Emotionally challenging work – managing the risk

Emotionally challenging work – managing the risk

Good morning and welcome to this Webinar on emotionally challenging work managing the risk. This Webinar is brought to you by Workplace Health and Safety Queensland, Office of Industrial Relations. My name is Nicole Hughes, Principal Advisor Workplace Health and Safety Queensland and I will be the facilitator for today's webinar. To introduce this topic we will play a short video from the honourable Grace Grace, Minister for Education and Minister for Industrial Relations.

Mentally healthy workplaces build and maintain work practices, which promote and support positive mental health and minimise the risk of psychological injury. They benefit workers, their families, the wider community and in broader terms, the efficiency and profitability of businesses and industry. As a Minister responsible for safe and healthy workplaces, I am encouraged that workers and business leaders are starting to talk about psychological or mental health. That means change is happening but we need to do more. My department has a number of tools available to help businesses including the people at work tool, a psychological risk assessment tool for the workplace. Our mental health ambassador, the wonderful Libby Trickett is sharing her journey at workplaces all around the state and we recently sponsored Mates in Construction to the tune of one million dollars. We can't do this alone. We need people like you to show the way with strong leadership when it comes to safety and positive culture in your workplace. This webinar will help you build mentally healthy workplaces and it is particularly helpful for those who take on emotionally challenging work. Please enjoy the session.

In terms of emotionally challenging work, what immediately comes to mind is roles in emergency, health and human services. Today we are drawing on the expertise of speakers in responding the risks inherent in first responder roles, however many jobs have emotionally hallenging elements acknowledging that the frequency and intensity of this exposure will vary and it is hoped that there are strategies and actions that we cover today that can be applied across workplaces. I am joined by guest presenters Rob Heslip, National Engagement Manager Police and Emergency Services for Beyond Blue and Todd Weir, Executive Manager, Staff Support Priority One at Queensland Ambulance Service. Firstly, just a quick reminder of the relevant legislation the Work Health and Safety Act 2011. The purpose of the Workplace Health and Safety Laws is to secure the health and safety of workers and workplaces. Health is defined as psychological as well as physical health. A person conducting a business or undertaking has a primary duty to ensure so far as is reasonably practical workers and other people are not exposed to psychological health and safety risks. Workers have a duty to take reasonable care for their own health and safety while at work and not adversely affect other people's health and safety. Workers must cooperate with reasonable policies and procedures relating to health and safety at the workplace. When conducting health and safety risk management processes, it is important to assess the relevance of the eight psychosocial hazards. Emotionally challenging work sits within the work demands category, see the Workplace Health and Safety Tip Sheets for more information. I will now hand over to Rob from Beyond Blue.

Thank you Nicole for your introduction and for providing Beyond Blue with this opportunity to discuss mentally healthy workplaces in particular those workplaces we know are emotionally challenging. Now I appreciate many of you will be aware of Beyond Blue, but just before I get started I want to provide a bit of a background on our Workplace Pacific Heads Up Program. Now while Beyond Blue has a number of target areas the workplace program has been promoting mentally healthy workplaces Australia-wide since 2004. And since this time Beyond Blue has found many Australian organisations would like to be mentally healthy, but they didn't necessarily know where to start whilst others felt that it was not their role nor even their responsibility. So in 2013 the Mentally Healthy Workplace Alliance was formed and for the first time this tripartalliance of government sector, mental health sector and most importantly the business sector came together recognising the benefits of all Australians of mentally healthy workplaces. The role of the business sector where was particularly significant because workplace mental health was no longer seen as nice to have but rather as a necessity both from an economic and a productivity perspective.

Today I want to cover the following topics, we'll start with an understanding of the societal context and then bring the workplace into focus.We'll touch on how we might better understand mental health by looking at the mental health continual and with this context and understanding we can then discuss what a mentally healthy workplace might look like. And not only how decision makers and implementers can go about creating a mentally healthy workplace but perhaps an even more importantly how all of us can contribute, even if you feel your role wouldn't normally carry the mandate or have such an influence. And I hope that not only you'll be able to walk away with a better understanding of what good mental health might look like but also give some practical steps and ideas that you can take back to your respective workplace for the collective benefit of you and your colleagues. Because don't forget, one of the things we know, particularly in emotionally challenging workplaces, those setting of Police, Ambulance, Fire and Rescue, Child Protection, Corrective Services, Health and Hospitals, Home Care and even customer service industry where you might be frequently dealing with the public in a heightened emotive state, these industries can all have employees that are significantly at risk because of the personal investment required for them to fulfil their role effectively.

