One in 10 emergency workers experience the same mental health condition

At first, Elisabeth Goh thought her anxiety, insomnia and short temper were about everything except what they were really about. She couldn’t sleep because her bed was too hard. She found herself unable to concentrate in meetings or skipping them altogether because she knew she’d lose her cool at someone. Her closest relationships were becoming fraught.

So she started drinking more alcohol and working constantly. It meant there was less space to think. But the pressure was rising and, in June last year, at an event for the rural fire service where she volunteered, everything exploded.

A woman of many hats: PTSD does not define Elisabeth Goh.Credit: Nick Moir

Goh recalls feeling an incredible anxiety and saying she needed to go. Then, the 32-year-old recalls: “I completely blanked out.”

A concerned friend followed her to the bathroom and realised Goh was in trouble. The friend later told her she kept asking the same question: “Am I safe?”

The next morning, getting coffee with another friend who wanted to check in on her, it happened again. She doesn’t recall it, but she went outside and tried to barricade herself in a bathroom stall because she felt unsafe.

Goh began volunteering with the Hornsby Heights Rural Fire Brigade in leafy northern Sydney more than a decade ago, while studying a law degree. The RFS, under which the fire brigades fall, are often the first responders on the scene of accidents and fires, particularly in rural areas, as their stations tend to be closer than those of other emergency services.

In her time with the service, Goh had experienced moments of helplessness, guilt and shame when they couldn’t save a home or a life. These were times when she felt their job was to save life and to save property, and they – or more specifically, she – had failed.

For the most part, black humour and a good yarn with colleagues back at the station helped to relieve the stress. The Black Summer bushfires, however, were overwhelming. From July 2019 to March 2020, 11,400 fires raged across NSW, killing 26 people and destroying 2448 homes and 5.5 million hectares of land.

Goh, who now works as a management consultant, took leave from work to spend more time on the ground fighting the fires. Eventually returning to her day job was hard – it felt like the world had changed. COVID restrictions and the inability to debrief properly with those in her brigade compounded the sense of disconnect.

Being part of the service and coming from a military and policing family, she knew about post-traumatic stress disorder (PTSD). But she didn’t consider that the irritability, anxiety and sleeplessness she was experiencing constituted PTSD.

“[I thought] you have to have experienced something really, really catastrophic,” says Goh. “Some of the other guys saw so much more than me that I didn’t feel like I deserved to actually say I have PTSD. So I was often just trying to say, ‘Oh, work is terrible’ or whatever it was. At the end of the day, you can still drown in 40 centimetres of water versus 40 metres of water.”

PTSD can result from an acute event – being in a bad car accident, for instance – or chronic exposure to trauma, as is often the case for emergency workers, who are twice as likely as the general population to experience mental health problems.

As Goh says, “Everybody’s worst day is your every day.”

Last week, the Black Dog Institute and the University of NSW launched updated guidelines for the treatment of PTSD among emergency workers. These are the first in the world to address the unique challenges they face, which include the cumulative effects of exposure, as well as the common desire to continue working in the field that keeps exposing them to trauma.

It was the influx of workers being treated for PTSD after the Black Summer fires that led to the update, says Professor Sam Harvey, executive director and chief scientist of the Black Dog Institute and the lead co-author of the guidelines.

There are more than 370,000 emergency workers in Australia, and it is estimated at least one in 10 develops PTSD.

Harvey and his colleagues realised they were seeing people too late. “On average it was eight years between when their symptoms began and when they first sought treatment.”

They also realised many were afraid of seeking help in case it affected their career prospects – an issue given many want to keep working in the sector. Also, many were being treated by therapists inexperienced with the nuance of PTSD in emergency workers. This meant some people were going for years without the right evidence-based treatment for their symptoms.

“The reason why that really frustrates us is we now know that you can get good treatment outcomes if emergency service workers get evidence-based treatment and get it early,” says Harvey.

The guidelines are based on a treatment model which achieved a PTSD recovery rate of 80 per cent, compared with a global average of about 50 to 60 per cent.

It involves free, anonymous support via the National Emergency Worker Support Service (NEWSS) video conferencing for those in remote areas, a combination of talk therapy and sometimes medication, relapse prevention, as well as supporting a return to work for those who want to continue in the emergency services.

For those who delay getting help, the rates of recovery are similar, but it takes longer, says Harvey, and it increases the likelihood of collateral damage, including issues from substance abuse and relationship failure, that also need to be dealt with.

After Goh’s episode, she began seeing an emergency services PTSD specialist twice a week.

“And then, it started to actually improve,” says Goh, who is now a crew leader in training at her brigade and who uses crotchet and photography as tools in her recovery to stay grounded in the present.

Recovery, she says, is a journey.

“But, PTSD won’t hold you back if you get support. And you have an onus to do that for not just yourself, but for the community that you want to support too.”

For free and confidential support, contact the National Emergency Worker Support Service or call Lifeline | 13 11 14

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