Meeting of the Parliament

Meeting date: Thursday, June 6, 2019

Official Report 1009KB pdf

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First Responders (Trauma Recovery and Support)

The next item of business is a members’ business debate on motion S5M-17253, in the name of Alex Cole-Hamilton, on trauma recovery and support for first responders. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that every day in Scotland, including in Edinburgh, people offer assistance to perfect strangers in moments of crisis and trauma; recognises that first responders, both in the emergency services and members of the public, are often called upon to intervene to offer assistance during incidents where they may witness scenes of trauma and death; understands that these experiences may stay with them and may cause psychological harm for many years; notes recent staff surveys that suggest low morale among emergency workers relating to unresolved trauma and stress; further notes what it sees as continuing problems around waiting times for mental health services throughout the NHS; believes that people die in the arms of strangers every week in Scotland, but that consideration is not often given to what happens to that stranger after the event, and notes calls on the Scottish Government to bring forward a national first responder trauma recovery strategy, which will ensure that anyone caught up in, or witness to, a traumatic event is given the support that they need in the immediate aftermath of the event.

12:49  

I am grateful to have the opportunity to lead this members’ business debate, and to be able to pay tribute to Scotland’s first responders—those who are professional and those who are voluntary; those who are trained and those who are thrown into the worst imaginable situations simply because they are there. They are unassuming heroes who act, sometimes, without forethought in coming to the aid of others, and they deserve the thanks of every member in the chamber and of everyone in the country.

Every day in Scotland, people die the arms of strangers, but we seldom stop to think about those strangers after the fact. Those inflection points of crisis can have an impact on the psychology of an individual that is similar to combat stress, but we often expect those individuals, be they professionals or bystanders, to carry on with little in terms of support or access to services.

For our professional first responders, that stress is reaching crisis point. Recently published research by Unison found that 25 per cent of ambulance staff rate their job as 10 on a 1 to 10 stress scale, with many thinking of leaving the service. It found that almost all—98 per cent—of paramedics have experienced violence and/or abuse while working, and that almost three quarters of respondents describe morale as being poor.

Aside from the regular stresses of working antisocial hours, those workers regularly attend events of acute trauma at which they might encounter multiple fatalities, sometimes involving children. In my first months as a member of this Parliament, I met an emergency worker who had attended the casualties of the Lockerbie bombing. He told me of the nightmares that he suffers to this day and of the fact that at no point was he offered any support. I also know of one 40-year-old paramedic in my constituency who was recently medically retired with post-traumatic stress disorder.

There is also a cumulative effect. Andy Cunningham is a constituent of mine who works at the Scottish Ambulance Service’s national risk and resilience centre as an ambulance worker. He came to see me recently about the mental pressure that he and his colleagues are under. He summed it up by describing how he felt when he recently retrieved the body of a young woman at Leith docks—an event that made him realise that he needed help. I asked whether I could use his words to tell his story in the chamber, and he agreed. He said

:

“I felt nothing. No feeling at all at the time other than I nearly lost her trying to hook the body in. That night I reflected on why I’d become so numb to death. I had seen 100s of dead people, by that time I’d lost my father, 2 close friends and a cousin to suicide.

So I knew what I was feeling wasn’t right. I felt so numb, so alone and it didn’t feel good. I knew it wasn’t normal for one human to feel nothing for another and that's when I knew I needed to speak to someone. I was lucky, in that I took some time off, found a counsellor that listened and helped with my perspective so that in time I was able to return to work. I still see that young girl’s body every day and will do for the rest of my life. Others aren’t so lucky. They are so traumatised by what they see, they are broken. They are broken for life but the lucky ones survive. Remember that 1 in 4 ambulance responders have considered ending their own lives. Dark thoughts to make the pain and trauma disappear. This cannot continue. We need to care for the carers.”

I want to thank Andy for having the courage to share his story with me and for giving me permission to share it with Parliament. His words speak to the trauma that is experienced by people in our professional emergency services. We blithely expect them to be there when we most need them, but we rarely consider the impact of what they bear witness to and the emotional baggage that they carry. In a public policy context, we are beginning to understand much more about trauma, so getting assistance to our emergency workers should be routine, but it is not.

