Normal or Numb 



Normal or numb: that is the question but what is the answer?
By Carl Betts MCPara, Aspirant Specialist Paramedic and Quality Improvement Advisor at Yorkshire Ambulance Service.

It is 9pm on a cold winter’s evening. I am at my local emergency department (ED) restocking some supplies for the Rapid Response Vehicle (RRV), when I receive a message from my control room to attend a Category 1 incident. It simply reads, “? Deceased, no bystander CPR in progress”. As I arrived on scene I was joined by a fellow RRV responder.

On entering the house it became clear that it was neglected. Proceeding upstairs I was directed to an attic room, where a clearly deceased man was laid prone, surrounded by used needles, syringes and improvised tourniquets. Little could be done other than complete our paperwork and wait for the police to arrive.

As we waited, my colleague and I discussed what we wanted for dinner. Eventually settling for a Chinese takeaway, to be picked up returning to the ambulance station. As I left the residence, I started to feel guilty about discussing our plans for dinner with a deceased person in the room. To us it had become a simple incident to manage – walk in, assess patient, confirm death, inform police and complete paperwork.

Questions started to cross my mind. How could I be so unaffected? As a member of the public just a few years ago, I would have been appalled at the sight of a dead person. Now I was able to continue as if nothing had happened. What had happened to me? Was it a healthy response or something that could in time lead to mental harm?

These questions returned to me, whilst dealing with a varying patient complaint list over the following couple of days. Any one of the incidents attended would have prompted an emotional response to an untrained person, yet for me and other ambulance service staff, these scenes are commonplace. The longer I work in this field, the further I seem to move away from responding emotionally like an untrained person. This then poses the question of whether this is healthy.

Of course, the answer isn’t cut and dried.

Without some form of coping strategy and the development of resilience through training, there is a real potential for burnout to occur and also a perception that staff are brash, uncaring and unsympathetic individuals.

Our employers, and the patients in our care, demand a high level of service. However we all come with human fallibilities having good and bad days both physically and mentally. Unfortunately, we still have to work despite not being in the best place at times, risking both our professional reputation, as well as the organisation’s.

If asked how your day has been and you un-emotionally reel off a list of incidents you have dealt with, most listeners would be shocked.
So the questions I have asked myself are, am I normal, numb? How is my mental health affected? And does the ambulance service attract people with particular characteristics and mentality whose level of perceived normality is slightly different from the start?

One of the significant issues with crew mental health is the incremental evolution of stress. Over time you may learn to build coping strategies including becoming numb or detached. Becoming numb or detached from the situation may also be the mind’s response, allowing us to deal with the issues we are faced with.

Suffering a decline in our mental health, affects our work and family life. Family life should be our number one priority, but it can become strained or in some cases destroyed. In many instances it is difficult for an ambulance person to open up, unless there is a family member who understands why it is all going wrong. Opening up can be very challenging, being twofold in nature. Firstly to protect the family from hearing about some of the experiences we deal with and secondly they just may not be able to understand or comprehend the issues that need to be discussed.

Mental health is personal. From my own experiences starting work as a newly qualified paramedic, I am aware that my stress level rose very sharply at first. Seven years in, I know that my stress level trajectory has eased off, but I am now becoming aware that the upward curve has still been progressing. Sadly, as with all aspects of mental health, I have no idea where my tipping point or cliff edge is. I am aware however that we all need to manage our stress curve as the upward motion of compounded post-incident stress and pre-incident anxiety continues to gnaw in our minds.

I can now visualise my own stress curve. How does yours look? Have you thought about the build-up effect? Not every person in the ambulance service will have a breakdown of course. I am aware, however, that there is a significant chance that we are exposed to enough 'stuff' to cause our personality to change thereby not being the same person as we were when we started our career. Our personal lives can also contribute to a negative mind set. Change is part of the rich tapestry of life, but it is concerning to see close friends and colleagues’ crash and burn as a result of our role. I have been struck by people asking the question “When did it all start going wrong?”.

This is a poignant question and one of the reasons why I have chosen to share my thoughts. As ambulance service staff, we still wait too long before we acknowledge or act on a deterioration of our mental health state.

I truly believe the world of ambulance work is bad for all of our long-term mental health and I do believe that we do become numb to many things and detached from situations, in order to protect ourselves. Following my time of reflection, I believe I am numb to many things, both good and bad feeling, I am looking at the world from behind a glass wall. Numbness and detachment are defensive walls allowing me to be disengaged from the reality of other people’s situations. Currently I feel like I am a long way off falling off a cliff on my current trajectory but it is anyone’s guess as to how much any person can take.

As a leader/manager, I strive to listen and encourage the frontline staff that have decided to disclose their mental health difficulties. I always find it a bizarre, and an incomprehensible concept that an employer will quite happily pay to have a member of their team off work with stress, increasing the isolation and so becoming more and more distant from their colleagues, rather than keeping them in the fold and allowing them to do alternative duties on a flexible personal plan. Staff should not be pressurised to accomplish tasks but should rather be given support to manage what they can do thus phasing in a return to normal duties. This has the potential to keep that person protected by their colleagues and be surrounded by people who understand and can empathise with the situations they find themselves in.

So what can we do to make things better? In very simplistic terms, watch out for your friends and ask them to watch out for you, and as a friend please speak up if you are concerned. The last person to notice or accept things going wrong is often the person themselves. I strongly believe that we are all potentially only one incident away from never working on the frontline again. It is imperative to keep a check on yourself and be honest. Sometimes acceptance is the hardest realisation, but with acceptance comes hope, and with hope comes positivity, and with positivity comes a willingness to open up and strive for personal change.

