unfindable, so to speak. I think that's probably what they'd rely on. I think that came in in about 2000. Prior to that, it was just physical paper case sheets. So the answer is that I don't know whether New South Wales has done any work on that.

Mr Kastelan : The concern with that approach is that sometimes there are false positives. Mental health and wellbeing is like a bucket being filled up. It slowly gets very, very full, but it can be the most inconsequential interaction that actually overflows the bucket. It doesn't necessarily need to be a significantly traumatic event for that to take place. It can be just something like turning up and thinking you're working with somebody and then being told you're not and you're going to another station. That can be enough to tip you over the edge. That's the stuff that's out of your control.

With regard to those studies you're talking about, I think the cost benefit would be exponential in recognising that paramedic welfare and resilience is critical for them to be able to provide that service to the community to the best of their ability that will not put the community at public risk and that will allow them to be competent at all times.

Senator PATRICK: I've got one last question. I will add that the bucket has been mentioned pretty much in every state that we've been to, so the committee is very aware of that. In one of the submissions that we've received there was a comment—and I just noticed you talked about the EAP, Mr Pearce—that some first responders don't want to access the EAP due to the belief that information may be passed back to the employer, risking their career. They may also not want to make a claim through workers compensation for similar reasons. Would you comment on that statement.

Mr Pearce : Again, the member feedback we've got is that they have real concerns that the information they gave in confidence in a bid to help themselves was inadequately or inappropriately managed. They actually got further harassment from the management process about that. So, that, combinedwith a number of other factors around EAP, has just led to having no confidence within that mechanism. I think that the ambulance took that on board, and that is one of the reasons they've sought to have their own staff psychology services funded and implemented over time.

Mr Kastelan : I n our submission , we said there are significant concerns from paramedics who've assess ed the program regarding the suitability of the professionals who are providing the advice to emergency service s. T hey're not actually really trauma counsellors they can be counsellors from a wide range of backgrounds. And , as Stephen mentioned earlier , we've heard of paramedics actually walking out of EAP programs where the counsellor is in tears because of what they've been listening to : the y're actually more traumatised b efore they started and they are the health professional s. T here are significant concerns about confidentiality and discretion , the timeliness and the availability of counselling sessions , and the value of telephone counselling . W e really believe that the service needs to be reviewed in full with a specific emphasis on the suitability of using E AP to provide specific counselling on trauma.

ACTING CHAIR: We'll need to leave it there. Thanks very much for appearing today. You mention ed that you had some information that you'd like to provide to us confidentially . W ould it be possible to get some , or all of that , in writing , and then we'll have you guys hopefully back either via teleconference or , if you can make it to Canberra , at our next hearing.

Mr Kastelan : Sure.

ACTING CHAIR: We're h appy to do it by phone , if you don't want to come up to Canberra completely understand that. Thank you both very much for appearing today .