Good afternoon and thank you to everyone for taking the time to watch this webinar in which we will be discussing the mental health and wellbeing of the Police and Emergency Services sector. My name is James Maskey and I am the Engagement Manager of Beyond Blue’s Police and Emergency Services Program. I also have the absolute pleasure of being joined by Professor David Lawrence from the University of Western Australia and I'll introduce him in more detail shortly.
From the outset I would like to acknowledge the traditional custodians of the land on which we gather today, the Wurundjeri people of the Kulin Nation, and pay my respects to elders, past, present and emerging. We appreciate that many of you will be aware of the work that Beyond Blue undertakes, but before I get started on today's presentation, I wanted to provide and bit of background information on Beyond Blue.
Beyond Blue is an independent, not-for-profit organisation working to increase awareness and understanding of anxiety, depression and suicide, and ultimately aims to help all Australians achieve their best possible mental health. Beyond Blue has a number of program areas and the area that I am representing today is the Police and Emergency Services Program. As we know, those employed in Police and Emergency Services roles, which include Police, Paramedics, Fire and Rescue staff and State and Emergency Service (SES) personnel, provide care and protection to the Australian community.
Sadly, the levels of anxiety, depression and suicide amongst this group of people in general are too high and the numbers seem to be growing. Established in 2014, the objectives of the Police and Emergency Services Program are to reduce the stigma associated with mental health conditions, attempted suicide and suicide amongst our Police and Emergency Services personal.
Our program has a national and whole of sector focus, and we see our role as a connector, facilitator and advisor. We focus on providing guidance and facilitating relationships, and have seen great benefit in continuing to build on existing efforts and networks. On the 29th of November last year, Beyond Blue launched the National Mental Health and Wellbeing Study of Police and Emergency Services, titled Answering the call. At the launch event there were approximately 160 delegates, from Police and Emergency Services agencies from around the country, with personnel, peak bodies, unions and research organisations also in attendance. And of note there were 23 Commissioners and Chief Executives from the 33 participating agencies, which presents a strong, unified and sector wide approach to our research.
Studies have been completed on a similar scale, either covering one agency or one sector or one area of mental health, like Post Traumatic Stress Disorder (PTSD). Due to our Study, Answering the call, we now have a comprehensive, national picture and a national data set. In total, 21,014 Police and Emergency Services volunteers and current and former employees across a range of roles, ranks and locations participated in our Study. The results of Answering the call are difficult to read; they reveal a workforce that is deeply impacted both by the nature of the work they do and the pressures of the environments in which they work. In many areas, it confirms, at scale, previous academic research, qualitative surveys and anecdotal evidence, and this confirmation is accompanied by new findings and deeper insights into the themes that Professor David Lawrence will present shortly.
Beyond Blue would like to say thank you to each agency that participated and the 21,014 employees, volunteers and former employees from across Australia who gave generously of their time to participate in this Study. Answering the call would not have been possible without your time, honesty and valuable input. And with this in mind, I would like to take the opportunity to welcome a short video message from our Chair, the Honourable Julia Gillard.
Professor David Lawrence:
Thank you very much James. It's a pleasure to be here and have the opportunity to talk about the survey that we've done Answering the call. So I'll give a short overview of the findings and also talk a little bit about some of the key themes and messages that we've found. The Study, as James said, is the largest of its type that's ever been undertaken anywhere in the world, as well as here in Australia. Over 20,000 people from 33 agencies took part in the Study. As well as completing the survey, many people took the time to tell us about their personal experiences. We're very grateful to all of the participants for taking the time and effort to be involved. At the outset I would like to acknowledge the hard work of the team at UWA and our partners at Roy Morgan Research. My thanks to the team at Beyond Blue, who funded and oversaw the survey and supported the Project at every stage. I would also like to express my thanks to the people who participated in the advisory group and the technical advisory group, who oversaw the Study and helped us greatly.