Some of our audience may have previously come across a graphic like this to better understand mental health. There's one way to explain mental health and mental health conditions, or the difference is to imagine mental health as a spectrum or a continuum for the positive and healthy functioning aspects at one end, through to severe symptoms or conditions that impact everyday life and activities at the other. Confusingly though, mental health is often used as a substitute for mental health conditions such as depression or anxiety, however having a mental health condition is not synonymous with being in the red, and indeed we know there are many people with diagnosed mental health conditions who flourish in the green by having contingencies and supports in place as they continue to contribute positively to their chosen role.

Mental health is about being cognitively, emotionally and socially healthy, the way we think, feel and develop relationships and not merely the presence or absence of a mental health condition. Everyone's mental health varies during their life and even on a daily basis, at the green end, people tend to show resilience and high levels of wellbeing, this doesn't mean they never experience any challenges to their mental health, rather they draw on a range of coping mechanisms and supports to effectively manage any difficulties as they come along. It's important to remember that mental health is complex. The fact that someone is not experiencing a mental health condition doesn't necessarily mean their mental health is flourishing, and likewise, it's possible to be diagnosed with a mental health condition while feeling very well in many aspects of life. So from a workplace perspective, the aim is to create an environment where as many staff as possible are in the green so that they are striving, productive and enjoying being at work and they're fully engaged.

As people move into the yellow and orange end of the continuum can perhaps show signs and symptoms and behaviours listed here. We know that it's important to ensure the workplace environment is one where they know it's okay to put up their hands and ask for help and that help is readily available. It's not enough to wait until people are actually in the orange and red and then act. It's particularly pertinent here to mention that it's often the colleagues of those displaying their signs and symptoms who might recognise them first so it's about educating and empowering, mandating everyone in the workplace to have that conversation and to know everyone is looking out for each other.

So let's take a step back for the moment. It's important that we discuss some facts and look at the overall societal picture and ensure we have a really good understanding of why mental health is so important. Indeed the facts are very sobering. Tragically eight Australian's take their own lives every day. Six of whom are males. This figure is almost two and a half times the national road toll and for every suicide, there are approximately 30 attempts. So when you consider these individuals all have husbands or wives, partners, children, families, friends, work colleagues, the ripple effect is profound and this issue touches countless of Australians every day. Mental health conditions, especially depression, are present in a higher proportion of people who suicide, many of whom were untreated at the time of death.

So today approximately 3 million people in Australia are living with depression and anxiety and we know these are conditions which can be effectively treated and that the individual can make a full recovery. So to achieve this, early intervention is vitally important. Sadly we know that only around half of the people who experience depression and anxiety actually seek treatment. So imagine if we could create environments where more people feel like they can put up their hand, admit they are struggling and do this early so effective help can be put in place.

So as we can see here, mental ill health is a major consideration within Australia's working population with one in five workers likely to be experiencing a mental health condition at any given time. And with the majority of those affected by mental health conditions being of working age, employers are in a unique position to have a positive impact on the mental health and wellbeing of their work force. And it's in their best interest to do so. Not only from a moral and legal standpoint, but as we can see here there are financial benefits. A study by Price WaterhouseCoopers, found out it was estimated mental health conditions have a substantial impact on Australian workplaces through lost productivity. Estimated around 10.9 billion dollars per year. And through the successful implementation of an effective system to create mentally healthy workplaces, organisations on average can expect a positive return on investment. Indeed, for every one dollar invested in such programs and interventions, there's an average return of $2.30. So taking a proactive approach to mention health helps to build your reputation as an employer of choice and simply put, a mentally healthy workplace is a workplace where people enjoy working and are engaged, healthy and productive.