I hope this little article is thought provoking and opens up positive conversation for you and your colleagues.

Thoughts from Health Psychologist, Esther Murray

“This is an excellent piece, Carl has captured the way numbing out is necessary but it numbs out everything - not just the bad... I think it's hard to be as honest and clear eyed as Carl is so I am really grateful to him for sharing here.

We often talk about psychological wellbeing in terms of end points, as if you were either sick or well and that was that, but it isn't. We all have mental health, just like we all have physical health, and over time and for all kinds of reasons the things that we experience affect us. Just as if you ran a lot of marathons and over years of running you developed sore knees, by the time that happened you would have learned a lot of tricks for soothing sore knees. It's not your fault, or your knees' fault or the marathon's fault that your knees are sore, it's just what happens.
I think our mental health is the same, but we haven't really been taught much about how to look after it. If you're into sports you're probably surrounded by a community of fellow enthusiasts who have lots of tips about how to deal with physical injuries and wear and tear, and there are lots of experts you can learn from on the internet and so on. Our mental health ought to be the same, we ought to be surrounded by people who are open about how to look after it, and to have easy access to advice and support.

Things are changing, that's for sure, and the pandemic will make them change faster. There is already a huge community of people who live with all sorts of mental health problems who know exactly how to manage because they have learned it, just like the marathon runners, and I think we will see more openness about it as time goes on. Sharing our experiences and learning to listen to one another knowing that we don't need to fix anything for each other, only be there, is a fantastic start. When more help is needed, there are professionals for us to talk to. There's nothing shameful or unusual in that, we're only bringing it out into the light just now, that's all. And it's about time."

HCPC Hearing: A Member’s Perspective



A member of the College of Paramedics shares their experience of receiving notification of an FTP allegation from the HCPC

I’ve been a member of the College since its inception and had the privilege of being a member of the Governing Council at an early stage. I’ve watched with interest as the range of member services and benefits have developed over the years but never dreamt that I would be in urgent need of the expertise and support of the legal services team.

I’ve been in the profession for 44 years in military and civilian paramedic roles and at all levels of the Ambulance Service from road staff and HEMS to senior management. I’ve been fortunate enough to be recognised nationally and internationally and had never had a concern or complaint raised against me. In early 2020, I became concerned at some issues in the management of the organisation I was working for and raised them through correct channels as I had a duty to do.

Within a very short space of time, my world imploded! I was suspended and became the subject of an investigation with serious allegations made against me. As this was initially an employment related issue, I was represented by my trade union and one-by-one the allegations against me were withdrawn, except one. I was offered a settlement package with strings attached that I could not accept and resigned.

As if these few weeks weren’t stressful enough for my family and I, as I’m planning what to do next I open my email to find an email from the HCPC informing me that an allegation concerning my Fitness to Practise had been made. I cannot describe the feeling of dread and stress that immediately ensued and with a sense of rising panic I called the College of Paramedics legal helpline. Andrea James (from Brabners Solicitors) called me back within 30 minutes and I just burst into tears; she was fantastic, calmed me down and asked me to explain what the allegation was. I went through everything in detail and Andrea was as incredulous as I at the basis of the allegation and told me how to proceed.

Having waited for the ‘triage’ stage of the HCPC process, my depression and mood just darkened when the HCPC decided to investigate the allegations as it fell within their scope. The only positive news at this stage was that the case officer had decided that there was no requirement for an application for interim conditions whilst the investigation proceeded. Frustratingly at this stage of the process, my legal representatives could only advise to wait for the HCPC to decide if the matter would proceed to an investigation panel who would in turn decide if the matter should go to a final hearing.

The next seven months were sheer hell; I heard nothing from the HCPC and my physical and mental health deteriorated to the point where I needed professional counselling which was fortunately arranged by the College via TASC. I cannot begin to explain the effect on my family and I and contacting the HCPC for an update proved fruitless; the regulator has no interest in the affect that their processes have on the registrant and this was apparent.

After seven months, the HCPC advised me that the matter would go to an investigation panel and required a detailed response from me within 14 days! I had had no contact from them for seven months or the opportunity to have any input from my perspective and now they wanted a response within a few days. I contacted my representatives at Brabners and a firm email was sent to the HCPC who granted a month’s extension.

Brabners provided me with very clear advice on what I needed to submit and how to construct it and they pulled the information together into a pack for submission to the HCPC with a covering statement summarising our response to the specific allegations and my points of rebuttal.

The outcome: after the worst and most stressful one year, three days and 16 hours of my professional career, as it was, I received a polite and brief email to advise that the investigation panel had met that day and decided that I had no case to answer and the matter was closed. My wife and I just burst into tears.

The effect on my mental health and personal and professional confidence have led to a position where I have had to leave a service, a role and career that I have loved but feel unable to continue in and I am now practising in a different environment.

The allegations and the subsequent HCPC process absolutely felt that ‘guilty until proven innocent’ was the starting point. Without the support of the College, Brabners and TASC I may not have come through this; there were some very dark times in the night-time hours but knowing that a friendly voice was only a call away and that there were those on my side was invaluable.

I’ll never forgive those behind the referral in my case or their motivations, and I cannot encourage strongly enough all Paramedics to join the College, it literally was a life saver for me and I’ll be forever grateful.