So we set out to establish a national baseline measure of the mental health and wellbeing of employees and volunteers in the Police and Emergency Services sector, and by that I mean the Police, Ambulance, Fire and Rescue, and State and Emergency Services agencies in each state and territory. But we also wanted to develop our understanding of how to better support the mental health and wellbeing of personal in the sector. The Study found that mental health issues are very common in employees in particular, and to a lesser extent, volunteers in the sector. Exposure to traumatic experiences in the line of duty is a major risk factor for developing mental health conditions, and while this may affect the nature of the job in the Emergency Services sector, the survey has identified and wide range of issues relating to health and how work places and agencies respond to traumatic events, to workplace culture, to stigma and use of services.
The survey results highlight the range of issues that need to be addressed to create genuinely mentally healthy workplaces. These issues span creating more positive mentally, healthy workplace cultures for all staff, through to issues relating to supporting people with serious and debilitating mental health conditions. So these issues include; managing resources and rosters to ensure that personnel can take time out when they need it after traumatic events occur, addressing pervasive concerns that talking about or seeking help for mental health issues is career limiting, continuing to reduce the stigma associated with mental illness, continuing to improve levels of mental health literacy, reducing the typically long delay between developing symptoms and seeking help and fundamental reform of the workers’ compensation system.
All agencies in the sector have policies and programs that address mental health and wellbeing and each agency provides a range of useful support services for staff and volunteers. However, there are opportunities to improve workplace cultures, management of risk in the workplace and to enhance the support provided to personnel when they need it. The survey targeted current and former employees and current volunteers in the Ambulance, Fire and Rescue, Police and State Emergencies Services agencies in each state and territory. We selected the samples of employees and volunteers from lists that were maintained by each agency. As there are no lists maintained of former employees, we had to use a different approach to obtain a sample of former employees, which was recruited through support groups. As a result, the former employees’ sample is not a representative sample. The survey was administered online and the question at length was restricted to an average of 20 to 25 minutes to minimise the burden this placed on respondents.
In its scope and in the number of people participating the survey is by far the largest study of mental health and wellbeing ever undertaken amongst Police and Emergency Services organisations, either here in Australia or internationally. Over 21,000 people completed this survey, including almost 15,000 employees and over 5,000 volunteers. Among employees, the response rate was twenty two percent, and it was ten percent amongst volunteers. This chart shows the number of participants in each sector. Among employees, the Police sector is the largest employer, and the largest number of survey participants were from the Police sector. While some Police agencies do have a small number of volunteers, because of small numbers, they were unable to be included in the Study, and the volunteers sample focuses on the Ambulance, Fire and Rescue and SES sectors. There are over 200,000 Fire and Rescue volunteers Australia wide, which is the largest volunteer group, and they are well represented in the survey.
The sample is representative of employees and volunteers in the sector. We have compared the profile and sample with information that we have obtained from the 2016 census, information from the productivity commissions report on government services, and also information that each agency provided to us on the breakdown of their personnel by rank, location, length of service and other characteristics. The survey data had been weighted in order to be representative of the full population of employees and volunteers.
One of the key aims of the survey was to establish a base line measure of the mental health and wellbeing of personal in the sector. We measured mental health and wellbeing in a number of different ways. Across all of the measures used we saw a consistent pattern emerging; employees in the Police and Emergency Services sector have substantially higher rates in mental health conditions and lower rates of mental wellbeing when compared to the Australian population in general, and to workers in other industries. We measured psychological distress using the Kessler 10 Psychological Distress Scale. This scale is widely used around the world and is a good tool for making comparisons between different groups. Psychological distress is primarily focused on symptoms of depression and anxiety, which often occur together. Very high psychological distress is a strong indicator of severe mental health problems and serious functional impairment that require specialist treatment.
Approximately four percent of the Australian population and two percent of Australians working in professional occupations have very high psychological distress. In comparison, nine percent of employees in the sector have very high distress. In addition, eight percent of Australians have high distress, which indicates likely mental health conditions that would benefit from treatment, and in comparison, twenty one percent of employees in the sector have high distress. Volunteers had lower levels of psychological distress than employees, and are more comparable with general population, with volunteers in the Ambulance sector having similar levels of psychological distress to the Australian population, have slightly higher rates than the Fire and SES sectors. Overall State and Emergency Service volunteers had the highest levels of distress amongst the three sectors.
