Self-identification of psychological wellbeing: a mental health continuum for EMS employees 

PRIMARY AUTHOR(S): Sasha Johnston^1,2

OTHER AUTHORS: Jo Mildenhall^3,4, Jaimee Wylam^5,6

INSTITUTIONAL AFFILIATIONS OF ALL AUTHORS:

¹ South Western Ambulance NHS Foundation Trust, UK.

² Department of Experimental Psychology, University of Oxford, UK.

³ College of Paramedics, UK.

⁴ University of York Management School, University of York, UK.

⁵ UK Health Security Agency, UK.

⁶ Leeds Teaching Hospitals NHS Trust, UK

Title

Self-identification of psychological wellbeing: a mental health continuum for EMS employees

Introduction

Emergency Medical Service (EMS) employees are more likely to experience poor psychological health and suicide than the general workforce. Exposure to work-related stressors and cultural stigma related to the acknowledgment and acceptance of mental ill-health are pivotal factors. The EMS environment is unique and unpredictable, making it challenging to find time for staff wellbeing. Therefore, a visual aid that enables employees to identify, articulate and disclose their mental wellbeing status and seek support in an easy and concise manner is needed.

Objective

To develop a visual mental health continuum, tailored to the EMS sector.

Methods

A literature review of available English-language, adult population articles related to mental health continua was conducted in July 2021. Electronic databases Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Epistemenikos, Medline, Prospero, PsycINFO, Scopus and Google Scholar. Existing mental health continua utilised by EMS organisations were also identified and alongside the identified database articles, an expert working group created through stakeholder mapping, examined and debated findings and developed an EMS specific continuum.

Results

A descriptive narrative of the included studies was produced. Several factors for supporting wellbeing, such as regular eating and sleeping patterns, are not achievable for irregular EMS shift work and would likely create a barrier to participation. Factors such as concise and de-stigmatising language and taking a holistic view towards employee mental wellbeing, were also identified as important. A visual four-point continuum consisting of Thriving, surviving, struggling and ‘in crisis’, anchored by five holistic factors of emotional, psychosocial, social and physical wellbeing, and addiction was developed. Elements such sleep hygiene moderated by shift work were included. Four suggested supportive techniques are provided to align with the four continuum self-identification points. 

Conclusions

Evidence suggests that a visual continuum can promote a shared understanding of fluctuating mental health and can help to reduce stigma. Although we recommend that this tool is disseminated and adopted by EMS organizations, given the lack of validation and evaluation for visual mental health continua identified in the literature, we suggest that evaluation of adoption, acceptability and effectiveness should be prioritised.

Dr Wylam

Jaimee Wylam qualified as a doctor in 2013. She has interests in medical education, leadership, mental health and wellbeing. She works as a speciality registrar in public health based in Yorkshire, United Kingdom.

Sasha Johnston 

Sasha Johnston is a Clinical Academic Research Paramedic who has worked in the UK and the Caribbean since 2002. She completed a PgCert in Advanced Practice and an NIHR funded Masters in Clinical Research, both with distinction. Her research interest is ambulance staff mental health and wellbeing, with an emphasis on organisational support and cultural change.
Sasha is a confident public speaker and has discussed ambulance staff wellbeing at a number of conferences, and on television, radio and other media. 

Her future research will develop an embedded reflective space to support ambulance employee wellbeing through an NHSE funded DPhil with the University of Oxford. The website for this work can be found at https://swastcpd.co.uk/research/ambulance-staff-wellbeing-research/. 

Jo Mildenhall

Jo Mildenhall holds the role of Mental Health Project Lead at the College of Paramedics (UK). Prior to this, she was Senior Lecturer of Paramedicine at the University of West of England. Jo is a registered paramedic with more than two decades of experience in operational and leadership roles including that of Team Leader and Clinical Lead for Mental Health. 

Jo is also a registered psychotherapeutic counsellor and is in the final year of completing her doctoral research. Taking a social psychological approach, her study explores the individual and collective impacts of frontline ambulance working during a pandemic disaster. By understanding how individual and collective thoughts, feelings and behaviours influence our emotional/ trauma responses, Jo hopes that this will lead towards a greater understanding of the psychological health and wellbeing of the ambulance workforce & contribute to proactive developments and enhanced supports within this sector. 

Jo has authored and co-authored of a number of mental wellbeing-related articles published in peer-reviewed journals and is an international conference speaker. Jo sits on a number of emergency responder mental health specialist interest groups including that of the College of Paramedics (UK) and Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh. 

In 2019, Jo was awarded the prestigious Churchill Fellowship which saw her travel to Australia and New Zealand to study innovative ambulance staff psychological wellbeing initiatives and strategy. 

Jo lives near the Cotswolds, England and loves adventure travel, sea-kayaking, hiking and the outdoors.