Ambulance Victoria and STAGE-28 International

Overview

The research project you have been invited to participate in was conceived by Stuart Stuart, Senior Chaplain and Pastoral Care Lead at Ambulance Victoria. His collaborator, Dr John Durkin (of STAGE-28 International) is a PhD practitioner and former-firefighter whose research is in the area of posttraumatic growth – the idea that we can become stronger, wiser people because of our involvement in life-critical situations, not despite it. What this means is ‘it’ changes us and we change with it, rather than refusing to change and trying to carry on as before.

Carrying on as before can look like resilience, whilst changing with it looks more like growth. Dr Durkin prefers to foster growth than resilience, seeing its seeds sown in what he witnessed as a firefighter. What can be missed by mental health experts is the experience that forces us into different ways of thinking that include warped humour, die-hard friendships and looking forward to the next challenge, however traumatic. If you look forward to something the expert would warn you against, they have much to learn and emphasises the point of this project.

What is it that makes us, on the frontline of emergency service, perform despite all the warnings and the evidence that some of us end up taking our own lives? It was the suicide of colleagues that brought Dr Durkin to this work and why this project is important to him. If beyond the mind and body of a paramedic is a ‘heart’ that remains undiscovered in clinical interviews and wellbeing assessments we need to find another way to look after ourselves and our own people.

What chaplaincy offers is a bridge between the world ‘out there’ and the private world ‘in here’. Stuart has selected chaplains he expects to handle whatever you throw at them and still persist with their availability. If so, we might between us find a way to stop that ultimate coping decision – suicide. This is a call to trust, even though it seems a rare commodity in many emergency services organisations. A step across from trust is privacy so for collecting your data Dr Durkin has top-level encryption for the online research portal so you cannot be identified by anyone at Ambulance Victoria. He will retain the e-mail address you type in to inform you of a concern but leave you to make the decision on the steps you then take. When all the scores have been collated and numbers crunched they will be summarised in a table and a report. Each page of the ‘General’ portal relates to a different psychological topic and listed in the e-mail you will receive. The link alongside each topic will take you to a paragraph to explain its significance to you.

Depression

Depression was measured by a scale called the PHQ-9. It has proved controversial because it was developed with the support of Pfizer, a pharmaceutical company. However, it is widely-used in psychological research and is used here to allow us to compare ‘like-with-like’. In other words, we can compare AV paramedics’ depression scores with the other types of people in research studies that used the PHQ-9.

The PHQ-9 has a range of scores from 0-27. Higher scores mean more depressive symptoms and when the top level is reached your score is recorded in red. If your score for ‘Depression’ is red it means you reported a similar number and frequency of symptoms as someone who is depressed. It does NOT mean you have a mental disorder, only that your scores are similar to someone who probably has.

The purpose of measuring depression is because of its link to suicide, something we hope to prevent. Most people with high scores on the PHQ-9 are not suicidal so even if your score came up in red the scores on the other measures can help us see what is protective, positive and different about you. If you do feel suicidal there is information at the foot of this page to find support and someone to talk to.

Anxiety

Anxiety was measured by a scale called the GAD-7. Like the PHQ-9 it is controversial for similar reasons but also widely used in research hence including it here.

The GAD-7 has a range of scores from 0-21. Higher scores mean more anxiety symptoms and when the top level is reached your score is recorded in red. If your score for ‘Anxiety’ is red it means you reported a similar number and frequency of symptoms as someone who has phobias or is prone to panic. It does NOT mean you have a mental disorder, only that your scores are in the same region as someone who probably has.

The purpose of measuring anxiety is because it is associated with fear, something we hope to reduce. Most people with high scores on the GAD-7 are not paranoid or panic-stricken so if your score came up in red the other measures can help us see what is protective, positive and different about you. If you do feel panic or dread for the future there is information at the foot of this page to find support and someone to talk to.