So what does a mentally healthy workplace look like, particularly when we are in an emotionally challenging environment? In emotionally challenging workplaces like many of those industries where recognised, while understanding they can take many forms, it's the nature of their mentally healthy working environment which gives them all something in common. They have a positive workplace culture and put simply they're places where people feel good about coming to work and everyone's encouraged and supported. The every day stress and other risks of mental health are managed. We know things like heavy workloads, unrealistic deadlines, poor communication and uncertainty, these and other factors can all contribute to anxiety and depression and it's up to the leaders and managers to keep these aspects in check. We need to ensure people with mental health conditions are supported. We know helping employees to stay at or return to work has very clear benefits, both for the individual and for the business and of course it should go without saying, you must have a zero tolerance approach to bullying and discrimination. As well as being a legal requirement, protecting employees from discrimination encourages a diverse workforce and ensures everyone gets a fair go.

So what does this look like in your workplace whether you're an employer or an employee? Let's have a closer look. What's really important to understand here is having a mentally healthy workplace, it's the responsibility of all of us. Protective factors and mentally health practices like we see here can offset or buffer against stressors in the workplace. Many of these do not require significant financial investment by organisations and in fact workplaces that are emotionally challenging are more likely to remain safe and healthy with specific protective factors. These might include pre-incident preparation and training, critical incident stress debriefing, peer support programs and the consideration of both internal and external counsellor or support measures and in fact we know access to a suite of resources and support means there is much greater chance of each individual's specific needs being met.

Now as much as it's important to understand what practices and factors can protect us in emotionally challenging workplaces, it's equally important to appreciate the broader range of workplace risk factors that can contribute to people developing anxiety or depression. We also need to recognise that some of these factors may in fact be inherent to a role and therefore it's even more important to consider what workplaces can do to mitigate and protect against these.

So how do we create mentally healthy workplaces in emotionally challenging environments? Perhaps if we can look at some key areas to focus on. There are three critical success factors when we're looking to implement a strategy for a mentally healthy workplace. Firstly we need commitment from your senior organisational leaders and we must ensure that the senior leaders have a shared commitment and belief in the goal. We also need to consider the influence of frontline managers and middle level management. Cause this is critical, they need to role-model the good behaviours and commitment messages and positive behaviours can be as powerful from someone in charge or at a local branch or station or on the factory floor as those from senior executives or the CEO. Secondly, employment participation is so important. We need to identify and celebrate the mental health champions and supporters. Keep them engaged throughout the process and help guide your strategy and communicate this across the organisation. Be sure to encourage all staff to have a voice and provide a safe and open communication forum where they can express their opinions and start thinking about new ideas. Giving them access to all information and progress made in developing and implementing a strategy will be key and always look for their input and feedback on how you're tracking. And thirdly, provide ongoing communication. We know consultation from communication is key. Employee awareness and involvement in decision-making is not only a legal requirement under work, health and safety legislation but it's supported by research and this approach increases the success of idea implementation and assists workplaces in coping with change. A culture of consultation and cooperation in the workplace is healthy and productive and businesses working to the best practice recognise the benefits or regularly seeking opinions and views from their employees. Whether that be through consultation with individuals, groups or unions or a mixture of all three. Don't forget there's working and reference groups that are probably already in place in the new organisations. So don't look to reinvent the wheel, tap into these invaluable resources within your own organisation. As you see here you'll have four key steps to developing a sustainable workplace mental health strategy and there are underlying principles at each step. While the principles of communication and participation, which we've just spoken about, underscore all of these and appear in the middle of this diagram. It's important to note here that there is no one right way and each organisation is different. So these steps are a guide and you may jump around from each one or revisit ones at any given point in time, cause we know a workplace is dynamic and constantly changing and so should be the ongoing management of your mental health and wellbeing strategies.

So once we have considered the three critical success factors and the four steps to implementing a strategy it also is very helpful to think about our overall approach and take an integrated approach to mental health at work is a sound and structured way to achieve this. An integrated approach to mental health in the workplace considers seven achievable goals within the three elements for success. These elements are to protect your staff and to promote programs and positive mental health and to support everyone when they need it. We see here how important it is to promote positive mental health and develop a positive culture where people feel supported and empowered to talk about their good mental health. There are key aspects of manager training pro-active leadership practices such as promoting employee strengths, providing constructive feedback and recognition and supporting employee growth, which are critical to this. We need to look to emphasise the meaningful aspects of work, celebrate achievement and praise effort as well as results. Many workplaces are looking to promote healthy eating, physical activity and provide programs to assist in smoking and alcohol abuse. And we need to look to educate our staff on the relationship between physical and mental health. Overall encouraging a holistic approach to good health is simple, quick and it's evidence based.

