The Mental Health Struggles of Australia’s Emergency Workers

Emergency service workers experience higher PTSD levels

Emergency service workers are twice as likely to experience mental health problems than the general population, in large part due to the high risk of trauma exposure at work, according to the Black Dog Institute.

Specifically, 1 in 10 of Australia’s 370,000-plus emergency workers and volunteers are estimated to develop post-traumatic stress disorder (PTSD) – a severe and persistent mental health impairment that can occur following exposure to single or multiple traumatic events – related to critical incidents on the job.

While the most up-to-date literature estimates that around one in 10 emergency workers are currently suffering from PTSD, rates are likely to be even higher if retired emergency workers are considered, according to a new report on the management of PTSD among emergency service workers.

Released by Black Dog Institute together with UNSW Sydney, the report states a degree of psychological distress is common after traumatic experiences, and in most cases, an individual’s personal coping strategies and established support networks will enable them to return to their usual level of functioning quickly.

However, some individuals will experience persistent symptoms or an increase in symptom intensity over time, leading to a psychiatric diagnosis.

A prerequisite to the symptoms of PTSD is that an individual must be exposed to threatened or actual death or serious injury to self or others, including repeated or extreme exposure to the adverse details of traumatic events, according to the report, which said PTSD comprises four additional major clusters of symptoms:

1. Re-experiencing symptoms, including intrusive memories, flashbacks, nightmares, and distress to reminders of the trauma
2. Avoidance symptoms, including active avoidance of thoughts and situational reminders of the trauma
3. Negative cognitions and mood associated with the traumatic event, such as an inability to remember important details about the event or persistent unusual ideas about the cause of consequence of the traumatic experience
4. Arousal symptoms, including exaggerated startle response, insomnia, irritability, and sleeping and concentration difficulties

“Emergency service workers encounter a range of traumatic events, from vehicle accidents to medical emergencies, exposure to violence and the increasing impact and severity of natural disasters,” said lead co-author Professor Sam Harvey, executive director and chief scientist of Black Dog Institute.

“Individual and cumulative traumas can both lead to PTSD. We have a responsibility to protect those who protect us by providing them with the best possible mental health care that science has available.”

The report notes that the nature and pattern of trauma exposure amongst emergency workers are different to those experienced by other populations.

Emergency workers expect to experience multiple episodes of potentially traumatic experiences while undertaking their usual work.

For example, they may witness individuals who have been badly hurt or deceased, be directly threatened themselves, or, in the case of police officers, be required to seriously wound or kill others as part of their job.

“As a result of this regular exposure, an emergency worker’s response to trauma is often anger and guilt rather than the fear or horror often described by members of the general population exposed to one-off, unexpected trauma,” the report says.

“Given these differences, it is not surprising that emergency workers with PTSD may present in different ways.”

Furthermore, individual emergency workers may experience a gradual build-up of distress and symptoms over a prolonged period rather than a sudden onset of symptoms after one isolated event.

Alternatively, they may present with an acute onset of symptoms after a single event, while many emergency workers exposed to repeat traumas demonstrate sensitisation, with increasingly severe responses to each successive trauma exposure, when lesser traumatic events that previously would not have caused them distress begin to generate mental health problems.

There are now several psychological and pharmacological treatments known to be effective at both reducing PTSD symptoms and improving functioning, according to the report.

“All emergency workers suffering from PTSD should be offered a variant of trauma-focused cognitive behavioural therapy (TF-CBT), including prolonged exposure, cognitive processing therapy and trauma-focused cognitive therapy, or eye movement desensitisation and reprocessing (EMDR),” the report said.

Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either TF-CBT or EMDR), each lasting between 60 and 90 minutes.

However, many emergency workers will require additional treatment sessions, especially if they have severe symptoms, have experienced multiple traumatic events or have co-morbid mental health problems.

The guidelines contained in the report draw on new research findings generated at Black Dog Institute, UNSW Sydney and other global research institutes over the past five years.

This includes clinical data from the Black Dog Institute and UNSW’s National Emergency Worker Support Service (NEWSS).

Since its launch in 2020, NEWSS has reached more than 125,000 emergency service workers and achieved a world-leading PTSD recovery rate of 80 per cent, compared to a global average of around 50-60 per cent.

“Treating an emergency service worker with PTSD is fundamentally different to treating PTSD in the general population,” said lead co-author professor Richard Bryant, director of the Trauma Stress Clinic at UNSW.

“Australia is now leading the world in the way we care for and treat emergency service workers with PTSD. These guidelines aim to share what we have learnt through more than half a decade of working with this population, to lift quality of care across Australia and internationally.”