Nor is such assistance readily provided to members of the public who get caught up in such events. Almost universally, the immediate first responder at any scene of a trauma will be a bystander, often unknown to the victims, and most will try to intervene, even though often they are untrained in any form of first aid.

In March 2015, I was walking through the city centre when, sadly, a man took his life by jumping off a tall building. He died on the pavement beside me. I was the first responder at that scene and I remember the trauma of that moment—I see it to this day. I still have nightmares about it, and I have a trigger response when I hear workmen overhead in scaffolding, because that reminds me of his screaming before he jumped.

I was joined at the scene by Janice Malone, with whom I was recently reacquainted. She was the same distance from the man as I was when he fell. The scene was like something from a war zone. I was lucky, as I got some trauma recovery counselling immediately after the event, but Janice has had a much harder road back, and has been diagnosed with post-traumatic stress disorder.

To her credit, she has taken on her experience and the depression that she had to battle through, and has come back from that and fostered a new desire to help people, like me and her, who witness terrible things. She and I will work with organisations including the Scottish Association for Mental Health and the Samaritans to build a package of support for people who are caught up in terrible events. I thank her for her courage, and for the work that we will do together.

Many thousands of individuals like me, Janice Malone and Andy Cunningham carry with them the trauma of what they have seen. Yet, in public policy we do not often stop to think about the ripple effect that such events and incidents can have. That is why I am calling for the creation of a national first responder trauma recovery strategy that will help to begin the process of healing the tens of thousands of our fellow Scots—professional and civilian—who have seen terrible things and been caught up in catastrophic events. As I said at the start of my speech, people die in the arms of strangers every day. We need to start thinking about what happens to those strangers afterwards.

12:56  

I thank Alex Cole-Hamilton for bringing the debate to the chamber, and for his moving speech. I will focus on adverse childhood experiences and the role of people who work with children. I thank Barnardo’s for its briefing ahead of the debate.

Yesterday, I met Tom Fox of the Scottish Prison Service to talk about the family visitor centre at Her Majesty’s Prison Grampian, in Peterhead. During a wide-ranging conversation about victims of crime, he related to me that many of the young offenders in Polmont have experienced multiple bereavements, which we maybe cannot even comprehend. He believes that those traumatic experiences, and the psychological harm that results from that trauma when it is left untreated are, in large part, the root cause of their offending behaviour, and he believes that many of them are themselves the victims of crime and, certainly, of childhood trauma.

Many of those children are also care experienced, with many having been in foster care after having lost a parent. Barnardo’s makes mention of the here and now service that it offers to young men and women at Polmont. In its briefing, it states:

“Too often we hear from our young people that they just wanted someone to listen to; someone to talk to; someone to be with them and alongside them through their experiences.”

I found that to be absolutely heartbreaking. Not many of us can imagine what it would be like, as a child, to witness a parent’s death. However, that is the trauma that many children are living with.

A former neighbour of mine—she no longer lives on my street, but we were reasonably close—was a foster carer. Some years back, she became a foster mum to a young man who had previously been adopted after he had been witness to his mother’s murder by his own father, when he was about five years old. A decade on, his relationship with his adoptive parents broke down, as he found himself reliving the trauma as he approached adulthood.

He was an incredibly bright young man, a compassionate chap and a lad who should have been looking forward to his future at college and beyond. However, his future and his experience at college were very rocky and he kept dropping out, because he was a very damaged young man. As he approached the age of 16, it became clear that he could not enter adulthood unsupported.

Many years on, children like him are not now in the position of facing the cliff edge of their foster care ending at the age of 16. More important than that, however, is that such children are exactly the kind of children who, without mental health interventions, could face a very uncertain future. I have been thinking about him a lot this week as I have been preparing for the debate. I wonder where he is now as an adult and what, if any, specialist help he got throughout his childhood. I also wonder what specialist help or training his adoptive parents, or my foster carer neighbour, had to help them to help him.

The work that is being done by the Scottish Government and partners including Barnardo’s on developing the Scottish psychological trauma and adversity training plan will be crucial in giving everyone who comes into contact with trauma-experienced children the support that they need in order to work with them, and to react to any results of the trauma that they see being presented.

