In 2018, I was awarded a Churchill Fellowship to research mental health and wellbeing in the American and Canadian emergency services. Fellows are given a grant by the Winston Churchill Memorial Trust and sent off to learn how people in other countries deal with issues we have encountered in our lives. It’s a brilliantly simple idea, empowering people to learn from the world for the benefit of the UK.
I already knew from my research that people in America and Canada had done extensive work in the field and had world-class support structures in place. So I was tremendously excited about what ideas I might bring home with me. I felt like a Victorian explorer setting off for an exotic land with a butterfly net.
First stop was New York and the 9/11 Memorial & Museum. I couldn’t even begin to imagine what the city’s first responders went through the day the World Trade Center came crashing down, but the museum does a very good job of telling their story. Clearly, one of the museum’s aims was to ensure those emergency workers and the people they tried to save would never be forgotten, which made me think about how the UK’s emergency workers are viewed. America is very good at lionising those who put their lives and wellbeing on the line for their country, whether it be their soldiers, firefighters or ambulance workers. The UK, not so much. Too often, the police are portrayed as prejudiced and bent and firefighters as lazy. Ambulance workers might as well be invisible.
I spent a week with the Las Vegas Metropolitan Police Department, leading up to the first anniversary of the Mandalay Bay massacre, in which fifty-eight people were killed. I wanted to see how they had supported their staff in the wake of the shooting, and what I found out amazed me. They had a whole department of former police officers whose job was to provide non-judgemental mental health peer support. These were people who knew what it was to be on the frontline and had received tailored training, rather than counsellors who could only guess. They were housed in a secluded, non-descript building away from the police station, so that an officer in need wouldn’t feel nervous about being seen entering. This peer support department also provided a pathway for older members of staff who otherwise might have retired and ended up feeling bereft and forgotten by the service.
Any Las Vegas police officer involved in a fatal shooting has to be referred to a counsellor, with the recommendation that that relationship be maintained for at least six months. When they offered to show me the board with the names of coppers who’d shot people and were receiving treatment, I expected there to be two or three. In fact, the whole board was covered. While it was shocking to see just how prevalent gun deaths are in America, it was also heart-warming to know that all those people were being unconditionally supported. Also on the menu was musculoskeletal treatment and a range of alternative therapies. It made health and wellbeing provision in the UK ambulance service look medieval.
At Louisiana State University in Baton Rouge, they were doing amazing things to support their students’ mental health, which I thought could be applied to people doing paramedic degrees in the UK. There was a lot of emphasis on building resilience, including the importance of leading a healthy lifestyle, exercising, eating well and looking after your finances. And what struck me most about their support network was its openness. If a student had a problem of any description, whether it be a drink, drugs or gambling addiction, they were safe in the knowledge that they could reach out for help without being judged or censured.
In New Orleans, I looked at a few more left-field treatments, such as music therapy and even beer yoga. Supping on a beer while in the downward dog position was surprisingly relaxing, although I’m not sure the bosses back home would be sold on the idea. New Orleans was a real eye-opener in terms of the level of crime their emergency services have to deal with. I spent a few hours with a New Orleans police officer, and that day he’d been to an armed robbery at a petrol station in which the man behind the till was shot dead at point blank range, and a drive-by shooting which left three people dead and a ten-year-old injured. That’s probably the same number of murders I’ve dealt with in fifteen years working for the ambulance service in the UK.
I was blown away by the ambulance services up in Canada. In Ottawa, they have a great peer support network, but arguably more important than that, mental health support is written into law. So instead of asking the emergency services to improve mental health provision for their staff, the authorities told them they had to. That’s a big difference, because you can put all the pretty pleases in the world at the end of a request and it can still be ignored. But if you write something into law and make it part of management’s targets, they will jump to attention. Managers in Canada not having a choice meant their workplace policies were a country mile ahead of ours.
Ambulance workers in Ottawa had the very best vehicles, the very best kit, the very best equipment and the very best uniforms. Everything seemed to be bang on. They also had ‘make-ready teams’, whose job was to prepare each ambulance before it went out for a shift. All the paramedics had to do was turn up, grab the keys and go, without having to worry if anyone had nicked a cylinder of Entonox from the back.