To protect individuals by reducing the risk factors is key here and decreases the likelihood of staff developing a mental health condition and indeed prevents those who are experiencing a mental health condition from becoming even more unwell. Actions such as improving work design, examples of this are perhaps regularly reviewing workloads or time lines and resources, ensuring their duties and expectations are clear and encouraging skills development. These are all really critical aspects, while the prevention of the known risks also plays a clear role in the protection of individuals. And the final approach in the integrated model is to support your work force. Provide early intervention to support employees when mental health conditions, regardless of the cause, so all staff feel supported and are able to seek assistance early and recover faster. Make sure you provide access to free confidential and accessible mental health supports, welfare or peer staff, HR support, employee assistance programs and community based health services. Develop a stay at work or return to work plans for staff who have been unwell and prioritise health and wellbeing above performance expectations and very importantly recognise the critical role families play in this space and have programs which also support them accordingly.

So I know we've covered a lot of ground here today and it can be quite overwhelming. So let's have a quick look at where to start. A Heads Up, there's free evidence based tools and resources especially designed for workplaces. So whether you're an employee, a business owner or a manager in a small or large organisation, there are resources here to help. And to close out what we're talking about today, I want to have a quick look at some of those resources and where you can start and then guide you through some of your plans.

Heads Up was designed both to support and help create mentally healthy workplaces while also providing resources for individuals. Heads Up provides simple, practical and free resources that can be downloaded or ordered directly from the website. Here you can find new entry points, so everyone coming to the site can easily find the information relevant to them depending on their role in their workplace. It uses case studies, personal stories, videos, tools and e-learning modules to demonstrate and educate individuals and their workplaces on what they can do to improve mental health of their workplace.

Looking across the top of the page in the Healthy Workplaces section this is about providing key information on why it matters, the legal rights and responsibilities for both employers and employees and a whole section on how to develop mental health strategies for your workplace. There's also specific pages for police and emergency services, the health services sector and importantly small business owners. Looking at the Your Mental Health section you can learn more about what mental health is and also about mental health conditions and there's a new section called Taking Care of Yourself and Staying Well which has some really helpful information about things you can do at work with your lifestyle and through social relationships including working through your own thoughts and ideas to keep mentally healthy.

There is also a section here for employees around workplace bullying and also working with a mental health condition. And there's also a really great tool here that helps you to decide whether you should disclose your mental health condition to your employer. In the Supporting Others section, this is all about how managers, employers and work mates can help support each other in the workplace. There's advice around how to have a conversation with anyone you might be concerned about, as well as specific information around workplace bullying for managers and employees and importantly suicide prevention. And finally in the Training and Resources section you can find some great tools and resources to help create awareness and educate all staff on mental health conditions and suicide.

There are case studies and personal story videos you can also use and the resources catalogue where you can order or download information booklets and flyers, wallet cards and posters all for free. There is also an education and training section where you can find face to face or online training programs to suit your needs. These programs are all free and many are (ui) compliant, so you can upload them into your organisations learning management system and staff can then access them directly from there.

So I'd like to thank everyone today for participating in this program and perhaps if I can leave with a definition of what a mentally healthy workplace looks like, this from our friends at Guarding Minds at Work in Canada. And what I like about this is the simplicity in the message and particularly as it really raises the profile of what's important and that's going home at the end of the day with energy left over. So thank you again to Work, Health Safety Queensland and for everyone today for taking the time to look at how you can create a mentally healthy workplace.

Thanks Rob for providing an overview of the integrative framework to achieving a mentally healthy workplace and the range of resources available via Heads Up. I'd now like to introduce Todd who's going to talk about the Queensland Ambulance Service Priority One program.

Thank you and thank you for the opportunity to talk a little bit about the QAS staff support service and perhaps about some of the things that we've learnt over the past 25 years and hopefully some of those learnings might be useful in your roles.