Don’t think ‘it won’t happen to me’ or underestimate the massive effect that a referral will have upon you, even if you think you’re confident you have nothing to worry about. The combined impact of an allegation and the subsequent HCPC process will lead to you needing all the help, support and professional representation that you can get. Only the expertise of the College and their legal team can provide this for you.

Perform or Panic? Challenge or Threat?

By Joanna Train


Picture: Roger Brown 

Reappraisal strategies for improving performance in a stressful situation.
Joanna Train is currently an MSc Sports Psychology student with an interest in applying sports psychology performance strategies to supporting emergency responders deal with high pressure situations. Click here to read Joanna’s piece.

#itsoktotalk about Mental Health and Well Being

Andy Elwood MCPara shares his personal experiences of mental health.


I’m no stranger to testing times and traumatic incidents after 20 years in emergency services, beginning in Northern Ireland Ambulance Service, but mostly as a paramedic on search and rescue helicopters. I have also served on the RAF Medical Emergency Response Team (MERT) battlefield helicopter in Afghanistan. I have experienced the full range of emotions from euphoria, after risking my own life to save another, through fear during a flashback and the depths of despair when attending many suicide incidents. I have been affected by the cumulative effects of my career, but even more so by the growing pressures of 21st century living in my personal life.
I have learned resilience through my military service and search and rescue career, but my mental strength has been tested most in my personal life through divorce, bereavements, building my own business in my spare time, whilst also changing full-time employment and multiple home relocations.

I became a mental health campaigner in 2016 with a video campaign online, which involved the coastguard helicopter and other 999 services doing press-ups. Our final video broke down some stigma around mental health, with over 45,000 views, but what was really important for me was that I didn’t feel alone anymore. The widespread support from other 999 colleagues made me realise that depression, anxiety and stress were just as common for 999 personnel as for wider society. 

TaIking has been an incredible help to me at critical points in my life. This has allowed me to share the burden of my worries and fears, gain another perspective, see a way forward and realise that I was just being human. This worked for me when I spoke to a psychiatrist after a traumatic incident, during which a patient vomited blood into my eyes and mouth; and also when I talked to my wife after having a flashback to a patient in Afghanistan, five years later, whilst on holiday in France. 

My bravest move v’s Self-Stigma
The largest stigma I have had to overcome, however, was my own self-stigma, when I spoke to my GP last year and admitted I needed some time off work. Burnout had led to depression and a loss of my self-esteem from the cumulative build-up of life stressors since childhood through the Northern Ireland ‘troubles’ and caring for elderly relatives, bereavements, moving home, new job with promotion and running my own business in my spare time. 

The bravest thing I have ever done in my life was to take time off work to rest, reset and then rebuild myself!
I now believe I will save more lives through mental health campaigning, sharing my experience that #itsoktotalk and by delivering Mental Health First Aid training, than I would if I was still dangling under a helicopter, as a paramedic.

Early warning signs
Have you ever noticed any of these in yourself or a colleague?
Irritability, aggression, tearfulness, inability to concentrate, indecision, loss of confidence? Perhaps this could be coupled by increased consumption of caffeine, alcohol, cigarettes or sedatives and some unplanned absences from work… 
Many of us may experience some of these feelings occasionally, which is normal. However, when these feelings start to affect someone’s participation in everyday life or their ability to function safely at work, then we should reach out with support. Mental Health First Aid is just as important as physical first aid. Would you know how best to approach a colleague or loved one, assist them in a crisis and listen non-judgementally?

Simple tips for improving your Wellbeing
I take a minute each morning and evening to note 3 things I’m grateful for, which gives me a positive focus at the start and end of each day. This allows me to focus on what I have, rather than what I am missing. I have an object on my key ring which also reminds me to be grateful during the day, if I’m feeling low. 
Try it and feel the difference yourself.
I also recommend the Five ways of wellbeing, based on research and recommended by the NHS (1), as a simple guide to improve your mental strength and wellbeing by realising it’s important to: 

-Keep learning
-Take notice
-Be active

The beauty of these simple categories is that you can tailor them to suit yourself and what you enjoy doing. I love the outdoors and nature, so meeting a friend for a walk or bike ride enables me to connect, be active and take notice of the beautiful countryside as we chat and enjoy ourselves. Giving can be as simple as sharing a smile with a stranger… it’s surprising how infectious smiles are, in a good way! 
To keep learning, I have challenged myself to make a short film about a trip, in my classic Land Rover, (#AndysLandie blog) around Scotland this summer to assist the introduction of the UK Search and Rescue Wellbeing & Resilience framework for Mountain Rescue Volunteers in Scotland. I’ll be meeting some amazing people on the journey and some of them are joining me to talk about wellbeing and mental strength from my passenger seat, which will be part of the film. Please get in touch if you’d like to be part of the film or if you’d like to invite me to your base as I journey from the Peak District to Scotland.

Work brings a lot of health benefits through a sense of purpose, fulfillment, being part of a team, especially in our line of work. However, mental ill health is usually caused when pressures at work become more intense, coupled with factors outside work; eg. financial pressures, relationship problems, greater caring responsibilities from an ageing population etc. If the workplace is not supportive at this stage, then mental ill health can be triggered into common conditions such as depression, anxiety or stress-related disorders.

Organisational culture can change for the better, as Mind Blue Light Programme (2) recently highlighted with these research key findings from their targeted support:

-staff improved their mental health, resilience and confidence to seek support
-managers & trainers had more confidence supporting staff in difficult situations
-stigma and lack of awareness still exists, but is improving
-sustained change requires practical investment, commitment, enthusiasm at all levels

Why not do something positive to start the conversation on mental health where you work? Or perhaps you could share some of this information with a colleague to promote some wellbeing in team999?

