Communication is crucial: mental health in the control room


In this article, previously published in the BAPCO Journal, Philip Mason explores the - often extreme - trauma faced by those operating in control rooms.

Thanks to the ongoing COVID-19 pandemic, we currently find ourselves struggling through one of the hardest winters in living memory.

This article for instance, was written under country-wide lockdown, the conditions of which made (and indeed, make) it impossible to physically interact with anyone outside one’s own home. At the same time, the long and cold nights have now made their presence well and truly felt, adding an additional layer of gloom to what was already a quintessentially lonely situation.

With that in mind - and staying on the subject of mental health - it’s perhaps no surprise that experts are registering huge concern about this area of wellness, especially in the longer term. Indeed, according to statistics published by the charity Mind last year, more than half of adults feel that their mental health has deteriorated over the course of the pandemic.

As stressful as the virus has been across society however, the level of worry has often been particularly pronounced for those working in the emergency services. This is true whether operating on the frontline, or ‘behind the scenes’ taking calls, with both environments now presenting challenges that were unheard of this time last year.

Even before the pandemic however, there was a marked increase in the level of awareness regarding the mental health of emergency services personnel. This is demonstrated by the likes of the aforementioned charity’s ‘Blue Light Programme,’ as well as by BAPCO itself, via the inclusion of a number of related sessions at last year’s annual Conference & Exhibition.  

Lack of closure

As mentioned, one of the most stressful emergency services environments is the control room, a fact which - thankfully - is now starting to receive the level of recognition it deserves. Proof of this, according to the BAPCO website, is the fact that over half of public safety communications professionals “screen positive” for a “mental health injury.”

Elaborating on these figures, immediate past president of the American National Emergency Number Association (NENA), Monica Million, says: “Mental health is a big issue in United States control rooms, and from what I’ve seen, the situation is exactly the same in UK as well. In the US we’re currently seeing considerable PTSD rates amongst personnel, as well as things like alcohol dependency, just to help people cope.”

She continues: “For decades, control room professionals have not been given access to the same mental health tools as their first responder partners. This has been due to the - entirely inaccurate - notion that if you don’t see something, you can’t be affected by it. The idea of ‘vicarious trauma’ is very real however, and it’s something which control room staff have to deal with every day.”

For Million, rather than easing the burden of the job, the ‘auditory’ nature of control room personnel’s interaction with the public actually has the effect of making things more stressful. This is in part due to the workings of the human mind, in particular its tendency to imagine the worst in every situation. Perhaps even more insidious however is complete the lack of closure once a call has come to an end.

Discussing this, she says: “For me, one of the huge mental challenges of this job is that we never get to find out what happened to the people who rang us for help. Did they survive? Did the woman who was hiding in the closet get away from her husband? That lack of information then leads us to create pictures in our minds about what’s happened, which in itself can be damaging.

“Once the call has ended meanwhile, we then have to move straight on to the next one. No matter how traumatic it was, you have to hang up and gather yourself, with no opportunity to process any anxiety or sorrow associated with the previous call. This happens many times a day.”

Amy Keogh is an emergency services call taker, working for West Midlands Ambulance Service. Despite operating thousands of miles away from Million, she tells a very similar story when it comes to the inherent stresses of the role of emergency services call taker.

Talking about her background, she says: “I’ve done two and a half years of taking 999 calls, after which I was moved to the 111-control room in the summer. I’ve seen both situations, and the toll they can take on people.

“On the emergency [999] side, I would say that lack of closure following on from the conversation is a major source of distress. The other side of that is that you never know what’s coming when you pick up the next call. The beep goes off in your ear and you don’t know what to prepare yourself for, which in itself is a source of adrenaline.”

She continues: “I’ve been in situations where one minute I’ve been answering a hoax call, with somebody swearing at me down the phone, and the next call is a woman screaming that her baby’s stopped breathing. Over the course of a 12-hour shift, you take about 60 calls, so the opportunity for stress is immense."

As discussed, over half of emergency services call takers suffer with some kind of issue related to their mental health. More often than not, this has been, if not created, then certainly exacerbated by, their experience of the job.

Discussing her own wellness issues in this regard, Keogh says: “I used to have anxiety as a teenager, and that certainly plays into any stress I might feel around the calls that come in. I also had a stroke when I was 19, about a year before I started here. I still suffer from PTSD because of that experience.

“Like a lot of people who do this work, any trauma I go through is often related to experiences that I’ve had in my personal life. For instance, the first time I took a call from a young woman who seemed to be having a stroke, I just couldn’t handle it. She sounded so helpless, and I just wanted to jump through the phone and be there with her.”

