Australian paramedic Paul Scully recently delivered a conference presentation that highlighted key elements of a comprehensive model of mental healthcare for paramedics and EMDs in the Queensland Ambulance Service. In this Q&A, EMS World talks with Paul about the role of Peer Support Officers who offer early intervention and support to ambulance personnel.
You’ve written a paper and delivered a presentation called “Taking Care of Staff: A Comprehensive Mental Health Support Model for Paramedics and Emergency Medical Dispatches” that highlights key elements of a comprehensive model of mental health care for paramedics and EMDs. Components include a peer support officer (PSO) who offers early intervention and support to ambulance personnel. Please explain the PSO position and how it works.
The wider mental health program, and specifically the PSO program, were introduced following a review/restructuring of the QAS in 1992, at a time when the Mitchell model of critical incident stress debriefing (CISD) was introduced and popular. The approach utilized within QAS has now moved substantially away from the Mitchell model. Debriefing does take place occasionally, though the PSO model has predominantly changed this approach.
In the 20 year life of the Priority One program—QAS’ Employee Assistance Program (EAP)—the QAS has appointed and trained approximately 520 PSOs. Naturally, some of these will have retired or stood down from the position or are otherwise no longer active. Currently the QAS, which responds to approximately 840,000 cases annually and serves an approximate population of 4.3 million, employs approximately 4,200 staff and has approximately 260 stations, with 80 to 100 active PSOs throughout the state. PSOs undertake a careful, discerning selection process, followed by a six day residential training course which covers, but is not limited to, essential counseling skills, essential components of acute stress, psychological trauma, bereavement, suicide and effective communication skills. The course is experiential and interactive, and draws on the experience of participants in order to enhance learning.
PSOs are required to attend monthly supervision with an identified mental health professional in either a group or one-on-one setting. PSOs are both pro-active and re-active within their work environment, following up cases with personnel subsequent to critical events. It has become conspicuous that there is a high level of trust in these individuals and they are frequently sought out by staff following critical incidents and, not uncommonly, more personal matters. PSOs also attend a three day refresher course offered annually.
How did your experience practicing trauma counseling and psychotherapy aid in the formation of the PSO position?
I have been an employee of the QAS for more than 40 years—prior to my retirement to private practice in June 2013—originally as an operational paramedic and later in paramedic training positions. In the 1980s, I undertook studies in psychology and was fortunate enough to be given the opportunity to develop this program from its outset. May I also say that the other full-time counselors employed by the QAS have been paramedics and peer support officers; it has made a big difference.
What kind of results has the QAS seen with the PSO model?
During 2013, 1,183 personnel sought face-to-face counseling with one of the three full-time counselors, or one of the 44 contract (sessional) counselors. Additionally, 1,528 personnel had individual contact with 54 PSOs, and the 54 PSOs totaled 1,539 hours of contact with personnel.
Our data over many years indicates approximately 80% of “issues” that personnel discuss with PSOs are resolved/dealt with by the PSO. Naturally, PSOs also encourage personnel to seek/attend professional counseling as necessary.
By 2011, mental health injuries within the QAS had dropped to seven in total, with only four of those related to PTSD. QAS total staff at that time was 3,376. While I am unable to provide data for following years, I am advised that the figures have not risen.
After creating the PSO position, did QAS see a culture change among personnel regarding use of these services?
The necessary “culture change” around understanding the “mental health” impact on personnel has come from education, beginning with pre-on-road exposure in the first, second and third years of university (since 2005, all paramedics are university trained in Queensland). Upon employment, all paramedics must complete an induction program which requires an extensive mental health education component, shift work and fatigue education, a personal stress and coping plan, and must also complete a personal journal recording their personal reflections on a minimum of six cases which they have attended in the first six months of employment. This journal is then reviewed by an identified mental health professional and in the presence of the paramedic in question; this not only provides a review and personal feedback for the new employee, but also a non-threatening encounter with a mental health professional. I must stress that while this is compulsory, the notes/details are not seen or examined by anybody other than the individual student and the counselor in question; the counselor then confirms with the appropriate department that the task has been completed.
I should also stress that education on mental health and on supporting staff is now mandatory for all supervisory and management positions within the QAS. This one day training program has revealed excellent results, and provides this group of employees with much needed resources.
What other services does Queensland Ambulance Service offer for employee assistance?
We have a monthly e-newsletter covering a different pertinent mental health topic in each edition; extensive brochures and educational material distribution; 24 hour free telephone counseling; chaplaincy service; and an indigenous employee support service, with approximately five indigenous PSOs. We also have all of these services focused on EMDs, including EMD peer supporters.