Looking after the mental health and wellbeing of Queensland Ambulance Service employees

Priority One – Queensland Ambulance Service

Todd Wehr, QAS

PSC caught up with Todd Wehr, Director, Staff Support at the Kedron headquarters to hear about the multi-layered Priority One program. It was an opportunity to see how the Queensland Ambulance Service provides more than 5,000 employees distributed throughout Queensland access to a range of services to support their mental health and wellbeing.

Why was Priority One developed?

In 1991 the Queensland Ambulance Service (QAS) was formed, combining 96 separate Queensland Ambulance Transport Brigades. One priority need identified at that time for QAS’s future success was to better care for the psychological wellbeing of the frontline employees. It was recognised there were inherent risks associated with the frontline roles and promoting mental wellbeing, preventing injuries wherever possible and supporting recovery was paramount.

After a national scan of support services for frontline ambulance and fire personnel, plus advice and available research from key experts, Priority One, a staff support program (the Program) was developed.

How has Priority One been adapted over time?

The Program commenced with a full time Coordinator and six selectively chosen external counsellors to cover employees throughout Queensland and after 12 months, QAS introduced the Peer Support Program. This network of peer supporters provides a first point of contact for incidents, including any critical incidents. In addition, employees are able to access a individually selected counselling network (Employee Assistance Program) and a confidential 1800 phone service.

Over the years significant changes have occurred in QAS, including the workforce profile. The program has continued to develop and adapt to QAS’s changing needs and in line with ongoing evaluations that ensure it is grounded in evidence-based current research. In 2001, new components for the Program were added including the Chaplaincy, Aboriginal and Torres Strait Islander and LGBTIQ+ programs.

How does the peer support program work?

QAS employees can volunteer to be a part of the Program and then undergo an initial five-stage selection process. Once selected peer supporters attend a six-day training course, including psychological first aid and embedding reflective practices in their lives and their interactions with others.

Following the initial training course, peer supporters are supervised directly by a mental health professional and undertake refresher training every 12-24months. This provides QAS with the opportunity to ensure peer supporters have the required knowledge, understanding and approaches to support others, maintain their own mental health and wellbeing, and are provided with the most up to date research and information available.

Currently, the Program has approximately 250 peer supporters comprising Paramedics, Emergency Medical Despatchers and corporate staff, ready to support colleagues throughout the agency. Peer support coordinators are drawn from this network and look after the resources within their work area – ensuring a roster of peer supporters is available, as well as linkages to the peer support supervisor, area manager and to the Kedron-based Priority One unit.

In addition, the Program has a state-wide network of approximately 100 counsellors (the majority are psychologists, plus social workers and professional counsellors with Masters’ qualifications). QAS employees, as well as family members, can access this network in a way that maintains confidentiality and independence from QAS. This network of counsellors is not provided through an outsourcing arrangement to one single company, but QAS selects the individual counsellors, ensuring the required skills sets to work in a trauma context and also the ability to build strong relationships within the QAS organisational setting.

In order to provide consistent service delivery across the state, internal resources have been significantly enhanced over the past twelve months. This has resulted in the addition of three psychologists to the Management team. A clinical psychologist as the Manager of Clinical Services to ensure a coordinated, consistent and collaborative evidence-based clinical service delivery; a Manager of Peer Support to provide a greater level of support and consistency for the Peer Support Officers and a Manager of Psychological Education to ensure consistent evidence-informed/ based education delivery across the state and across the different life and career transitions of QAS employees.

These three Managers and Todd provide support to a multidisciplinary team of nine full-time Staff Counsellors located across the state who are able to provide a more localised and nuanced approach to the needs of staff, their families and the peer support officers in their locations. This structure provides a greater opportunity for a collaborative and consistent approach between internal and external psychological supports, the organisation and the staff and their families to ensure that people receive the most appropriate and timely psychological care for their individual needs.

Another avenue for support within the Program is a Manager of Spiritual Services, or Senior Chaplain, who is tasked with the role of providing appropriate spiritual and pastoral pathways for QAS Staff and their families across the state.

How does Priority One connect with frontline employees?

QAS recognises the necessity of maintaining good mental health and wellbeing, and sees building skills and capabilities from their new employees to those with long term tenure essential to keeping employees well.

A critical component for Priority One is the early training for potential during their university training that helps breakdown barriers and reduces the stigma in seeking support. Training commences with students prior to their first placement in QAS. Sessions include what to expect on the job, the potential risk of post-traumatic stress disorder, the importance of building resilience as well as post-traumatic growth and other topics. As Todd says, ‘we aim to help people look after themselves in order to maintain mental health and wellbeing during their career in QAS’.