She continues: “To take another example, a colleague of mine recently lost a family member to suicide. Since then, she’s taken a couple of calls from mental health patients threatening to take their own lives, and it’s been too much for her. She can’t help but see her own relative in them.

“Instead of putting her back on the phone, we’ve given her an alternative duty such as auditing calls. There’s not a single assessor on my team who hasn’t had to cry in the toilets at some point. Everybody has something that will be close to home.”

No longer afraid

Both Keogh and Million will have many such stories about time spent working in their respective emergency services control rooms. Trauma is the same all over the world after all, as is the inherent fragility of human beings.

With that in mind, it’s probably no surprise that their views on how to look after communications personnel are also quite closely aligned. For both of them it primarily comes down to having the opportunity to talk honestly about experiences, something which relies on having a strong support network both at work and at home.

“The culture is really changing in the US now, which is something I’m extremely glad about” says Million. “Agencies across the country are now really doing their best to stand-up programmes for personnel, both on the frontline and in the control room. We’ve had to battle against a prevailing ‘hero culture’ for years.

“One of the very first things that became available was peer support teams, which are made up of individuals trained to check on people after traumatic events or really hard calls. We’re now also seeing regular check-ups being provided by psychological professionals.”

According to Keogh meanwhile, this growing awareness of mental health at an organisational level has also been accompanied a fundamental change of attitude on the part of those taking the calls. Or to put it another way, they’re no longer afraid to ask for help, whether from colleagues, or the staff advice service which is now available across West Midlands Ambulance.

“As a supervisor, I’ve come to understand - as we all have - the importance of communication,” she says. “I have a lot of staff come and talk to me now, particularly after a difficult call. We just try and be as supportive as possible, saying take as long as you need and come back when you’re ready.

“From my perspective, I don’t believe you’d actually be able to do the job without having the opportunity to talk about what’s happened. I’m lucky in that my partner is a paramedic, so we can discuss cases - always anonymously - over dinner. Most people don’t have that, so it’s vital that we have other measures put in place.”

As mentioned above, as well as the usual stresses and strains of the job, emergency services personnel are also now having to deal with the added pressures of working during the COVID-19 pandemic. This is certainly true of those on the control centre side, who not only have to work through concerns about their own safety, but also witness the potential impact of the virus on those calling in.

This first concern has been illustrated several times in the past few months, with the likes of Northern Ireland Ambulance Service increasing their control room space in order to help their people socially distance. West Yorkshire Police meanwhile has gone as far as to enable vulnerable control room staff to work from home, via the use of a VPN.

Discussing the dangers and fears around the virus itself, Million says: “It’s certainly added another level of stress. Obviously, that includes people’s concerns about their own safety, but on top of that there’s now also an added layer of isolation, precisely because of the safety measures which have been implemented.

“People always felt isolated in the control room, because of the hours you did and the nature of the job. Now, we’re not only asking them to socially distance at work, but also to have less contact with their wider family and friends. Going back to our earlier discussion, it’s exactly that kind of interaction - which they now don’t have - which helped them cope.

“I believe that the longer this crisis goes on, the more problems we’re going to see. I honestly think that this year, mental health issues will heavily outweigh those related to COVID-19.”.

Discussing the caller distress element meanwhile, Keogh says: “As I mentioned, in the last few months I’ve been working on the 111 side, which is stressful in a different way from the emergency control room. Whereas with 999, you get these massive traumas being passed on over the phone, with ‘1s’ it’s more about individual stories with an emotional connection.  

“During lockdown, we’ve heard from a lot of lonely people, many of whom are old or vulnerable. A lot of them call saying that they’ve got a physical ailment, but really all they want is someone to speak to.

“On a 111 call you can be talking to someone for 20 minutes, because the whole idea is to build up a really good rapport. When someone’s talking to you about how lonely they are, that can again be really draining.”

It’s impossible to even begin to cover the needs and experiences of emergency services call takers in the space of a few pages. Suffice to say that it is a crucial - you might even say heroic – task, carried out by people utterly dedicated to the wellbeing of the public.

For anyone reading this who might be struggling with their own wellness meanwhile, the only advice is seek out whatever help is available. After all - to quote the first thing said by Keogh during our conversation -, “we need to get rid of the taboo around mental health. The more we talk about it, the better.” 

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Media contact

Philip Mason
Managing Editor, Critical Communications Portfolio
Tel: +44 (0)20 3874 9216