The kind of trauma that I have just described in relation to my neighbour’s foster son is always going to leave a mark—of course it is. However, with trauma-informed training and extra interventions such as having in place school counsellors to relieve the pressure on adolescent mental health services, we can, I hope, assist such children to cope with trauma and to lead lives that do not result in further tragedy.

13:00  

I add my thanks to Alex Cole-Hamilton for bringing the debate to the chamber. One of the things that we are talking about today is the fact that trauma is not always physical. I attended and spoke at the Police Scotland wellbeing conference earlier this week, which was quite timely because I knew that this debate was coming to the chamber.

One of the things that was discussed at the conference was the idea of vicarious trauma, which was explained as being a process of change resulting from empathetic engagement with trauma survivors; anyone who engages empathetically with survivors of traumatic incidents, torture and material relating to their trauma is potentially affected. It stays with us, as Gillian Martin highlighted in her discussion of adverse childhood experiences and how a single traumatic event in early life can affect the rest of an individual’s life.

I spoke yesterday about the problem of drug and alcohol consumption, which is linked to how we protect our children and links into this as well. As Gillian Martin says, people who have experienced ACEs are more likely to have issues with problem drug and alcohol consumption and are more likely to have poor outcomes if those issues are not addressed.

Our first responders are people who choose to put themselves in harm’s way to help others. In recent years, there have been several major incidents where the emergency services have dealt with hugely difficult situations. We had the Stockline plastics factory explosion and the Glasgow bin lorry crash; it feels to me that all of us were somehow involved in that because we saw the pictures and even some video coverage. We also had the Clutha helicopter crash, which I think was even more difficult for the emergency services to deal with because their colleagues were among the victims.

It is not just major incidents that can be traumatic. First responders can encounter the aftermath of violent crimes, and they themselves can be assaulted or attacked. At the conference, I heard about the great work that is being done inside Police Scotland through its wellbeing team and its wellbeing champions, recognising the need for people to have somebody to talk to—somebody who will listen.

Child Bereavement UK also attended the conference, which is hugely important. We forget that our first responders sometimes have to break terrible news to children.

At the conference, Police Scotland’s use of trauma risk management was looked at. Some of the warning signs and behaviours that were highlighted included people finding it unusually difficult to support clients as police officers normally would, people making more mistakes than usual, and a reduction in people’s normal self-care activities. Alex Cole-Hamilton highlighted very well in his speech the risk of compassion fatigue and burnout.

Physical signs of trauma that were given included exhaustion, insomnia, headaches, frequent minor illnesses, and somatisation, which is the physical manifestation of psychological concerns. Behavioural signs included issues around the use of alcohol and drugs, sickness absences, anger levels, avoidance of clients and decision making, the breakdown of personal relationships, reduced compassion and care for clients, depleted parenting, and changes to eating habits.

We should all be aware of the signs of trauma and be able to recognise them. When we look at mental health, we need to look beyond the national health service; we need to look to our third sector and to ourselves to see how we can support those who may experience trauma.

13:04  

I congratulate Alex Cole-Hamilton on his success in bringing this important debate to the chamber and, if I may say so, on his moving and insightful speech. I apologise, Presiding Officer, but I need to leave at 1.30, as I have a meeting with health professionals. I apologise to members, but I will have to leave if the debate goes on for that long.

A quote that is often repeated in the wake of public tragedy is “Look for the helpers.” It was the late American children’s television host Mr Rogers who said:

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of disaster, I remember my mother’s words and I am always comforted by realising that there are still so many helpers—so many caring people in this world.”

Immediately after seeing the scenes that are all too often on the news, such as those around the Grenfell tower disaster or the terror attacks at Tower bridge and the Manchester arena, we need to find comfort in seeing the good in other people; and seeing strangers risk their lives to help those in need is an important part of that. These days, with the rise of social media, such people can sometimes be applauded and cheered across the globe. Of course, they should be celebrated—selfless acts of bravery and kindness are often all that we can cling to at times of tragedy—but what happens after that?

