Wavne Rikkers

This paper describes the development and validation of the Post-Traumatic Stress Disorder Assessment Scale for Emergency Services (PASES). The PASES was developed to address the needs of Australia's first National Mental Health and Wellbeing Study of Police and Emergency Services, Answering the Call (AtC) which covered Police, Ambulance, Fire and Rescue and State Emergency Services personnel. PASES offers several advantages for use in the emergency services sector over other Post-Traumatic Stress Disorder (PTSD) screening scales, including assessment of functional impairment, a dimensional measure of severity which includes identification of sub-threshold cases experiencing distress and impairment, and allowing for experience of cumulative trauma. Analysis of Composite International Diagnostic Interview (CIDI) data from a large national sample identified PTSD symptoms that usually co-occur allowing streamlining of the scale with minimal information loss. In a large sample, PASES had high specificity and adequate sensitivity in comparison to self-reported PTSD diagnosis. Data from AtC supported there being a strong dimensional gradient in distress and associated harms, including suicidal behaviors, across the levels of severity of the PASES. In a subsample of 191 fire sector employees who completed both PASES and PCL-5, both scales had equivalent discrimination compared with self-reported diagnosis of PTSD by a mental health professional. The paper also presents population data for Australian volunteer and employed emergency services personnel collected in AtC.

Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.

Objective: This study aimed to determine patterns of help-seeking among first responders for conditions such as post-traumatic stress disorder (PTSD) and psychological distress. Method: Data from Answering the Call, the Australian national survey of the mental health and wellbeing of police and emergency services, was analysed to determine mental health help-seeking associations, as well as to measure patterns of service use. This encompassed 14,868 employees across the ambulance, fire and rescue, police, and state emergency services sectors. Results: Over half of employees needing help for a mental health issue neither sought nor received help. First responders with severe mental distress who delayed seeking help reported that they needed a lot more help than they received. Poor help-seeking behaviour and experiences were found to be associated with high levels of PTSD and psychological distress, low levels of mental health literacy, and career concerns. No significant differences were found between the sectors with all employees exhibiting high levels of poor help-seeking behaviour. For organisation-sourced services and programmes, usage levels and perceptions of usefulness were consistently low. Conclusions: Findings support the importance of early help-seeking amongst first responders with emerging mental health conditions. All sectors exhibited sub-optimal help-seeking behaviour and experiences. The problems go beyond the organisational structures, policies and programmes of any individual sector and are likely to be systemic. While all organisations provide mental health and wellbeing programmes and services, they are either not well taken-up, or are not considered sufficiently useful by the people they are designed to help. KEY POINTS What is already known about this topic: What this study adds:

Purpose To assess employees’ experiences of the workers’ compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers’ compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers’ compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6–9.8) while 70.3% had a poor experience (95% CI 67.6–73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers’ compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.

Concerns have been raised of a potential connection between excessive online activity outside the academic realm and increased levels of psychological distress in young people. Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing provides estimates of the prevalence of online activity and allows an exploration of associations between this activity, a range of mental disorders, socio-demographic characteristics and risk taking behaviour. Based on a randomized nationally representative sample, a household survey of mental health and wellbeing (Young Minds Matter) was conducted in 2013-14. Interviews were conducted with 6,310 parents and carers of 4–17 year-olds (55 % response rate), together with self-report questionnaires completed by 2,967 11–17 year-olds in these households (89 % response rate). The survey identified a range of mental disorders and emotional problems using a variety of diagnostic tools, with the self-report including questions about use of the Internet and electronic games. Five behaviours were measured related to this activity, with ‘problem behaviour’ being defined as exhibiting at least four out of five behaviours. Levels of Internet use (98.9 %, CI 98.5–99.3 %) and electronic gaming (85.3 %, CI 83.9–86.6 %) were high, and 3.9 % (CI 3.2–4.6 %) of young people reported problem behaviour. The proportion of girls with very high levels of psychological distress and problem behaviour (41.8 %,CI 28.8–54.9 %) was twice that for boys (19.4 %, CI 7.7–31.1 %). Those engaging with a range of risk factors reported higher prevalence of problem behaviour than others. Youth who suffered from emotional problems or high levels of psychological distress spent the most time online or playing games. Multivariate analysis showed associations with problem behaviour and having attempted suicide, experiencing high to very high levels of psychological distress, using alcohol, and living in a poorly functioning family. It was not possible to determine the direction of the associations. There are links between problem behaviours associated with Internet use and electronic gaming, and mental disorders and risk-taking behaviour in young people. Further studies are required to determine whether these are precursors or sequelae.

The aims of this study were to assess participatory methods for obtaining community views on child health research. Community participation in research is recognised as an important part of the research process; however, there has been inconsistency in its implementation and application in Australia. The Western Australian Telethon Kids Institute Participation Program employs a range of methods for fostering active involvement of community members in its research. These include public discussion forums, called Community Conversations. While participation levels are good, the attendees represent only a sub-section of the Western Australian population. Therefore, we conducted a telephone survey of randomly selected households to evaluate its effectiveness in eliciting views from a broader cross-section of the community about our research agenda and community participation in research, and whether the participants would be representative of the general population. We also conducted two Conversations, comparing the survey as a recruitment tool and normal methods using the Participation Program. While the telephone survey was a good method for eliciting community views about research, there were marked differences in the profile of study participants compared to the general population (e.g. 78% vs 50% females). With a 26% response rate, the telephone survey was also more expensive than a Community Conversation. The cold calling approach proved an unsuccessful recruitment method, with only two out of a possible 816 telephone respondents attending a Conversation. While the results showed that both of the methods produced useful input for our research program, we could not conclude that either method gained input that was representative of the entire community. The Conversations were relatively low-cost and provided more in-depth information about one subject, whereas the telephone survey provided information across a greater range of subjects, and allowed more quantitative analysis.

Measures of the gap in living standards, life expectancy, education, health and employment between Indigenous and non‐Indigenous Australians are primarily derived from administrative data sources. However, Indigenous identification in these data sources is affected by administrative practices, missing data, inconsistency, and error. As these factors have changed over time, assessing whether the gap between Indigenous and non‐Indigenous Australians has changed over time, based on data unadjusted for these sources of error can potentially lead to misguided conclusions. Combining administrative data on the same individuals collected from different sources provides a method by which a more consistent derived Indigenous status can be applied across all records for an individual within a linked data environment. We used the Western Australian Data Linkage system to produce derived Indigenous statuses for individuals using a range of algorithms. We found that these algorithms reduced the amount of missing data and improved within‐individual consistency. Based on these findings, we recommend our Multi‐Stage Median algorithm be used as the standard indicator of Indigenous status for any reporting based on administrative datasets when multiple datasets are available for linkage, and that algorithmic approaches also be considered for improving the quality of other demographic variables from administrative data sources.