I’m part of the Paramedic Mental Health & Wellbeing Steering group for the College, a Mind Blue Light Champion and I write a blog called ‘Andy’s Landie’, which discusses Mental strength and Wellbeing. 
You can follow me on twitter and Insta @4ndyElwood
Stay wonky and remember #itsoktotalk
1. Five ways to wellbeing. New Economics Foundation. 2008. 
2. Mind Blue Light Programme Research Summary 2016-18. London: Mind. 2018.

Mental health crisis and the emergency services - Helping you help me

Liv Pontin, a service user in mental health shares her experiences and contact with the emergency services.



From 2016 to 2018, I experienced a long period of mental health crisis, with multiple experiences of contact with police officers and paramedics, including being detained under the Mental Health Act and on one occasion receiving CPR from police. This article is based on a blog post I developed to share some thoughts on what can help from the emergency services attending to a person in mental health crisis.

We’re here to help”
Firstly, even if you are with an individual who has been in crisis before, emergency service involvement is terrifying. I fear being in trouble, I am terrified that you think I am attention-seeking or wasting your time. Please reassure me that you are here to help me. Remind me that I am not well. This may seem obvious, especially if someone is diagnosed with a mental health problem, if you ‘know’ somebody who you see regularly, or if somebody is clearly distressed. But in crisis, we can lose insight. Please keep reminding me that this is my illness talking, and that I need some help to get well again. I may need to be told the same thing multiple times in order to take it in, but it does stick with me later.

Self-harm and suicidal thoughts
Self-harm and suicidal thoughts/acts are generally not attention-seeking or ‘cries for help’. For many, they are deeply private and shameful, and even for those cases which are ‘attention-seeking,’ serious help is still needed if someone is turning to harming themselves. ‘Attention-seeking’ is not in itself necessarily a bad thing. We all desire human contact and interaction. Whilst many can communicate effectively with words, others may not be able to do so and may communicate their distress in other ways. We never know what has brought a person to that point, and those who need medical treatment as a result of a mental health problem deserve the same care, empathy and treatment as anyone else.

Suicide may seem objectively ‘selfish,’ but to a person in that state of mind, it often seems like the only option. Please do not try to make me feel guilty. Having said that, talking about the impacts on others – including the police or paramedics who are called out to deal with this – can be a very effective way of halting the intention to act on these immediate urges for some.

And thirdly, please do not ever tell somebody that ‘If you really wanted to die, you’d have done it.’ It is not the case, just as it is not true that ‘Truly suicidal people don’t talk about it.’ Sometimes it simply means that somebody is taking every step to help themselves. I have always promised that I will do everything I can to avoid acting on my thoughts. It doesn’t mean I didn’t want to die at those times. But I didn’t want to want to die.  

What it can help to say
In emergency situations it can be tempting to deal with things as quickly as possible and move on. But in mental health crisis, adopting a slower pace, being patient, taking the time to listen, understand and build up trust helps. That rapport is so important. Use that rapport as much as possible: for example, allowing the person who has got that rapport to accompany the individual in the back of an ambulance or to explain decisions.

One thing that can really help to build a rapport is just to talk about ‘normal’ things. We all have likes and dislikes, hobbies, interests, a sense of humour. These are the things that make us who we are, but sometimes it is hard to remember them in crisis point. Where appropriate, use your sense of humour. If you can make me smile, you have got me engaged. Remind me that there is hope, that I have a future and am a worthwhile person. Where appropriate, self-disclosure can also be beneficial. A lot of people suffer from mental health problems at some point, and it is so reassuring to know that people can get through these and find something they love in life.

Two of the most helpful phrases I have heard from police officers are ‘Focus on my voice’ and ‘I’m not going to let you hurt yourself.’ The sound of a calm, caring, firm and direct voice can help me to feel safe and grounded, to listen to your voice and to know that someone is in control of the situation. 

Please try to give me options where appropriate and try to guide me towards making the ‘best’ choice. However, please also be aware that at times I am so consumed by my illness that I need you to take control away from me and make the best decision, even if I can’t see it at the time.

And finally, always remember the difference you make
The impact you have will stay with someone forever. I know at times it is frustrating for you, particularly if there are repeated incidences and nothing seems to be happening as a result, and particularly where the system is clearly failing. It may take time for me to get well. It is likely to be a slow journey with many ups and downs. But you are making a difference. I will remember the care you provide to me, be that good or bad. The words you say will stay with me forever. And I cannot put into words how grateful I am to you. 

We are deeply saddened by the tragic news about Liv Pontin.
Only recently Liv chose to write a powerful & emotive piece for us to help paramedics and those experiencing difficulties with their mental health. For this we are extremely thankful. Our sympathies go to those that knew her.
A JustGiving page has been set up in her honor.

The College of Paramedics is thankful and honoured that Liv has shared her story and insights with our members in this article.

For anyone needing support or advice:
The Ambulance Service Charity 
0800 1032 999 

MIND Blue Light Infoline 
0300 303 5999 (local rates)    
Text: 84999

24-hour helpline: 116 123

British Association for Counselling and Psychotherapy (BACP)
01455 883 300
For local practitioners

Cruse Bereavement Care
0808 808 1677

Rethink Advice And Information Service
0300 5000 927 

My Mental Health and How I Manage it

Gary Strong MCPara talks about his experiences of mental health and what he does to manage it.