The trauma of witnessing such events—whether it is a one-off, as with a terror attack or watching a loved one die, or sustained, as with domestic abuse or active service in the armed forces—can have a long-term negative effect on mental health. The effects might show immediately or they might not become apparent for some time. All too often, those effects go hand in hand with other health concerns, such as drug and alcohol misuse, broader mental health conditions and poor wellbeing. Unresolved trauma and stress can cause psychological harm for many years, regardless of whether they are triggered by a single incident or complex circumstances.

First responders vary, from those who work on the front line—particularly those in the emergency services and in the third sector—to members of the public who step up when they see people in need. Because waiting times for NHS mental health services are alarmingly high, many people who need psychological help are left wanting, so we are unable to thank the helpers by helping them in return. As well as that, the NHS is struggling even to help its own staff with mental health. These people have gone above and beyond the call of duty but, when they need our help, they have to wait months and sometimes years.

For clarification, I point out that, obviously, the NHS has a duty of care to its staff and it has in-house counselling services that staff can access, on a confidential basis, through the occupational health service.

I am aware of that. As the minister knows from our recent joint visit to New Craigs psychiatric hospital in Inverness, staff on the front line can experience trauma and emotional difficulty. I understand the point that she is making.

I support the motion and Alex Cole-Hamilton’s call for the Scottish Government to bring forward a national first responder trauma recovery strategy. It is time for us not only to look for the helpers but to help them, too.

13:07  

I thank Alex Cole-Hamilton for the opportunity to debate this important matter. His motion calls on the Scottish Government to bring forward a national first responder trauma recovery strategy, and I am pleased to support that call. We are all hugely appreciative of our first responders. We are beyond grateful to all who intervene to save lives. In some cases, they are not professionals, but people who step in until trained first responders arrive at the scene.

One of my brothers has been a firefighter for 22 years. I asked him about his experience of accessing support, whether there are any barriers and, if so, what they might be. He has good support at home. His wife is a neonatal nurse and is ideally placed to understand the desire to protect and preserve life, because that is what they have chosen to do for a living. She knows him well enough to understand what kind of day he might have had without the need for him to go into the sort of detail that he might not be ready to share at the end of a shift and that might take some time to come to terms with.

When I ask him how he is getting on, he will tell me about station banter, communal cooking on shift and how busy it has been, but he does not go into detail. However, as members might imagine, in an on-going career of more than two decades to date, he has seen what he describes as “horror stories”.

I know that he was sent to the Clutha helicopter crash that Brian Whittle mentioned. Most of us will never come across a badly burned body and we will never see a body hemmed in and slumped over a steering wheel, never to move again. We may have seen loved ones as they have passed away. That is never easy, whether it is expected or not, but it is exceptionally demanding when someone’s everyday work is focused on helping people in the most challenging of circumstances.

My brother appears to take much of it in his stride, and that is a testament to the training provided by the Scottish Fire and Rescue Service. However, there are occasions when he and his colleagues are faced with demanding, uncertain events, with outcomes that devastate people and their families.

In his experience in the fire service, if there is a fatality or a critical incident, a questionnaire is sent to the firefighter’s home address—it is sent there to give that person the space and time that they need to complete it, if they wish to. It is voluntary. In 22 years of service, my brother has filled in the four-page questionnaire on many occasions. He says that it is very well designed to elicit the information required. In 22 years, he has requested to use the counselling service once, as he had been experiencing flashbacks following a critical incident.

The counsellor he saw was hugely helpful to him in processing the particular experience that had sent him there. However, he is clear that it is vitally important that counsellors have the appropriate skills, as there is the potential to hinder rather than help. He is hugely grateful to the excellent staff at the Rivers centre in Edinburgh.

He understands that, at times, what might be called bottling it up can be a perfectly understandable coping mechanism, but that at other times professional assistance to share information and process it in the most helpful manner is essential. He told me that when he went to the Rivers centre he was expecting people in white coats, but it was the polar opposite—he said that people could take their partner, wife or friend to the appointment.

Clearly, my brother is speaking as a member of the fire service and cannot speak for all first responders or for our other essential emergency services, but he firmly believes that such services must be available to all first responders in all emergency services and outwith them, including individuals who intervene in traumatic situations and social workers, who may experience situations that we cannot comprehend. They all need that help to be in place.