Workplace exposure to traumatic experiences is undoubtedly a risk factor for mental health and wellbeing, and personnel in the Police and Emergency Services are at high risk. We adapted existing PTSD scales to include extra questions about the impact of symptoms on day to day functioning. As this measure is based on a self-report survey and not diagnoses of Post Traumatic Stress Disorder by a professional, we are calling it a measure of probable PTSD, with estimated overall ten percent of employees in the sector have probable PTSD. Rates varied from six and a half percent in the State Emergency Service up to almost eleven percent in Police. In contrast, the prevalence of PTSD in the general population has been estimated at four point four percent. Most people with probable PTSD also had high or very high psychological distress, which accounts for about one in three of those with very high levels of distress. The additional cases of high psychological distress highlight that depression and anxiety are also common in personnel in the Police and Emergency Services, as well as PTSD. Among volunteers, rates of probable PTSD were lower; four percent amongst Ambulance volunteers, five percent in Fire and Rescue, six percent in the State Emergency Service.
PTSD was strongly associated with exposure to traumatic events and experiences in the course of duty. One clear pattern that emerged was the increasing rate of PTSD by length of service. Among employees with less than two years of service, only two percent had probable PTSD, and this increased to twelve percent amongst those with more than ten years of service. The survey results strongly suggest that agencies are recruiting personnel who are mentally healthy and that mental health is strongly impacted by experiences at work.
We also measured mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. This scale was designed so that fifteen percent of the general population would be in the high wellbeing category and fifteen percent would be in the low wellbeing category and at risk of mental health issues. It has been calibrated this way based on populations of England and Scotland and surveys here suggest that the Australian population is very similar. Employees in the Police and Emergency Services sector had much lower levels of wellbeing than the general population. Only six percent of employees had high wellbeing compared with fifteen percent, while over thirty percent had low wellbeing, doubled the expected number.
In comparison, levels of mental wellbeing amongst volunteers were much closer to the general population, with lowest levels of wellbeing in the SES sector. The survey also included a number of other measures of mental health; we measured whether people had been diagnosed with a mental health condition, and if they still had it, the level of functional impairment associated with psychological stress in PTSD, anger symptoms and resilience. Across all of these measures, we saw a consistent pattern in which volunteers had slightly higher rates with problems, and employees had substantially higher rates compared with the general population. These issues were very similar across all agencies, suggesting that mental health and wellbeing is an important issue across the entire sector. While it is important to recognise that even among long serving personnel, the majority of people have good levels of mental wellbeing and positive mental health, however the rates of mental health conditions represent a significant mental health burden. We have estimated that across the sector, there are almost eleven thousand employees with very high psychological distress and ten thousand volunteers, keeping in mind that there are many more volunteers than employees in the sector.
Another aim of the survey was to look at suicidal thoughts and behaviours – there are varying theories in the literature. It has been suggested that Police and Emergency personnel may on the one hand be at higher risk of suicidal thoughts and behaviours, because of their enhanced access to lethal means. While on the other hand the job can entail a level of exposure to suicide, that makes very real, the tragedy of suicide and enormous impact that it has on families, friends and colleagues. In the survey, we asked employees and volunteers if they have ever seriously contemplated taking their own life, they had done so in the twelve months prior to this survey, if so, we asked if they had a plan on how they would do so and if they had attempted suicide in the past twelve months.
Over five percent of employees and volunteers had seriously contemplated ending their own life in the twelve months prior to the survey, which is about twice the rate in the Australian population. Two percent of employees, one and a half percent of volunteers, had made a plan to take their own life, which is about three time higher than the rate in the Australian population. The rate of suicide attempts was comparable to the Australian population.
The survey collected a lot of contextual information about individual, team and organisational factors that may affect mental health and wellbeing. A number of these factors are relevant in any workplace, while some are specific issues that relate to the Police and Emergency Services sector. Mental health can be affected by individual factors and by the environment around us. Let's look at some individual factors first. The survey found that some of the factors associated with positive mental health included; looking after your physical health, getting proper sleep, having strong social support networks both at work and outside of work, as well as participating in and using the programs and supports provided by each agency.