In my family history, there are persons who have suffered, and continue to suffer mild, moderate and - in one case - severe mental health issues. Apart from the severe case, much of this was never diagnosed. As children we were told that such and such a person was ‘bad with their nerves’. My parents’ generation didn’t talk about such things, which only made matters worse. I guess all this puts me ‘at risk’. 

This didn’t even occur to me when I joined the ambulance service and applied to become a paramedic. But after some years of being out there ‘on the road’, I came to realise a couple of important facts. Firstly, there are many, many families that have to contend with mental health issues on a daily basis, and some of these issues are utterly soul destroying. If I am at risk, so it seems is much of the population. Secondly, being a paramedic can be good (as well as bad) for my mental health. Let’s put it this way: in what percentage of the calls we attend is there somebody there who is really pleased to see us, and very grateful for all we have tried to do? The gratitude of patients, families and the general public, in my experience, far outweighs the abuse we get. 

These days in practice, when I frequently find ways of keeping folk out of hospital, it seems to me they are even more grateful! All this is psychologically positive and has a great impact on my personal sense of well being. We all need to be ‘stroked’, say the psychologists, and alongside this positive affirmation, there is a great deal of job satisfaction in making a good referral. But what of the downside of the job? Maybe I’ve been lucky over the years. Compared to some of my colleagues, I haven’t seen too many mangled bodies, and the biggest major incident I’ve ever attended was a county-wide flooding which went on for a couple of weeks. But those severe mental health incidents in the middle of the night, they unnerve me. They are just a bit too close to home sometimes, which leads to another important realisation: we are all vulnerable over something. In some ways, to do this job, you have to harden up. If every messy injury or sad social situation gets under your skin, then you are probably in the wrong job. But no matter how strong you are in yourself, you are human, and there is always the risk that one incident you attend will find your weak spot and hit your mental health where it hurts. Fortunately, nowadays, it is ok to say that you are not ok. 

For the many paramedics who move ‘off the road’ into another role, the risks to your mental health start to appear from other directions. In primary care, the patient that turned up late with a seemingly intractable problem, when you were already feeling mentally drained, well they may have left your clinic, but they just won’t leave your head. In education, it might be the pressure to take on more students or inflate grades. In management, you can have a great day, successfully completing the tasks you set out to do, then that one little email on top of all the others, whoever it is from, whatever it is about, that’s the one that punches a big fat hole in your resilience and wrecks you for the rest of the week. What do you do about all this? What do I do about all this? Think back...what is the first thing you are taught to do when approaching a scene? ‘Check for dangers.’ If you don’t do this, you may become a casualty and then we have a bigger problem. But how many of us check for dangers in our own lives? 

These days I am much more aware of the dangers, and there are a few things I do that might be termed ‘preventative medicine’. They could equally be called: ‘switch off, focus on the positives and enjoy life!’ I love playing guitar, mostly bass guitar, and although I am not particularly proficient, playing in a band means having to concentrate and forget about work for a while, and being a paramedic helps in some ways: if I play a few bum notes, or we have a bad gig, well, well nobody died did they? After all, it’s only rock’n’roll. Recently I have been learning to sail dinghies, and again, I have to concentrate, or I am going to fall into the river. Most importantly, for all I said about mental health issues, I have some very positive relationships with family and friends, and here’s a tip: no matter how much you love this amazing profession, make an effort to keep up with your friends outside of work. They will still be with you when work becomes a thing of the past, and they will help to keep you sane. Finally, for me, there is a lot to be said for having an energetic dog. Like most of my patients, he is always pleased to see me, and on a miserable wet days like today, he insists I get some exercise! 

Gary Strong
National CPD Lead (Education), College of Paramedics

A Personal Account of Mental Health

By Rory O'Connor MCPara, Northern Ireland Trustee and Paramedic with Northern Ireland Ambulance Service.



Mental health and wellbeing are important topics both for the wider public, but also for members of the paramedic profession and wider health services. Unfortunately, an online poll carried out by MIND in 2016 found more than one in four (27%) people had contemplated taking their own lives due to stress and poor mental health while working for the emergency services, while nearly two thirds (63%) had contemplated leaving their job or voluntary role because of stress or poor mental health. This is allied to the fact that the Office for National Statistics has found that the paramedic profession has proportionally one of the highest rates of suicide.

Behind each of these statistics there are personal stories and experiences. For some, years of working in and dealing with hugely traumatic events can cause a gradual deterioration in their mental health, and for others single traumatic events can trigger a crisis. 

I have been working as a paramedic on a double crewed ambulance for six years. In this time, as is relatable to most of my colleagues, we unfortunately can experience events and situations which are tragic, traumatic, stressful, upsetting and on occasion all of these.

We all have our own experiences and thought we can turn to when our colleagues mention ‘bad cases’. But, whilst the causes are diverse, our experiences I have found are shared, acute and unique to those who work in a frontline ambulance.

