RUOK? Team, Livingston Station

We make time to ask - RUOK?

This is the story of how two colleagues identified a need for better welfare support and collaborated to improve staff experience whilst removing the stigma of mental health, not just in their own local teams, but throughout the Scottish Ambulance Service and extending to Ambulance Trusts across the UK. The introduction of iMatter gave them hope that they could discuss staff welfare and staff experience issues openly. Their journey demonstrates how individuals can engage in the workplace to effect change for the benefit of all.

Background
A survey of emergency service workers conducted by Mind, the mental health charity, in 2015 as part of its Blue Light Programme, revealed that members of the emergency services are even more at risk of experiencing a mental health problem than the general population, but are less likely to seek support. The incidence of poor mental health amongst ambulance staff in particular is alarmingly high. Some of the statistics from that survey can be found in the boxes below.

Additionally, the Scottish Ambulance Service Board’s iMatter survey results in 2017 revealed that only 57% of staff felt that the organisation cared about their health and well-being. It has become increasingly apparent that ambulance staff are being profoundly impacted by their job and the type of incidents they may be exposed to during their career.

Gail Topping, a Paramedic at Livingston Ambulance Station, is one such member of staff. Gail felt that she could not admit how badly she had been affected for fear of being perceived as “weak”. Gail, with 20 years experience in the Scottish Ambulance Service (SAS) ranging from Ambulance Control, Operations and Education, has battled with her own mental health for several years. Very early in her Operational career, Gail attended a traumatic incident that has profoundly affected her mental health - an incident that involved the death of several children. There was no opportunity to debrief. There was no one really asking ‘Are you ok?’ afterwards. There was no follow-up and there was no one who recognised the changes in Gail’s behaviour over the following, weeks, months and years. During that time, like many other members of staff, she became disillusioned with her job and felt that she as an individual did not matter to the organisation. Gail was clearly suffering from the trauma of what she had witnessed. With no opportunity to speak about it, the trauma festered.

Thirteen years after that incident, Gail attended an assault. A knife was drawn on her and her partner. They escaped unharmed but Gail was again emotionally traumatised. After the incident the Police required statements. There was still 2 hours of their shift left. No one from the SAS contacted them in that time to ask if they were ok. It caused flashbacks of the incident from 13 years previously and raised again the question of ‘Does anyone really actually care?’. Gail decided that it was time to speak out, time to try to make a difference for those other staff who we know are suffering with poor mental health but too afraid to admit it, or managers who are too afraid to discuss it with their employees. The launch of iMatter across NHS Scotland had given her hope that she could make a difference and her voice would finally be heard.

A meeting was arranged between Gail and Ruth Anderson, Duty Manager for the East and NorthAmbulance Control Centres. Ruth suggested Gail tell her story, certain that the impact would have people talking, with the aim to get colleagues looking out for one another, regardless of grade or position. They wanted staff to identify the signs and symptoms of stress so people would notice when someone is struggling and feel confident enough to start a mental health conversation by simply asking ‘Are you okay?’

It might be that person’s only lifeline and a conversation really could save their life.

What did they do?

Gail and Ruth trialled some discussions with members of staff based in the East Ambulance Control Centre, focusing on Gail’s experiences where support was not offered and the impact it could potentially have on colleagues and their mental health. Initially the focus was on encouraging dispatchers to “look after” operational crews who have responded to incidents. However, it quickly became evident that dispatchers and call-takers are also affected by incidents, either directly or indirectly and their mental health is also suffering. So they devised a campaign to appeal to all members of staff within the Scottish Ambulance Service to look out for each other, regardless of their role or job title.

During their research, they discovered a suicide prevention charity based in Australia called “RUOK?”, with resources available online that were easily accessible. Contact was established with them and they subsequently granted a licence to use their branding within the SAS. Ruth and Gail devised a leaflet (see below) that was sent out to all members of staff and developed a presentation that highlights how to recognise when someone may be experiencing poor mental health and the importance of initiating a conversation by asking “Are you ok?”. Central to the presentation is the sharing of Gail’s own personal story and her mental health journey in an effort to remove the stigma and normalise conversations on a day-to-day basis so colleagues can support each other in the initial aftermath of a distressing event.

They reinforce the message that everyone’s voice matters and that one person’s idea for improvement really can drive change within a large organisation, not just locally but also potentially at a national level. They discuss the Service’s (and NHS Scotland’s) core values in relation to staff welfare and how being caring and compassionate towards each other, treating each other with dignity and respect, being open and honest with each other and taking responsibility for each other can improve the quality of our working environment and promote better teamwork.

Gail and Ruth continue to deliver these presentations in between working their usual shifts and the majority have been given to staff who have volunteered to attend in their own time. Attendees have also included members of the Scottish Fire and Rescue Service, Community First Responder groups, Her Majesty’s Coastguard, as well as other healthcare professionals from the wider NHS.

Gail Topping and Ruth Anderson

 They also created a dedicated section on our intranet for anyone looking to access some of the resources highlighted during the presentation or in the leaflet, including an area for staff to submit their own anonymised stories so they can share either positive or negative experiences of mental health support and provision within the SAS.

The quarterly “Response” magazine produced for employees of the SAS regularly includes features to promote the campaign and raise awareness of staff welfare and wellbeing in general.

Feedback

Here is a selection of some of the feedback we have received to date from the presentations we have delivered:

“It was uplifting to hear you, it meant a great deal to me personally learning that I was not alone in the service and I was not unique having the dark time I had. Your work is vital and is without a doubt a lifesaver.” - Paramedic

“Having someone who has been through it and is brave enough to speak about their experience really helped. I think it will help a lot of people feel confident to speak up.” - Calltaker

“What an amazing initiative! This really should be rolled out to all staff ASAP!” - ACC Supervisor

“Really brought home how simple changes can have a big impact. Inspiring!” - Dispatcher

“A must-do for every course!” - Trainee Technician

“Every member of staff should be put on this course. I have been nearly 40 years on frontline ambulances. Every aspect of this presentation I have had to deal with pretty much on my own. How refreshing to hear it from someone else and that it is being addressed. Excellent.” - Paramedic Team Leader

“You may feel that you are alone when you feel down but actually there is help.” - Firefighter

“Stress is a significant risk for our staff...This is a very simple but effective workshop! The grassroots / operational-led approach works especially for us with an organisation of volunteers. Brilliant!” - Senior Coastal Operations Officer, HM Coastguard

Achievements to date

• Developing and printing leaflets for distribution to all staff in SAS
• Creating a PowerPoint presentation to deliver workshops which have been rolled out across Scotland
• Having a dedicated page for staff wellbeing on the @SAS intranet
• Securing the development of a pre-set message linked to Control from the ambulance in-cab terminal to highlight to dispatchers when a crew have been affected by an incident (it’s not always the immediately obvious jobs that get to us)
• Represented SAS at an accelerated design event for Project A in London in March 2019
• Recognised as a worthwhile initiative through Project A with the Association of Ambulance Chief Executives adopting the “RUOK?” strategy for rollout to all UK ambulance trusts
• Submitting a chapter for a book on ambulance staff well being, to be published in 2020
• Received the Chief Executive’s Award in the 2018 SAS Staff Awards
• Finalist in the 2018 Scottish Health Awards “Care for Mental Health” category

Aspirations for the future

• Better governance of staff welfare and follow-ups
• A more structured approach to informing line managers when staff have been involved in an incident or have requested a stress break after an incident
• A dedicated Welfare Department, solely focused on staff wellbeing
• Development of a peer support network across Scotland

#itsokaynottobeokay #timetotalk #removingthestigma #oneteam #RUOK