There was a strong relationship between sleep quality and wellbeing. Only two percent of those with good sleep had very high levels of psychological distress, while twenty four percent of those with poor sleep did. This relationship can be reciprocal; poor sleep quality can affect our mental wellbeing and poor mental health can affect sleep. While the relationship between sleep and mental health is true for everybody, the nature of work in the Police and Emergency Services sector can impact sleep patterns. Over half of employees in the sector work shifts that include evening or night shifts. Almost one quarter routinely work more than forty-five hours a week, with seven percent routinely working over fifty hours a week, and seventeen percent of employees often return to work with less than a twelve-hour break between shifts
We measured levels of social support in the survey using the Shakespeare Finch Two-Way Support Scale. This looks at both levels of social support received from others around you, and also the levels of support that you're able to provide to your family members, friends and colleagues. Most personnel in the sector have higher levels of both giving and receiving social support. Social support has a strong protective effect on your mental health. About thirty percent of those who receive low levels of social support from those around them have probable PTSD. This was true for both employees and for volunteers. Again, we know this can be reciprocal, as we know that low levels of social support are a risk factor for developing mental health issues, and mental health issues such as depression, anxiety and PTSD can impact on people’s relationships.
One thing that emerged from the survey results was that poor workplace practices and culture can also has a significant impact on mental health and wellbeing. Workplaces that are supportive and inclusive, that have regular discussions about workplace experiences, and those that more effectively manage emotional demands on staff have lower rates of mental health issues. Being able to take a break and regroup after a particularly difficult job, being able to talk about the things you've experienced, and being able to support each other are all important to being able to manage the rigors of the job. A natural question that arises in a big study, such as this, is which agencies are doing the best and can we learn from what they do. The survey data show the key themes such as the high rates of mental health conditions, low levels of support seeking and the stigmatising attitudes towards mental health affect all agencies; these are sector wide issues. Also most of the agencies in the sector are large and diverse and there can be big differences between teams or stations within the same organisation, and we found this is where the differences were more so than between agencies. Mentally healthy workplaces require a combination of both organisational and team level commitment to supporting the mental health of personnel.
Shift work, irregular hours, being on call and intense periods of work are part and parcel of working in the Police and Emergency Services sector, however constant high intensity work can stop personnel from having the time and the opportunity to take stock after particularly traumatic or intense events occur. Over half of employees report that they work at a higher pace throughout most or every working day. One in four employees felt that their work took up so much of their time and energy that it adversely affected their personal life, and forty percent of operational staff say work demands mean they do not have adequate time or opportunity to recover after a traumatic incident.
Another hazard of work in the sector is the potential for harassment or assault in the line of duty. One in five employees report being physically assaulted on duty, particularly in the Ambulance and Police sectors. Fifteen percent of Ambulance and Police employees say that they are often harassed or verbally abused in their work.
There are multiple aspects to stigma. We asked participants who had experienced mental health issues about their experiences of stigma from those around them. We asked people who had not experienced a mental health issue, their feelings about working with others who may have a mental health condition. And we asked people about their own attitudes and beliefs about mental health, but we also asked people what they thought the attitudes of those around them were. We call this perceived stigma and it is important as perceived stigma can influence if you seek support when you need it. Most employees and volunteers told us they would be fully supportive of their colleagues if they were experiencing a mental health condition, however many people in the survey were concerned about the way that their colleagues and their organisation would treat them if they had a mental health condition. For instance, only eighteen percent of employees said that they would not want to work on the same team as someone who had anxiety or depression. But almost fifty percent said they thought most people in their organisation would not want to work on the same team as someone with anxiety or depression. The survey found that self-stigma, the fear of what others may think or an inability to talk openly about personal feelings and circumstances, is still stubbornly common.
About half the people in the survey reported that their managers were clearly supportive of people experiencing mental health issues, as similarly, about half believe that their immediate colleagues are supportive. However, only sixteen percent of employees in the sector believe that when people recover from a mental illness, it does not affect their career. About half of employees believe their organisations committed to making changes to promote mental health and wellbeing and about forty percent believe that their organisation has the skills and resources to do so.