I just want to provide a caveat however that what works for QAS may not work for everyone and I think it's important to understand the context of your workforce and understand the organisation so that you know that strategies that you implement is going to fit for the organisation and that there's going to be uptake within the organisation. So what we know works for us, we know because we understand what the organisation is about.

So to give you a bit of context around the QAS, I'm sure you know that it's an emotionally challenging work environment and I'm sure, I'm sure you know what ambulance services do and provide. But, but perhaps what you don't know is that the QAS has full time ambulance services to over four and a half million people across 1,730,648 kilometres. So it's a really big state which presents a number of challenges on how you provide support to people who are working in stations from Cunnamulla on the New South Wales border all the way up through to Thursday Island. And some of these locations are extremely remote locations, so it presents challenges on how do you provide support to those people and be in a position where you can touch base with them to, to see how they're going.

The other aspect, we have around 4,300 personnel across the state and we respond to a lot of cases. I think it's often not recognised as how many jobs that the ambulance service responds to.  Last year we responded to over 1.2 million responses. So averaging at around 2,700 responses per day and that presents a number of risks as well. Because we know that we have that many ambulances and paramedics responding to emotionally challenging context on a frequent basis and we also have our emergency medical dispatchers in the comms room taking all of those calls in certainly emotionally challenging environments. The other caveat is that these things take time and resources. It's, it's not something that can be developed overnight and it's not something that can be set up and then just left. It's important to make sure that it's an ongoing process and an ongoing evaluation of that process.

To give you a bit of insight as to the history of the Priority One program you can see that we started back in 1991 and but throughout the program there's been a number of, a number of different aspects that have been added to the program over these years and they haven't just happened by accident. They've happened through a continual evaluation of the program. And the other important component is in assessing to make sure that that's actually working and that's what's actually helped us to continue to develop the program over a number of years. So the first part back in '91 we introduced was counselling and back then we had around a dozen counsellors who we selectively chose. So we didn't, we decided at the time not to outsource to an EAP company. We decided that it was important to, to individually choose the counsellors that we were using so that they could have an understanding of the organisation and we could embed them in with the organisation so they can understand the culture.

So we didn't just look at their clinical skills, that was important, we wanted to know that they could work within a trauma context, but we also wanted to know that they could work within the culture of the organisation and that they would have a fit to that culture. People certainly need to feel comfortable in knowing that they're talking to somebody who understands the culture. So now we have around 60 external counsellors located across the state and each year we provide an annual counsellors workshop where we bring those counsellors together so that we can give them some professional education around trauma or, or different context. But most importantly we can also let them know what's happening within the organisation so they can understand what changes there are occurring. What sort of you know programs are being introduced and what are the key issues of the organisation and importantly it brings us altogether as a team so that we're working collectively rather than as individual components of a staff support program.

The other component of the counselling is that we have an internal team of counsellors consisting of four counsellors as well as the external counselling network and that internal counselling team provides a context and enables people to access people who are a part of the organisation so they can feel more valued by the organisation. Also in that internal team there's a mixture of people who've been on road. They now have mental health qualifications and are mental health professionals but they've had an experience of working within the operational context. And for some that's important to know that there may be people who just may not have otherwise accessed counselling if they hadn't felt that they were talking to somebody who had that experience. The other thing about the Priority One program is that it's separate yet part of the organisation. I think having different layers of separateness is important. So having the external counselling is, is a little bit more separate again. It offers people some sense of confidence and, and around accessing, yet also the Priority One program is a little bit separate in that it doesn't sit within a corporate services structure, it actually sits and reports to the Commissioner. So it sort of sits a little bit separately and it gives that confidence to people that they're accessing a service that's part of yet a little bit separate to the organisation. And so the counselling's available to all staff and their immediate families for any reason, not just trauma related issues.

The other, the next part of the program that we introduced was the peer support program and but I think there's lots of different types of peer support and for us it was very important to make sure that we selectively chose those people to be the most appropriate people. So we have a five stage selection process that people go through and they're still not a peer support officer until they complete their, their first peer support course. That course is a six day live in course covering didactic and experiential information and I think the six days is important. You can teach somebody psychological first aid in a, in an online course of you could teach it within a couple of days. But we don't just want them having an understanding of psychological first aid, we also want them to have an understanding of their own reactions to trauma, of how it might be to be able to support somebody else within that context. We want them to be able to provide support in an intentional and considered manner. So it's very important for us that we have a, a course that enables that for them and enables for them to experience that. And that peer support programs been replicated in other organisations both nationally and internationally.

