Spoiler alert – Paramedics experience higher levels of depression, anxiety, post-traumatic stress disorder (PTSD), and mental fatigue when compared to the general public, and other emergency services.
It is widely known that paramedics experience high rates of mental health illness and emotional distress. However, there is limited understanding of how the environment in which paramedics work contributes to this problem. Psychological harm experienced by paramedics takes its toll on individuals in varying capacities and it is not our intention to blanket the problem with a generic solution. However, we will draw your attention to our last two articles in the paramedic wellbeing series entitled You Are What You Sleep, and You Are What You Eat. These articles both related and discussed how shift work, extended shifts, poor eating and repeated exposure to trauma can disrupt the normal sleep–wake cycle (circadian rhythm) and affect the mental health of the responders. These linkages increase the likelihood of adverse mental health outcomes in paramedics by almost 30%.
This article will discuss mental health from a paramedic perspective, delving into the notion that you are what you think, therefore have an element of control.
Mental health: Don’t survive, thrive
Paramedics experience higher levels of organisational stress in comparison to other vocations due to shift work, long hours, repeated exposure to death, difficult interactions, and high levels of responsibility. A recent systematic review of 27 international studies reported on 30,878 ambulance personnel. This systematic review estimated prevalence rates of 11% for post-traumatic stress (PTS), 15% for depression, 15% for anxiety, and 27% for general psychological distress among ambulance personnel.1
Roman emperor Marcus Aurelius once wrote, “our life is what our thoughts make it”. Whilst we are not drawing parallels between gladiators and paramedics, the universal message is that our thoughts make us what we are. Scientific evidence has shown that a large number of the same areas of the brain are engaged when we are performing an action or thinking about performing an action.2 Your thoughts are incredibly powerful. If you think negative thoughts, you’re more likely to produce negative outcomes. The opposite is also true.
The increased stress responsivity, mood disorders, cognition, memory and performance deficits caused by interrupted sleep, traumatic patient scenes, smart phone distractions, missed meals and overtime can leave paramedics feeling drained and emotionally fatigued.3, 4 Whilst no two dispatches are ever the same, paramedics work in an environment akin to a revolving merry-go-round of stress. Not just traumatic stress from critical incidents but also work-related stress such as workplace culture, operational management, legal and ethical dilemmas, constantly evolving clinical guidelines and community expectation. Did we mention your own personal expectations that you place on yourself? It is a wonder that we are even able to function each day on shift.
Amongst this all is Marcus Aurelius’ notion revolving around the simple idea that you are what you think. How we see ourselves and what we think about affects our mental health and in turn our physical health. So, if the thoughts are negative, the emotions are drained and physical exhaustion is approaching, the cup is nearing empty. This poses two questions how can you pour from an almost empty cup (look after patients) and how do you avoid the cup nearing empty in the first place?
Many of us go about transforming our environment believing that doing so will create the necessary sustenance for us to continue. However, often we fall back to where we started, stressed and possibly unhappy, and the cycle repeats. This is caused by the false assumption that change begins from the outside and if we do that, we will feel better. We are somewhat wrong. Whilst the environment we work in can play a large role in our circumstances, the root of the cause is actually in your head. If you want to change the outside, you must first change the inside. We cannot control what we are dispatched to, where we are sent to work, who we are required to work under, and how physically demanding the work is. However, we can control where we sleep, what we eat, how much we exercise and what we think of ourselves.
Sometimes this is not easy to do alone. Finding a friend, a confidant, even a therapist if you need to, to challenge your own thinking pattern and lift yourself will defend against the slippery slope of poor mental health. With this control the cup will avoid nearing empty. Sometimes we just need to look inside or reach out for a little help to think better of ourselves and our workplace.
Paramedics are superheroes, it’s true. However, even superheroes have flaws, need downtime to mentally reset and need help along the way. Nothing about mental health is simple, and nothing about a paramedic work environment is easy. If we encourage people to consider their own perception of themselves, we may work out some strategies for improving our own wellbeing. Listen to your inner voice, reflect on what it is saying and know that making time for your mental health and reaching out is a sign of strength, not weakness.
What you think directly influence your emotions. Your emotions directly influence how your body reacts. How your body reacts directly influences how you behave. How you behave defines who you are.
James Allen wrote: “[You] can only rise, conquer and achieve by lifting up [your] thoughts…[and] only remain weak and abject and miserable by refusing to lift up [your] thoughts.”
You are what you think, your life is what your thoughts make it. Be kind to yourself.
1. Lawn S, Roberts L, Willis E, Couzner L, Mohammadi L, Goble E. The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research. BMC Psychiatry. 2020;20(1).
2. Hanakawa T, Immisch I, Toma K, Dimyan M, Van Gelderen P, Hallett M. Functional properties of brain areas associated with motor execution and imagery. JNP. 2003;89(2).
3. Medic G, Wille M, Hemels M. Short and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9
4. Clompus S, & Albarran J. Exploring the nature of resilience in paramedic practice: A psycho-social study. International Emergency Nursing. 2016;28.