When mental health issues occur, receiving appropriate help in a timely way is a fundamental key to reducing the impact of mental health conditions and promoting full recovery. Among employees with high or very high levels of psychological distress, less than half received any form of support or treatment in the twelve months prior to the survey. That's either provided by their agency or through services outside of the agency. Nine percent of those with high or very high distress did not believe they had a problem, another twenty five percent recognised they had a problem but did not believe that they needed any support, twenty percent recognised they needed support but did not seek or receive support in the year prior to the survey. Less than half received some form of support and only one in five employees with high or very high psychological distress received what they believe was a sufficient level of support for their needs.
These are clearly significant gaps in access and receiving mental health support services, however we know this problem is not just limited to the Police and Emergency Services sector. There are similar gaps in support seeking, if not larger, in the general population. For people with probable PTSD, two and a half percent believed that they did not have a problem, even though they had told us about their symptoms and the impact those symptoms were having on their day to day lives, which are part of the criteria for assessing PTSD status. Another seventeen percent recognised that they had a problem but did not believe they needed any help, twenty two percent recognised they did need help but they did not seek or receive any help in the year before the survey.
While sixty percent received some form of support, only one in three believe they received adequate help for their needs. Overall that's only one in five employees with probable PTSD who received what they believed was a sufficient level of support.
A critical first step to seeking support is recognising the need for support. Some people in the survey told us about their symptoms and the negative impact that they had on their daily lives. They also thought that they didn't have a problem or they didn't need any support. This may reflect issues in mental health literacy and by mental health literacy I mean; understanding what the signs and symptoms of emerging mental health issues are, knowing when to seek support, knowing what types of support are available, and knowing how to seek help when you need it. While mental health literacy is improving in Australia in general, there is still need for further improvements. Many mental health conditions including anxiety, depression and PTSD, often develop gradually over a period of time and often we don't seek help until the problem is very severe. Getting appropriate support when a problem is first emerging greatly increases the benefit of treatment and the likelihood of complete recovery.
We weren't able to asses in the survey the time between first onset of symptoms and the time when someone first perceived that they might need help, but we did ask about the delay between recognising the need to seek support and actually seeking support. Almost forty percent of employees waited more than three months and seventeen percent waited over a year before actively seeking support. These figures were higher for those with probable PTSD, where twenty five percent waited over a year before first seeking support.
We asked people who didn't seek support or who delayed seeking support for a mental health condition, what were the reasons for not seeking help. For both employees and volunteers alike, the most common barriers to seeking support included; wanting to deal with the problems by themselves or informally with family and friends, concerns about being treated differently, or being perceived as weak. Employees were also worried about harming their career prospects or being removed from operational work. These barriers may reflect commonly held stigmatising attitudes and beliefs about mental health. However, based on the many individual stories told to us by participants in the Study, there is evidence to suggests that for some, negative career impacts and being removed from operational work were genuine experiences and not just perceptions.
For people who develop severe mental health conditions that impair their ability to work, the workers' compensation system is designed to play an important role in supporting them and assisting in their recovery. We asked employees about their experiences with the workers' compensation system. Fourteen percent of employees had made a workers' compensation claim as a result of trauma, stress or a mental health condition sustained in the workplace. According to figures from Safe Work Australia the rate of claims for psychological mental health related conditions is about ten times higher than the average for the Australian workforce for Ambulance, Fire and Rescue, and Police Services, and these agencies had the highest rate of claims related to mental health of any occupations. Safe Work Australia do not provide separate figures for SES employees. Most of those who had made a workers' compensation claim found that the process was unsupportive and stressful and they reported that it had a negative impact on their recovery.