After attending several ’incidents’ in a short space of time, my mood was low, I could not sleep, I was irritable with family and friends, had no time for my children whom I love, and became more introverted and closed off. However, I am a paramedic and this is what we do, so I soldiered on and continued to work. This was most certainly the wrong decision, but it is a decision many of us make in the profession for exactly the reasons I have outlined. I thought, this is the job, I need to be tougher, I need to keep going, this is what we signed up for and I need to just keep going to work and eventually everything will be ok. Whilst this is my own personal experience, and this how I rationalised going to work day after day whilst on the verge of mental breakdown, I have learnt and can assume that my reasons are not uncommon amongst ambulance staff who continue to go to work even when being acutely impacted by the work we do.
I had not recognised that in fact I was in the midst of a mental health crisis and was barely functioning on a day to day basis. I marched on and kept going until I had one bad incident too many and couldn’t march on and go on any longer. It all caught up with me like a tsunami and I ended up home from work in the middle of a night shift completely broken.
Once I could not go on and made the decision to go home from work, I experienced crushing lows which I had never experienced before. Day after day of struggling to get out of bed and go on. I sought help via the external counselling service offered by my employer, but initially found this of little benefit as I was not placed with a counsellor with any understanding of our job or how it can impact on us. Eventually, my extremely supportive line manager arranged counselling with a specialist trauma counsellor who recognised that I was suffering with PTSD. It was not PTSD like the movies, it was how we experience it in real life. Flashing images of tragic events, not sleeping, lucid memories of awful scenes and incidents, things that I thought were long in the past and dealt with coming back and causing me to doubt myself, my profession and my ability to ever do the job again.

Thankfully, the second counsellor I attended was fantastic. It was difficult confronting my issues, but with a wonderfully supportive family and appropriate help I did so, and managed after an extended period of sick leave to go back to full operational duties.

I work and feel comfortable being back at work. However, I am not the same paramedic or man that I was prior to this. I feel like I carry my experiences with me every day, and some days are good and some are not, but I am acutely aware of the warning signs and dangers of my own mental health. 

My advice is, we are not super human. We should not soldier on. We should not keep on going regardless. Don’t just say this is the job and I have to do it. Don’t feel worthless or like a failure. Don’t worry what anyone else will think, you will find that almost all of your colleagues will be supportive, understanding and will want to help you. If you need it, get help. Get help from your employer, from your GP, from a confidential service, from any service you think will help. But ask for help, and if you don’t feel like it helped the first time ask again.

For further support: 
Blue Light Infoline: 0300 303 5999
Or, the Samaritans: 116123

Rory O'Connor
Trustee for Northern Ireland

Grief, a Personal Journey of my Mental Health

Bob Fellows FCPara gives a personal account of his journey with mental health.



It has been said that grief is the sudden breakdown of your life as you know it and then the challenge of trying to pick up the myriad of small pieces to be able to put your life back together or at least try. My grief didn’t start on the day of Helen’s death, it was already underway when I knew she was very ill with cancer. Some short-term false hope was offered by a hospital Doctor who told us it was eminently treatable by a hysterectomy, sadly not so. MRI and CT scans stated that it was so advanced it had escaped into the rest of her lymphatic system and across into her lungs. The shock of being told the final diagnosis immobilised me, yes, I was speechless, stunned, angry, who could I blame, who could be held to account. We clung to each other in a hospital corridor. Sod it, why us.

When you tell people, they say they are sorry, why? are they to blame? Reality is that we don’t know what to say to people. I didn’t even know how to tell people, let alone my children. So, the next question is, how long do we have? What treatments will make a difference? Who gets to decide?

Whilst all this is going, on you start to crumble, you cry, you struggle to exist, it’s all oncologists and discussions related to your journey into the dead. Did I handle it well? I don’t know, I made myself busy and very few people could get close, even Helen started to shut down. She cried the day she was told at the hospital and I only ever saw her cry once more. She was a woman with a very strong Christian faith, and she was fully convinced she would die, and her spirit would go to Heaven leaving the rest of us to deal with the discarded body via a ceremony and a disposal, her choice a cremation.

I was primary carer and my paramedic background gave me no preparation and, I am sad to say, I was soon so tired, I just wanted to sleep. Could I have handled it better, probably. Fortunately, the diagnosis to her actual death was 56 days, that is less than 8 weeks, the final three days were in a hospice.

It was only after she had died, did I truly let myself feel, I kept people clear as my broken mind was too intimate to share. I was still me, despite my mental health being shot to pieces, I wasn’t ashamed, I was just totally numb. I spent hours walking my dog trying to make sense of it. I wanted answers, I wanted to understand why, what had we done to deserve this. I briefly considered what it might be like to die and join her. Does that make sense, not if you consider it from the point of my children or my friends or even my dog. Death was not an escape, it was not an option, well not for me. I never took sleeping tablets or went on to antidepressants, I knew the journey ahead was very long, I needed to be fully awake. Not that I slept very well, alcohol suppressed some of the silence. I would cry at music, pictures, memories, I’d even cry at the loneliness and the emptiness of just being on your own. Deep down I was angry.

The funeral was tough, but necessary. I chose to speak, and I allowed anybody to speak who wanted to. Yes, it was in a church, yes it was very full and yes there was singing and a message of Helen’s faith. But it was a celebration of her short life (55 years) and what a joy she was to so many. Did it comfort me, no. But it wasn’t about me.

So, is my ongoing, but fading grief a temporary mental health condition, is it a form of depression. Do you know? Well I don’t care, I don’t want to know. It just crushed me for a season. How long was my season, is it over yet? Well I am scared, but no longer crushed, am I sad? Well sometimes, am I over it? I don’t know, what am I getting over? Please don’t tell me its early days, how would you know. Most of you haven’t trodden my path and even if you have experienced something similar, maybe you had it worse than me or maybe it had less impact. Don’t try to fix me, just be my friend, listen to me if I want to talk, laugh with me if I am laughing, don’t tread on egg shells near me, they are small fragments of me, its ok.