Psychological Wellbeing

Low = 18; High = 108

Think of this as a measure of ‘character’ with a range of scores from 18-108. If you’re interested in philosophy you might know about Aristotle, virtue and eudaimonism. This is a modern way of measuring those qualities and the higher the score, the more of those qualities you recorded. This scale is made up of autonomy, positive relations with others, self-appreciation, purpose in life, control over your environment and personal growth. These are not ‘happy-clappy’ feel-good qualities, more the satisfaction that comes with achievement after being challenged. Given the concerns that might be raised for having high scores on depression or anxiety (see above) is how these six aspects of character might oppose or overcome them.   

If you scored low on ‘Psychological Wellbeing’ (e.g., 70 or less) you might want to reflect on your work and relationships to see what you might change to get more from life. If you have a score of 70 or less, and a red score on depression or anxiety, you might benefit from discussing your views on life with someone supportive. Information to contact someone to do that is at the foot of the page.

Growth

Low = 0; High = 30

This is a measure of how positively our outlook changes after enduring a setback with a range of scores from 0-30. A low score would imply that little good came out of the setback you had in mind when you completed the questions, while a high score would suggest a lot of good came out of it. Referring back to the depression and anxiety scores (above) the ‘positive change’ measured here would be of interest if it is a quality that keeps us going back for more. Feeling suicidal is probably saying we’ve had enough of being challenged, hence the effort to measure whether and how our outlook gets changed.

Perceived support

Low = 0; High = 9 (size of network)

Low = 0; High = 6 (satisfaction with network)

This is a two-scale measure of the support we expect to be available to us whenever we need help, someone to talk to and feel understood by them. One scale measures roughly how many people we believe are available (0-9) and the other how satisfied we think we will be when we seek their company (0-6). The more people and the higher satisfaction seems likely to enhance our confidence because we can get on with the job, even take a few risks, because there are several people we expect to be helpful. The fewer people and the least satisfaction with those few we count on seems likely to reduce our confidence because we’re not sure if anyone will be available or that we will find them helpful.

Meaning in Life

Low = 10; High = 70

In the Overview (above) we introduced chaplaincy as a means of communicating across a bridge between the real world and our private world. We operate in the real world with our minds and bodies but seem to experience it privately too, as ‘heartfelt’ and that poses big questions around what life is for. If these are the questions in the mind of the those who are suicidal we want to look more deeply, and it is this ‘heart’ that the chaplain’s presence is meant to address. This questionnaire measures two forms of meaning, both of which will relate to “What’s it all about?”; one being the purpose of our lives, and the other our search for meaning. The scale has a range of 10-70 with higher scores indicating a greater effort to gain meaning in life. Given the role of the paramedic in preserving life these fundamental questions are likely to occur more often in this profession than probably any other. If someone felt suicidal, it seems likely that finding no meaning in life contributes to their decision of what to do next.

Received support

Low = 6; High = 42 (support quality)

Low = 1; High = 7 (satisfaction with support)

This is a measure of ‘enacted’ support at the time we wanted or needed it. Unlike ‘perceived support’ (above) this is what actually happens, not what we believed would happen. It measures how much emotional and practical support was made after a crisis on a scale of 6-42. Higher scores mean more support was provided than lower scores would indicate. How satisfied we were with the support provided is measured on a scale of 1-7. By comparing the actual support received with the support we expected (see Perceived support above) we will either find that our expectations were met (good or bad) or else they were challenged or not met at all. If we expected little or no support and got plenty that would contrast with expecting a great deal and being disappointed. Both of these outcomes will help inform how much is enough support, and of which type, to meet the demands of the work of a paramedic.

Conclusion

Scores in red (high-risk) for depression and anxiety indicate you might benefit from support, an assessment or at least someone to talk to. Contact details of those who are available at Ambulance Victoria are given below. If you choose to meet a mental health professional you can forward the e-mail to them to save time ahead of your meeting. They are professionally bound to keep your information confidential.

Contacts and Resources

For mental health and wellbeing support please visit, e-mail or call one of our support services:

1800 626 377 (1800 MANERS)

Press 1: Peer support

Press 2: VACU Confidential Telephone Counsellng Line

Press 3: Pastoral Care (AV Chaplains)

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