Workers' compensation claims were much higher amongst employees than volunteers and were highest in the Police agencies followed by Ambulance, then Fire and Rescue and SES. Only seventeen percent of those who had made a workers' compensation claim related to stress, trauma or a psychological condition, reported that the experience positively impacted their recovery, while almost forty percent said that it had a negative impact on their recovery. Over forty percent reported that the claims experience was not at all supportive, while only thirteen percent reported that it was very or extremely supportive. Almost fifty percent of those making a claim reported that the experience was very or extremely stressful, while only nine percent found it not at all stressful. While mental health is influenced by a combination of life experiences both at work and outside of work, the survey data strongly suggests to us that it is workplace exposure to traumatic experiences and not life outside of work that is the major driver of the high rates of mental health conditions and PTSD, in particular, in the Police and Emergency Services. The current process does not seem to be serving claimants well. Our understanding of the impacts in mental health conditions should inform how we design workers' compensation process'. In contrast to many physical injuries, we know that mental health conditions can affect people’s cognitive abilities, their decision-making processes, their relationships and their communication skills.
For people with PTSD in particular, the claims process may be particularly challenging because of what we know are the common symptoms of PTSD. People with PTSD often experience hypervigilance, suspiciousness, difficulty concentrating and a numbing of emotional responses including detachment from others and lack of positive hope for the future. These symptoms may negatively impact their ability to navigate a complex, drawn out and time-consuming process. They may also result in claimants being perceived by people who don't know them and don't have an ongoing relationship with them as the person being difficult or non-compliant. As a result, employees experiencing significant mental health conditions may require a much higher level of support to be able to negotiate this complex process.
We included former employees in the Study but we had to use a different approach to approach them. The former employees’ sample was recruited through groups and associations. It is not a random sample and it may not be representative of the experiences of all former employees in the sector. The former employees who participated in the survey had higher rates of mental health conditions; almost one in four had probable PTSD, one in five had very high psychological distress and one in four had high distress. Five percent had made a suicide plan in the past twelve months. These rates are all higher than for current employees. Former employees had low rates of resilience and social support, less than half had high resilience and only fifty six percent had higher levels of giving and receiving social support, which is much lower than for current employees. For some, leaving the service may mean losing access to friends, colleagues and support mechanisms. Most former employees have limited or no ongoing contact with their former organisations.
Thirty five percent of former employees felt that they needed support for a mental health condition in the past twelve months, and in most cases the mental health conditions started while working in the sector. Eighty percent of those who needed support, sought some form of support. Of those who sought support, forty percent felt they received adequate support and one third had been through the workers' compensation process. Most of those who had been through it found it to be unhelpful.
So in summary, we found that almost one in three employees and one in six volunteers had high or very high levels of psychological distress compared with only one in eight Australian adults. One in ten employees and one in twenty volunteers had probable PTSD. Mental health issues are strongly associated with exposure to traumatic experiences in the course of duty and with length of service. Almost half of personnel with high psychological distress or probable PTSD, do not seek support or do not receive support when they need it. Only one in five of those with high psychological distress or probable PTSD feel that they receive adequate levels of support. Stigma remains a major barrier to seeking appropriate support in a timely way, when it is needed. A majority of those making workers’ compensation claims related to psychological trauma, or stress or a mental health condition, found the process to be unhelpful and negatively impacted on their recovery.
There is a significant group of former employees who continue to need support years after leaving the service.
Overall, the survey found that mental health issues are common in Police and Emergency Services agencies, but that individuals, teams and organisations do not always seek help when needed or support each other as well as they could, and stigma of mental health conditions remains the major barrier to seeking appropriate support in a timely way when it is needed. While there is still much that we need to learn about mental health conditions, a big part of the issues we face is not that we don't know what to do, but that we fail to do the things we know are important, the things we know do help, and that we don't support each other as well as we could at the individual level, at the team, workplace or station level, and at the organisational level.
So there was much more on the survey than I've had time to go through today. Reports with more information on the survey are available on the Beyond Blue website at www.beyondblue.org.au/pesresearch. We hope that this data will support ongoing efforts in the sector to advance our understanding of the importance of mental health issues and how to improve mental health across the sector. As we've collected more data than we've been able to report on fully in the National Report, we will be making a Confidentialised Unit Record File available to the research community and we hope that this data will be supportive of ongoing efforts in the sector to advance our understanding of the importance of mental health issues and how to improve mental health across the sector.
So I’ll finish at that point and say thank you to each agency that participated in the survey and to all the employees, volunteers and former employees from across Australia who generously gave your time to participate in this Study.