My experience of working with Australians in the emergency services, military, and medical professions, is that they are generally resilient, intelligent and thoughtful people.
But, in common with many trauma-exposed organisations around the world, most of their employers have not fully embraced contemporary evidence about how to best support and care for staff who are routinely exposed to trauma in the course of their work.
While these professionals are often trained and equipped to react effectively to physical threats, they are considerably less likely to have received formalised and evidence-backed training to protect their mental wellbeing. Furthermore, their organisations often have poor mental health awareness training or a lack of exposure to effective traumatic stress management. Increasing access to both has the potential to create wholesale positive cultural change, but implementation will take time.
However there are a number of relatively easy changes that could extend the benefits of existing programmes and eliminate those that don’t work, leading to substantial improvements in the short to medium term. These improvements can then be reinforced and added to as we set new standards in the prevention, detection and treatment of traumatic stress-related disorders such as PTSD.
Screening is an illusion
One enduring misconception lies in the use of mental health screening as a mechanism to detect vulnerability or to identify developing mental health difficulties. On joining some Australian police services, for instance, new officers may speak to a psychologist and complete a questionnaire designed to predict psychological resilience to traumatic events.
Australia is certainly not alone in this case – similar techniques are in place across many first world militaries and emergency services – but according to a major peer-reviewed study completed in the UK, and another in Canada, it is impossible to reliably predict a predilection to developing mental illness in this way.
A second type of mental health screening comes into play following traumatic events or as a matter of routine for those in challenging roles, when they are asked to see a psychologist or fill out a questionnaire on a six month basis. Like many militaries around the world, the Australian military screens soldiers returning from deployment in this manner.
With funding from the US, I was one of the Principal Investigators on a high quality study of post-deployment screening which showed that it did not improve the mental health of troops, nor did it increase the likelihood that troops with mental health difficulties would seek help. Many respondents are not entirely honest when completing the questionnaire out of concern for their careers, or from a sense of shame arising from their problems.
Despite the good intentions behind them, it is clear these screening techniques make little difference to the mental wellbeing of men and women working in profoundly difficult conditions, while being a waste of time and resources for the organisation at large.
Small steps go a long way
The good news is there is strong evidence to show that people working in challenging roles do speak about their difficulties and concerns with those they trust, such as colleagues, friends, family and even managers.
Research has shown, when used properly, peer support networks can reliably identify and help those suffering from traumatic stress, even in its very early stages.
Some 20 years ago in the British Royal Marines, we pioneered a peer support framework called TRiM (Trauma RIsk Management). As part of the programme, marines trained in the identification and initial management of traumatic stress would reach out to at-risk colleagues after potentially traumatising events and begin informal conversations.
The aim was not to provide counselling, which has not been shown to help immediately after traumatic events, but to identify who might be at risk of suffering a prolonged or severe reaction and provide them with basic support. All participants in the process met again a month later and those with continuing difficulties were given access to professional care for a full assessment and evidence-based treatment if required.
TRiM is now used around the world to support trauma-exposed organisations such as the emergency services, media professionals, diplomats, healthcare workers and train drivers to name but a few, and its effectiveness has been confirmed by scientific research.
Some Australian police services do have peer support frameworks, but do not seem to use them pro-actively. And while programmes such as TRiM work well delivered face to face, there is also strong evidence to show that remote support – through Skype and mobile devices –is also effective, making this type of pro-active peer support more accessible for officers with less time on their hands or in remote postings.
Winning over junior and middle managers
Aside from the importance of pro-active peer support networks, another key principle is to ensure junior and middle managers – around sergeant level in the police force and military – really understand the impact of their attitudes and behaviours on those they lead.
In my experience, junior and middle managers have frequently seen the threat posed by mental health deterioration first-hand. So we tend to find equipping these managers with the tools to identify and manage traumatic stress – in themselves and their team members – often results in them examining their memories and experiences through a new lens.
Once empowered to speak to potentially distressed team members, these managers generally find a range of simple support mechanisms can have dramatically beneficial effects, and encourage staff at all levels to be more open about mental health.
Equipped for the future
Fortunately we are making some headway in this area, and attitudes towards mental health are much more positive today than they were even 10 years ago. In the future, we hope this positivity will continue as treatment options are broadened, improved and made more accessible.
Certainly, there are a great many more avenues to explore in improving mental health management and treatment. This is partly because – despite the significant advances made in recent years – mental health remains a young and relatively unexplored area of medicine. But, in my view, we owe it to the women and men undertaking emotionally traumatic work to do whatever we can to ensure they remain well in spite of the challenging work they do.