There is a sacredness in my tears, a silent language of grief and no pain is a great as the memory of joy in the present. I have three chairs in my life, I put them in a row. One represents the past, one is the present and one is the future. Did you know how uncomfortable it is to try to sit on two chairs at the same time. In the early days of grief, the present is too much so you sit in the past. Practically, you must switch to the present and then go back again for memories, tears and the experience of personal loss and pain. Funnily enough I can only measure the pain in the present. I avoided the future for a season (whatever that season is for you) and now I have spent a lot more time in the future planning a new season. I still have all three chairs, I will never get rid of them, they are part of my past, my present and a new hope in my future. My faith sustains me, it is stronger than ever.

I am not ashamed of my story, I hope it inspires you and gives you hope for your future.

Bob Fellows FCPara
Head of Education, College of Paramedics 

I’ve seen terrible things as a paramedic. The worst isn’t what you’d expect

Liz Harris FCPara talks about the worst thing she has seen as a paramedic


What’s the worst thing you’ve ever seen? Ask any paramedic and they will have been asked this question many times over in their careers. I’d never given myself time to properly think about the answer, until recently.

Is it having my fingers in the back of a teenage boy’s brain as my colleague and I lift his limp bloody body into a bag after he had flipped over his new car on a dark country road?

Is it looking upon a small, wafer thin, dead child curled up on her Cinderella duvet after drinking her parents’ medication that they use to help with their addictions?

Is it the elderly man whose closed curtains had gone unnoticed by his busy neighbours while he lay decomposing into his own carpet?

It is none of these.

My answer starts at 6.10am one morning many years ago with a callout to an elderly man who is struggling to breathe.

We arrive at a slightly neglected bungalow where a frail elderly figure limps slowly to the door and greets us with an apology – she didn’t want to bother us. Her husband is slumped in the front room. I know he is not well and he needs to go to hospital. Mavis*, the woman who answered the door, is visibly shaken on hearing this news but she finds solace in starting preparations for her beloved husband, Bert, to leave for hospital. He needs clean pyjamas and a toothbrush, and after fondly rubbing his chin, he will need his razor too.

I give Bert some oxygen and start to think that if we don’t get him to the ambulance quite quickly he will collapse. Mavis returns tearful with her husband’s belongings. I talk to her to try to convey the seriousness and urgency of the situation. Bert is stoic in his responses, telling his wife he will be fine, but he is kind too, reminding Mavis of how much he loves her. Mavis is proud, they have been married for more than 60 years, she says, as she ambles away again.

I look around the room at faded photos of many generations of their family. Bert tells me they are all dead now, even their son who died young. I talk with him and reassure him that we will be going to hospital soon. She is the love of my life, he says, between tiring breaths; there has never been anyone else. I remember his soft slow words perfectly and the telling look in his eyes – he knows he is not coming home again. I worry that we are taking too long. Bert needs to be in hospital quickly; I don’t want him to die in my ambulance.

Mavis is elderly and frail herself, and accompanying her husband to hospital isn’t an option. I worry there is no one to come to help her when we are gone. My haste to get Bert out of the door and to hospital is abruptly subdued by the realisation that this is most probably their final moment together; they are about to say goodbye to each other for the last time.

I try to convey the gravity of the situation to Mavis. I think she finally understands when her eyes fill up. She limps back towards Bert, who is still protesting to her that he will be fine. Her hands cup his cheeks as her small stooped frame leans forward to give him a kiss. I pause momentarily, trying to be invisible, and then ask quietly if we can go. Mavis delicately flattens Bert’s hair to one side of his head, smiles at me and nods her head. I ask Bert if that is OK and he smiles and nods too.

Bert died later that day and I spent a lot of time wondering what happened to Mavis. I knew that I had cared for Bert and looked after him well, but I had deserted Mavis, I had left her all alone. I toyed with the idea of visiting her to check up on her. This felt right in many ways, but wrong in others too. I didn’t know what to do. I had prioritised Bert’s care but in doing so neglected what Mavis needed. I was left feeling I had failed her in many ways.

When thinking about my answer to the “What’s the worst thing you’ve ever seen?” question it didn’t take me long to remember this job, even though it happened many years ago. It is the job that I most agonised over. It is the job that stayed with me for the longest time after it was over. You might think it can’t be the worst thing I’ve ever seen, but it is definitely the worst thing I’ve ever felt.

I never did go back and check on Mavis.

Liz Harris
Head of Professional Standards, College of Paramedics

Stress in the sector: A member’s perspective

Adrian McGrath MCPara from Northern Ireland discusses perceptions of stress in the current paramedic role



My dream was to be a paramedic back then, in those days we lifted stretchers into ambulances as the troubles in Northern Ireland alerted my colleagues to something gut wrenching minutes away. Where casualty departments inspired me as I saw consultants and young doctors being taught and managing in a timely fashion the sick trauma or medical patient that had just came through the door. Inspiration is a little harder to come by these days in that context. I achieved one of my dreams and I've probably grown, matured and absorbed what I could over the years. Currently, stress has a strong penumbral edge to it, as the wide measure of society and its illnesses and those increasing accidents of life demand our skills and energy on a much larger scale than what was needed in the past, with fewer resources. So where do we (I) go from here?

Personally, stress can subtly tease out the unseen good or hidden ability in us, where that propensity to overcome and to adapt to unforeseen situations (or delayed time) on scene enhances one’s ability to cope. However, that said, there’s a fine line in that sticky medicine of service and self-balance, whilst caring for another in that acute phase of trauma or illness. To be your best you have to feel your best. This only comes from re-energisation of the self with careful gentleness in how you approach the busy mind, the mind which most likely has seen something nasty, as the sensory and visual response post-shift kicks in. This is a necessary quality we must fulfil and master, in order to live a long, mentally healthy and purposeful life, whilst we work on that escalator of fuelled adrenaline at times! I've considered a complete alternative to this new era and changing face of the pre-hospital world I inhabit...thou that is yet to be decided! However, there is something honest and pure in being able to help another in their hour of time will be my judge on that decision.