All new frontline employees then undertake a resilience training program ‘Finding the Silver Lining’. The first stage of this program is a half day face to face education session which examines critical incidence stress including the physical, psychological and emotional factors, strategies for adaptive coping and signs of non-healthy coping. It also focuses on resilience and post traumatic growth as potential outcomes of trauma with healthy coping strategies, supportive work culture and early access to supports being the key. The focus being on the importance of maintaining wellbeing.

Following this program new frontline employees maintain a reflective personal journal and workbook. This journal is filled out for the initial 12 to 24 weeks on the job and then taken to an external counsellor for review and discussion around healthy coping strategies. The review and discussions around the workbook and journal is completely confidential. The aim is to support the employee to identify early changes to their personal circumstances that may impact on them, identify healthy and unhealthy coping strategies and new ways to employ healthy coping strategies and break down barriers to accessing support when they need to.

Todd says, ‘feedback from frontline employees underlines the positive experience and engagement with a professional counsellor early in their career and has been useful in developing coping strategies around both work and personal circumstances. Building a relationship with counsellors in the area, getting to know them and how to access them, especially as and when a critical incident may occur is central to Priority One’.

The program includes other strategies to support employees besides training programs and peer support. As Todd mentioned, ‘having counsellors undertake station visits, getting out about and getting to know and engage with employees in the area when they are not under stress helps to further build the relationships and makes it easier for employees to reach out after a critical incident’.

Over the past 10 years, QAS has transitioned from a paramilitary styled hierarchical structure to a more person-centred and health-based organisation. Priority One has played a role in ensuring managers know and understand how critical their role is in workplace health and safety, critical incident management and supporting staff. A significant benefit to QAS is that it is far more beneficial to provide support directly to staff in response to a critical incident, than fly in a team of psychologists to support. Todd says, ‘a supportive work environment provided by the manager is critical’.

Todd says, ‘more often he is hearing from new frontline employees that their manager has talked to them about how they have accessed a psychologist and wished they had accessed that resource earlier’. This confirms and provides ‘permission’ for new staff that it is okay, even if you’re a manager, to access support at different times. This has helped to build the culture that seeking support is normal and part of looking after yourself.    

Over time, a number of the people who have worked in the Program have been paramedics or who have worked in a frontline role. This has provided some built-in lived experience and the ability to talk from not only a theoretical base, but also from a life perspective. Again, this has been a way to build relationships and a confirmation for new employees it is okay to reach out and gain support for your mental health and wellbeing.

QAS uses ongoing research to ensure the Program and the components continue to provide the necessary training, education and support services to meet the changing demands and needs. Compared to the type of work and the workforce in 1991, QAS now has a different workplace culture, workforce and job demands. Every 10 years, a formal external evaluation is undertaken to review all aspects of the Program and look at the wellbeing of QAS employees more broadly. This review helps to inform QAS of the overall future direction for the Program and also if there need to be any modifications or adjustments made. Based on the research undertaken and the identification of gaps and different needs in QAS, the Program has continued to evolve over time.

With positive results and feedback from QAS employees, support through Priority One will continue to be evidence-based through ongoing research. That might mean that a popular approach to support employees in one organisational setting may not meet the needs of QAS employees.

What does the future look like for Priority One?

The success of the Program in QAS is underpinned by strong support from the executive leadership team – support in providing key messaging throughout the agency of the importance of the Program and also the ongoing resourcing. Todd commented, ‘successive Commissioners have seen the value and benefits of the Program through ongoing research and the evolution of the components to ensure it continues to provide for the mental health and wellbeing of QAS employees’.

Developing and maintaining resources for the Program that are useful wherever you are is an ongoing challenge given the geographical diversity of Queensland. One of these challenges has been in getting mental health resources on the ground. QAS has been able to meet this demand, in part, through the availability of Skype, providing the connection of frontline employees, counsellors and other support workers.

Todd sees the strength and success of the Program in continuing to build and maintain strong and positive relationships throughout Queensland, along with providing resources and training that meet current and emerging needs.

Many aspects of the Priority One Program have been recognised and replicated in other services and organisations both nationally and internationally. This ongoing collaboration and sharing of resources has and continues to be an important component of evaluating and refining the current aspects of the Program.

More information

If you want to find out more about what makes Priority One work in keeping QAS staff mentally healthy, you can email to: todd.wehr@ambulance.qld.gov.au