They also employed a traffic light self-assessment tool to encourage staff to talk about any mental health issues. You turn up at work and someone will say, ‘Are you in your green today?’ If the answer is no, you’re feeling amber, then it might be time to have a chinwag with someone, even if the issue isn’t directly related to work. If you’re in the red, it’s definitely time for a chinwag. It might sound a bit corny to a cynical British readership, but the overriding feedback from the rank and file staff was that they felt valued. And there is an understanding from bosses that if you value your staff, you will reduce sickness, increase retention and make working for the ambulance service feel less thankless.
Not that the nitty-gritty of the job was much different. Riding in an Ottawa ambulance as an observer, the first job we went to was an attempted suicide. A woman just out of the army and struggling to come to terms with civilian life had driven her car into a lamp post. When we got back to the station at the end of the shift, there were staff there who had just been to another traumatic incident. No one was talking, a couple of them were teary. And then a therapy dog came bouncing in, acting daft as a brush. Everyone was stroking and cuddling it, and suddenly the same people who had been silent and crying were laughing and chatting about the job they’d just been to. It was miraculous. The dog even went out to jobs in an ambulance car. I understand there are businesses trialling therapy dogs in the UK. And they work – I’ve seen it! – and are testament to the benefits of thinking outside the box.
In Maryland, I spent time with the Bladensburg Fire Department. Bladensburg is a little bit rough around the edges and most famous for an 1812 battle in which the British routed the Americans, but the locals didn’t seem to mind me being there. On my first morning, I was having a nice cup of coffee in the station when the hooter went off. Me and the lads piled into the engine and we tear-arsed towards a house fire. There was no holding back, they went straight into this burning wooden building with their hose pipe and seemingly no regard for their own safety.
A few minutes later, another engine turned up from another station, and I couldn’t help picking up on a bit of animosity between the two crews. It was only afterwards I learned that both sets of crews were volunteers, and there was something close to a sporting rivalry between them. That’s not ideal, but what I learned from the Bladensburg lads was the benefit of an emergency service operating as a tightknit team. They were a community, a family. And they loved their job, even though they weren’t even being paid for putting their lives at risk. There were no formal support networks in place, they just had each other. It confirmed my belief that mental health provision isn’t just the responsibility of employers, it’s the responsibility of all of us.
I wasn’t a fan of their leather helmets, though. One bloke got hit on the head by a piece of wood and a nail went into his face. I said to him afterwards, ‘Why don’t you get some decent lids?’ He replied, ‘We’ve had these for years, we’d never change them.’ It just goes to show that workers all over the world can get stuck in their ways and you will always find things that can be done better.
In Paramus, New Jersey, I spent time with two lovely ladies who had set up something called the Paramus Stigma-Free Zone. Their aim is a grand one: to build a society in which people are free of the stigma of mental illness and can access the help they need without fear of being judged. They put up signs in schools, offices and first responder stations, declaring them stigma-free zones. Anyone can sign up, and a lot of people have.
When you sign up, you have to pledge to do something to reduce the stigma of mental illness. That might be organising a stigma-free football game or barbeque – or any event where people can gather and feel comfortable talking about their mental wellbeing. It’s about giving people the tools to be able to discuss mental health and change the way society views it. They loved the fact that I was this guy who had travelled all the way from England to learn from them. That, in a nutshell, is what a Churchill Fellowship is all about.
Stigma-free zones will feature prominently in my fellowship report. But aside from my report, I need advocates in Parliament. You would think a pledge to look after 999 workers better would be a vote winner, but at the moment workplace wellbeing isn’t even on Parliament’s agenda. Finding politicians to push my recommendations is the easy part. Finding politicians who are genuinely passionate about the issue might be more difficult. I also need to gather more empirical evidence. If I can say to the powers that be, ‘By investing x amount of money in each ambulance worker’s wellbeing, you will save x amount of money further down the line, by reducing sick leave and increasing retention,’ then I’ll have their attention. Appealing to the emotions of these people is one thing; you need to waft cold, hard numbers under their noses to get them to take action.
I’d love the fellowship paper to lead to legislative change and I’m always hopeful. Perfect legislation would include resilience training before we even start out on the road, a clear referral pathway, regular mental health ‘MOTs’ and mental health professionals with an intimate knowledge of the problems faced by ambulance workers, on tap. Weaved into that would be a directive for bosses to implement visible peer-led grassroots support. I’d also like guaranteed funding for the NHS to enable all this to happen. But never mind money, it needs to happen because it’s the right thing to happen.