Steve McDowell retired from the ambulance service with PTSD following a harrowing career. Credit:Dallas Kilponen "The culture is, suck it up and keep going," Mr McDowell said. "I had suicidal thoughts because I couldn't handle the anxiety that I was feeling, but also what the anxiety leads you to, which is drinking, smoking, gambling." When a doctor requested that he be taken off night shifts, the ambulance service requested another certificate proving that he was not afraid of the dark. Infuriated, he emailed the entire NSW Ambulance expressing concern about the attitude of management towards mental health problems and received more than 100 emails from staff outlining similar stories.

Mr McDowell is campaigning for a dedicated support unit staffed by professional counsellors similar to that run by the NSW police, saying the chaplains and peer support program were inadequate to deal with serious mental health problems. "There's a huge drug problem in the ambulance, drug and alcohol, because when people don't know what PTSD or depression really are they use self-medication." An analysis by the Victorian Coroners Prevention Unit found ambulance workers were second only to veterinarians in the likelihood that they would take their own lives, with a suicide rate nearly four times higher than the average. One paramedic said she lost faith in management in her first year of service, when she sought the support of a senior officer after attending to somebody who had received a gunshot wound to the head eight years ago. "His response to me was, 'When you get home, drink a bottle of bourbon, watch some porn and you'll be right'," said the paramedic.

"I felt from there on in, I've got to look after myself." The Black Dog Institute last week released guidelines for diagnosing and treating PTSD among emergency service workers, which include strategies to reduce workplace stigma associated with mental illness and to identify and treat PTSD. NSW Ambulance said it was closely involved in the development of these guidelines. "The nature of the work our staff undertake, particularly our frontline paramedics and Triple Zero (000) call takers, puts them at higher risk of suffering mental, physical and emotional health injuries," it said in a statement. "As an organisation, our focus is not just on treating and assisting staff with PTSD, it is also on preventing its prevalence within our workplace."

It said there had been significant improvements in the understanding and treatment of mental health issues in the last two years and staff were now trained in identifying the effects of stress, what action to take and how to build resilience. The service is currently managing 12 psychological claims with work injury damages cases and 133 staff are undertaking alternative duties. Injured workers receive 26 weeks on full pay before they drop down to the statutory rate of about $470 per week until they can return to their former duties or be medically retired and receive a payout. Australian Paramedics Association assistant secretary Wayne Flint said the ambulance service had good policies, but often failed to follow them. A new policy mandated that every effort should be made for injured workers to be placed in a role equivalent to their former duties, but it remained to be seen whether it would be heeded by case managers, he said.

Injured workers could technically be placed anywhere within NSW Health, but they were seldom offered roles in hospitals, for example, as NSW Ambulance still paid their salary, he said. "They go off with a physical injury and the way the ambulance service fails to deal with it creates a psychological injury," Mr Flint said. TALES FROM THE FRONTLINE A former paramedic, who did not want to be named because she is still fighting the service for her entitlements after resigning earlier this year, said she spent months in a sector office that its inhabitants referred to as "the dungeon". "There were six of us there at that time, and no one ever checked on us, no one ever gave us anything to do, we just sat there on our chairs," she said. "They think they're doing us a favour. But every time I went in and put my uniform on, I was reminded of the fact that I wasn't doing what I wanted to do. I was looking at the train lines outside and thinking, 'That's got to be a better option'."

She eventually got a more stimulating desk job, but some of her peers complained that she had only received the promotion because she was injured, and she was returned to a control centre, which triggered her PTSD and rendered her unfit for any work. "A better option would be to look at the skills of the officers, encourage the managers to create a list of work that they have, and give that to the return-to-work officers," she said. A serving officer, who has sustained three injuries during her career and fought NSW Ambulance over each of them, said nothing had changed in her 13 years of service. "We're in a situation where we care for other people, but no one cares for us. "People are overworked. Pretty much everyone I work with has PTSD. They're angry, they're depressed, they hate patients.