The, as I said the, the training program is a six day, this is an example of the program, it's a six day course and it's a pretty intensive course. There's, there's fairly long hours and long days but I think one of the critical components for that is, you'll see the, the circled area in the middle there where the, the Commissioner of the organisation always attends the courses at some point in time to be able to validate their role and to validate the importance of that role within the organisation. And I think that's really important and something that Rob talked about the importance of that leadership as well and, and that provides an example of, to the peer support officers that this is important from an organisational perspective.

The other part of peer support that's very important for us is that you can't just give them some training and off they go and, and let them do what they do. It's important for us to make sure that we also look after those peer supporters. So every year we run two new peer support workshops and we run two refresher workshops. So we invite the peer support officers back every two to three years to undertake a refresher training course and the, and the context of that is very similar. There's experiential plus didactic training, the process is very similar for them and it, it enables them to come back and retouch base with the skills that they learnt in the first course and also to, to consider their own self-care. The other important aspect is having supervision for those peer support officers, so our external counsellors across the state, we have selectively chosen external counsellors who provide supervision to those peer support officers and that's in a group context and an individual context. And in fact they are actually required to undertake that supervision as part of them and in a way so that we can look after them. We also really invite them to consider taking time out when they're required, because it's important for us to make sure that they're okay. It's okay to take some time out. It's important for them to also model to others how important it is to sometimes re-evaluate what's important and what things we can take out of our lives.

Peer support I think is often underestimated on how much of a difference it can make and, and this is a bit of a model that I'm not going to talk to at all, because I don't have time. But it actually provides a significant number of factors across the organisation that it can, that it can assist with and not just in terms of following up after critical incidents. But it also can have significant changes to shifting culture in a positive way, providing that peer support officer, the peer support is really well supported.  And it can also provide you know safety and a sense of connection across the organisation.

So how many people access peer support. Certainly for us on average 1500 people per year access peer support officers and I would say that that numbers pretty under reported because peer supporters do this on a volunteer basis, they don't get paid for it and often times providing back data or statistics is not as important for them as it is other factors and, and I can understand that.

So but I think they actually do a whole lot more than that. The other thing is approximately 82% of people don't require further referral, so counsellors or GP's. And that makes a big, significant difference to the organisation in terms of a cost saving but also it suggests that people are feeling connected and getting what they need out of that. And not everybody needs a counsellor, not everybody needs a GP. And out of the top five issues, what we consistently find is that they're accessing peer support officers, not just for work related issues but personal issues and all sorts of other issues and it tells me that people trust peer support because they wouldn't be accessing them for those reasons in the first place, which is very different to where we were at when we started the program, the peer support program around 23 years ago.

So our wellbeing framework consists of four key focus areas, as well as two special focus areas and it's centred around a persons centred approach. So you'll see in the middle of the diagram an individual's resilience and it's important to provide the skills and training to, for people to be able to engage that resilience. But the key factors are reducing barriers to support. So having a number of different programs and, and different aspects of the program that enables the reduction of barriers to accessing support. So peer support is always a big one, LGBTIQ plus support, ATSI support, having chaplaincy available for people, management support. Having that mixture of internal and external counsellors, helps reduce some of those barriers and having counsellors with operational backgrounds. Having a salutogenic approach to, approach to education, so normalising reactions to trauma and actually providing an opportunity for growth out of those reactions. So not using a pathological approach and this is, breaks down some of the stigma for people accessing support.

The other part that's important for us is that multi-pronged approach to education. Last year the team, Priority One team did over 900 hours of training across the organisation across the state. Part of that was through a resilience program that we provide to all new frontline staff coming through called Finding the Silver Lining where they undertake a four and a half hour based face to face session, they undertake a workbook and reflective journal and they actually have to attend a face to face session with one of the external psychologists. That remains confidential but it provides them with an affirming experience with a psychologist very early on in the piece and they actually start to realise that there's some useful adaptive coping skills that they can learn from that and it breaks down some of those stigmas about what it is to access a psychologist and everybody has to do it so it normalises it for them. And all, and most importantly it provides them an opportunity to do that when they're not feeling so hyperaroused and distressed, that they're able to do that a point in time where they can think it through. So hopefully at a later point in time they'll know how to access that support.