There is no quick fix here, the system is fractured and continually fracturing; and like any spiral fracture it can take a long while to heal itself, but undoubtedly it leaves its mark and weakness creating a fissure upon the system. My colleagues, who I admire give 100% everyday as they travel the highways and byways carrying out life-saving procedures at times whilst on route to hospital, whilst interacting with that multidisciplinary team of professionals we encounter each day; for that one, or perhaps multiple casualties we have to treat on the roadside, or in the various communities that we are invited into. The system is impinging on us and our response, in my opinion, is that we must be more visceral in how we react to this demand upon our physical wellbeing; and to recognise when we need to nourish the body as well as the soul, through our shared experiences, recognising when we need genuine time out. In order to carry on providing that cutting edge professionalism we offer to our patients.

We've got to try to hinder ourselves from becoming attached to that second victim syndrome, through that loading dose of stress which may be unresolved from previous calls, due to demand, or from re-living a terrible incident, where perhaps lethargy, mental fatigue or negative self-worth spirals our thought processes in these difficult, challenging and demanding times that we find currently ourselves in.

Maybe the periscope with how I see the world may need a new optic to recast and renew a fresh inspiration for me, as this New Year offers me its blank canvas of invitation and surprise. Other crises when one looks back into the history of turbulent times, would perhaps suggest at that time they also had to deal with such challenging structures of change in their communities, in accessing their necessary social or health needs; for life is merely passing through us and the only inherent gift we all have is to be resilient and kind towards our toughest challenges, to meet and filter stress with a fresh objective whilst we look after ourselves and each other, the best we can in these challenging times...

I don't want to lose any of my colleagues to terminal burnout or something even worse…

Adrian McGrath MCPara, Paramedic, Northern Ireland

HCPC Hearing: A member’s perspective

A member of the College of Paramedics shares their experience of receiving a letter from the HCPC.


In 2015 I made one of the best decisions of my career when I joined the College of Paramedics. If you’re not already a member, I urge you to do the same; you never know when you might need them.

I became a paramedic in 1996 after a distinguished career in the army. My 20 years’ experience includes specialised training, mentoring, and leadership roles with organisations as diverse as the Helicopter Emergency Medical Service and the London Ambulance Service. I’m also a previous winner of the Allied Health Professional Worker of the Year Award. 

As a paramedic, you dread the Health and Care Professions Council (HCPC) envelope dropping onto the doormat, especially when it’s not renewal time.

I remember it vividly. It was a bright and sunny morning when it came through, the gleam of the white envelope imprinted with the HCPC logo stood out on my dark and dusty doormat.

The hairs on the back of my neck stood up, ‘hmmm HCPC’ I thought, ‘what do they want from me?’

I carefully peeled back the envelope and withdrew the letter. As I slowly read through I realised my worst fears had come true, it was a complaint about my fitness to practise.

The wording of the letter I found quite petrifying; terms and phrases that were alien to me that I found quite intimidating given the situation in which I now found myself. I felt extremely vulnerable and quickly formed the impression that I had a guilty verdict hanging over me without even having been able to put my side of the story. What felt worse was it appeared they’d taken months to prepare the case and I had only seven days to respond.

As I took a step back, the magnitude of the accusation dawned on me. This one thing could ruin my career, which would also have a devastating effect on my family.

I sat on the bottom of my stairs, with my head in my hands wondering what on earth I should do next – ‘Where do I start? How do I start?’

As I sat there contemplating life, I remembered as a member of the College of Paramedics I receive fitness to practise insurance as part of my full membership.

I nervously picked up the phone and made the call to the College and was greeted with a supportive and sympathetic ear at the end of the phone who quickly calmed me down. I was advised to call the insurance company to lodge my issue. I called them straight away and again, I was greeted by a very friendly and supportive person. Whilst on the phone they sent me a simple form to fill in via email, which I sent straight back. I soon received a phone call from the legal team providing excellent advice and reassuring me that they would handle everything. Their first job was to contact the HCPC with a strongly worded letter for an extension to the time-frame they had given me to respond, which in their opinion as well as mine, was unreasonable. They also informed the HCPC that they would be handling my case, which took a huge weight off my mind.

I was given a list of things they required and a number at which they could be contacted on. This number was always answered, I was never fobbed off and if in a meeting they always called me back.

Both the solicitors and the College were excellent in providing support and guidance and keeping me informed at every step of the way. The solicitor put everything together and assured me that my case wouldn't even go to a hearing, they were surprised it had even got this far.

The file was duly sent and only four days later we received a reply of ‘no case to answer’. This was great, however, the whole process had taken eight months to conclude. The College and the solicitor were fantastic. I cannot thank them enough. For less than £10 a month, the support I received was second to none and I would strongly advise any paramedic to join the College, not just for the insurance but for the support of having someone at the end of a phone.
The views expressed in this article are made by a member of the College of Paramedics. 

The opinions expressed by the various contributors are not necessarily those of the College of Paramedics. The inclusion of a blog does not necessarily imply recommendation of its aims, policies or methods. The College of Paramedics will not be liable for any errors or omissions in this information nor for the availability of this information.