My brother is content for me to share his experience in order to help ensure that no one hesitates to ask for help when they require it. It is important that first responders and our emergency services do not feel that we expect them to be superhuman—dealing with extreme situations on a daily basis, but unable to admit that they need to take care of themselves, not just us. We must ensure that, when it is needed, the right help is there, as a matter of urgency. That is the least that we can do.

13:12  

I thank Alex Cole-Hamilton for securing the debate and for sharing his deeply personal experiences with us. We rightly pay significant attention to injuries and deaths on our streets, be they accidental or not. However, it is fair to say that we often do not provide adequate support for those who are first on the scene—usually members of the public making a dreadful discovery or emergency services staff who do incredible jobs in the most trying circumstances.

There is no doubt that in previous generations, mental health was not given the care and attention that it was due. As a result, society could probably be somewhat dismissive of the psychological trauma that results from the kind of situations that members have described. For example, last year saw the opening of a new major trauma centre in Aberdeen. That was a welcome step forward for treating serious injury, but I cannot help but wonder what the staff there have had to witness, and how that has affected their lives. Those staff are the professionals, but for members of the public without training in responding to major incidents, I can only imagine that the effect is compounded many times over.

I do not wish to be overly political in the debate, but there are performance gaps that require urgent redress. Statistics released this week show that for much of March this year, there were more than 28,000 patients waiting for psychological therapy, and 38 per cent of them had been waiting for more than 18 weeks. At the same time, against a 90 per cent target for treatment within 18 weeks, the current rolling national average is 77 per cent. Although those figures go beyond first responders affected by trauma, if we want to do right by those people, service levels must improve.

I support the idea of a national first responder trauma recovery strategy. The Scottish Government has a significant number of mental health strategies, but if this new strategy focuses minds on delivering the right services to those for whom we need to do better, then it should be considered.

Whatever route we go down to address the issue, we must look at the support networks around people who go through such experiences. We all agree that it is much easier for someone to process a traumatic event if they have family and friends to whom they can speak openly and on whom, in dark days, they can lean.

Whether or not it is someone’s job to respond to major traumatic incidents, people cannot take something that serious in their stride and soldier on as if nothing had happened. We cannot predict when any individual might find themselves in such a situation but, if it happens, the right support must be there for them. We might not think of them at the same time as the victims or their families, but their need for care can be every bit as acute.

I hope that the effect of our debate will be that the needs of first responders are fully considered, and that, if changes need to be made, we will work constructively to make that aim a reality.

13:16  

I am pleased to respond on behalf of the Government. I thank Alex Cole-Hamilton for securing this important debate, and I thank Janice Malone for bravely sharing her story. Janice is one of my constituents, and I had the pleasure of meeting her last week.

The world in which we live is unpredictable. In the past week, a tourist boat capsized on the River Danube, and searches continue for mountaineers in the Himalayas. Just beside Edinburgh castle, there was a horrific fatal stabbing of a young man, Paul Smith, in broad daylight. His family and friends will be struggling to cope with that tragic loss, and the ripple effect will be felt by the witnesses and the emergency service workers who responded.

Psychological trauma is not prompted just by accidents, disasters and sudden acts of violence. Complex interpersonal trauma is caused in relationships, which can have a terrible legacy. From coercive relationships and domestic violence to the cruel, horrific realities of child abuse, neglect and exploitation, traumatic experiences have a devastating impact on people. The ripple effect is felt by those who are caught up in the aftermath, such as emergency services workers, social workers, teachers and others throughout the workforce, or jurors in criminal trials.

Across Scotland, thousands of people offer assistance to strangers in moments of crisis. We know that exposure to traumatic events can have damaging effects on people’s lives; the good news is that people are resilient. Just as for physical trauma, the body has an in-built self-repair mechanism that applies to mental health trauma. Most people recover through time and with a supportive and safe environment of family, friends and other support networks.