The other part is providing training to the managers and supervisors. Giving that middle management and upper management an opportunity to learn about mental health and we made some assumptions when we first started training this, which was about eight, eight years ago we started training with our managers and supervisors. We made some assumptions that they knew a lot more about mental health because they were paramedics predominately. But what we found was they actually only knew about it in the acute context. So this was about providing them with an opportunity to give them skills and training on how to provide that support within their work role. And we've found since undertaking that training we're getting a lot of calls from managers and supervisors across the state when they want advice about something. But we've also found that a lot more managers and supervisors are actually accessing counselling for themselves and they've been able to know that it's okay to do that and that helps normalise it for other parts of the organisation. The other important thing for us is having a commitment to best practice. So over the last 35 years we've, over the last sorry 25 years we've had 35 research collaborations and that's given us a really good view around what's working and what's not working and what is needed and what's not needed.

I'm not going to talk through this model but what it shows is it's, is that it's important to have not just one approach to critical incident management but having multiple pathways for support and how people might access it and it's not just about in the moment but providing prevention and preparedness is important as well. Same thing with suicide prevention, having multiple layers to that and I'm not going to get a chance to talk through this whole diagram, but not just looking at identification and intervention but protection and prevention. How do we prevent people from getting to that point in time? Once again peer support plays a major role in that but also having a well embedded counselling program and chaplaincy and lots of different layers of support that people can access.

So does it work? Well we know that the attrition rate is less than three percent within the Queensland Ambulance Service. We also know that our PTSD rates are lower than the general population. We've undertaken some research, the last large research we did, which was externally conducted in 2014 had 1042 respondents and it found that QAS had very low levels of secondary traumatic distress, very low levels of burnout, high levels of resilience and high levels of posttraumatic growth. In fact out of that 1042 respondents we only found two people who demonstrated high levels of burnout. What we also found was that participants who had experienced trauma and had accessed Priority One had significantly lower, lower levels of distress and burnout, they had higher levels of resilience and they had significantly higher levels of compassion satisfaction and organisational connectedness. And we consistently find through this research and other research that peer support officers consistently show higher levels of resilience and post traumatic growth.

So I just want to leave you with this final diagram that we've called the Tailored Care Model in terms of staff support and providing support. Once again Rob talked about the investment from leaders and (ui) leaders, so I think that's a critical component. Identifying what your risks are within your organisation.  Evaluating what strategies you currently have and assessing those gaps. Research is an important component, if you can conduct research or look at what other organisations have done in terms of research and see how it might fit with your organisation. Developing a strategy or strategic plan and then consulting and engaging within your organisation so that it becomes embedded and people don't feel like it's just put upon them and then applying those models and strategies and it's important to review and research to make sure they're working and meeting the risks that you've identified in the first place. But it's also important to evaluate the whole program periodically and most importantly this is an ongoing process, it can't be stopped once you've finished.

So thank you for the opportunity to talk a little bit about the program. It's been a very quick overview in terms of the program and I hope that some of the components might be helpful in terms of what you're doing within your organisation. So thank you.

Thanks very much Todd for sharing information of Queensland Ambulance Service's Best Practice Staff Support Program and the fantastic results achieved. So in summary this light outlines some of the key considerations relevant to the area of emotionally challenging work.

The first point relates to the monitoring of organisational health indicators. Things like keeping track of absenteeism, workers compensation data, use of the employee assistance program etcetera.  The second point is using consultative processes to identify social hazards, assess risk, develop control measures and monitor and review.

The third point, employee support programs, which you've heard an example of from Todd and a commitment to early intervention. And lastly the importance of stay at work and return to work programs and applying reasonable adjustments to support employees who have suffered a health issue as a result of the emotionally challenging work that they engage in.

The next slide directs you to the Work Safe site for further information. There is a screen shot of the web page that you'll find at Worksafe.qld.gov.au under mental health at work. So thanks very much for listening to our Webinar today and I'd like to thank our excellent presenters, Rob Heslip from Beyond Blue and Todd Weir from the Queensland Ambulance Service.

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