Traumatic events occur in everyone’s lives. They can be of variable severity, and the effects on an individual are dependent on their meaning to them. People’s reactions are particular to them, so services need to be trauma informed. Staff must be comfortable asking about trauma and must understand that different sorts of help are needed. After a major incident, within three months, about a third of the people involved will develop post-traumatic symptoms that will require treatment. Primary care services can help by using mental health resources in their teams and communities. After a major incident, about one in 10 people involved will have more complex problems that will require specialist assessment and treatment.

I note Alex Cole-Hamilton’s call to bring forward a strategy to ensure that people who are caught up in an incident get the support that they need. We have a raft of work under way to support recovery from psychological trauma, recognising the impact that it has on first responders and members of the public. Since I became the Minister for Mental Health a year ago, we have been working tirelessly to transform our mental health service into a responsive, transparent and effective service that meets the needs of all. Our NHS workforce is at a record high level, and, since 2007, psychological services staffing is up by 69 per cent.

In Scotland, we have remarkable services that specialise in providing support to people who have experienced trauma. I recently visited the Glasgow psychological trauma centre, the Anchor centre and the Rivers centre in NHS Lothian, which was mentioned by Alison Johnstone. They are centres of excellence in dealing with psychological trauma. The Anchor centre was at the forefront of responding to emergencies such as the horrific Glasgow bin lorry and Clutha bar accidents, and experts from the Rivers centre responded to the psychological impact of the Manchester arena bombing and the Tunisia attacks. Both services work with abuse survivors, refugees, asylum seekers and others who have been exposed to trauma. They have international expertise and they share knowledge generously to inform national guidance and programmes.

Scotland has multi-agency “Preparing Scotland” guidance on community resilience to emergencies, including on psychosocial and mental needs. Large-scale incidents of mass violence such as the Manchester and Tunisia attacks demonstrate that all nations must be prepared to cope with the aftermath of tragedies on all scales. With that in mind, the Scottish Government is currently working closely with the Rivers and Anchor centres to examine the psychosocial response to mass casualty incidents.

The Scottish Government has placed prevention of, and recovery from, psychological trauma at the heart of our programme for government. Scotland was the first country to develop a robust knowledge and skills framework for psychological trauma, and we have invested £1.35 million in a three-year national trauma training programme that is led by NHS Education for Scotland. The programme aims to train at least 5,000 front-line workers including teachers, prison officers, social workers and the third sector, and, in its first year, almost 3,000 people have received training. Regional delivery pilots will commence later this month in Glasgow, Midlothian, and Argyll and Bute, to deliver local priority training. As of May 2019, the national trauma training programme has service level agreements in every health board to co-ordinate the training, support and supervision of staff. Last month, the Deputy First Minister chaired the first national steering group to identify future priorities, and a trauma training plan will be published soon.

In order to support the public, we must support staff, most of whom have their own trauma history. Our police, ambulance, fire service and mountain rescue personnel dedicate their careers to serving the public, and many are exposed to traumatic events. They are the first responders to suicides, terrorist incidents, acts of violence or abuse and fatal car accidents. Our emergency services therefore take staff welfare very seriously, with support from qualified health and wellbeing departments, and a wide range of support services are available, such as employee assistance programmes and occupational health support, which includes trauma counselling and pastoral support.

There are examples of best practice. Police Scotland is one of the first police services in the United Kingdom to implement mandatory mental health and suicide intervention training for all officers up to, and including, the rank of inspector. Another example is the lifelines Scotland programme. Lifelines was established in 2016 by the Rivers centre to promote resilience and wellbeing among volunteer emergency responders, and it is supported by Scottish Government and LIBOR—London interbank offered rate—funding. Lifelines provides training and online resources for volunteers and their families and friends. People are encouraged to notice the vital warning signs—as Brian Whittle eloquently outlined—to embed a supportive culture and to know when and where to get support. The programme has been widely acclaimed and work is under way to explore its roll-out to all three blue-light services.

I thank our emergency services and those members of the public who have dealt with, and deal with, traumatic situations in order to help others. Their courage and compassion make a visible and huge difference to people’s lives when they are at their most vulnerable. Trauma can touch the lives of anyone at any time, and it is our collective duty to bring about cultural and transformational change in order to support people to live their lives well.

13:23 Meeting suspended.  

14:00 On resuming—