Enhancing mental health awareness in emergency services (the ENHANcE I project): cross-sectional survey on mental health stigma among emergency services staff

Abstract

Background The number of mental health-related 999 calls to emergency services has increased in recent years. However, emergency services staff have an unfavourable reputation when it comes to supporting people experiencing mental health problems. Aims To assess the levels of explicit and implicit mental health stigma among accident and emergency, ambulance and police staff, and draw comparisons with the general population. Additional analyses sought to identify which variables predict mental health stigma among emergency services staff. Method A cross-sectional survey of 1837 participants, comprising four independent groups (accident and emergency, ambulance and police staff, and the general population). Results Levels of mental health stigma across all four groups were lower than those reported in recent surveys of the general population by the ‘Time to Change’ campaign. Within this study, explicit levels of mental health stigma were lower among the general population compared with emergency services staff. There was no difference between emergency service professions, nor were there any between-group differences in terms of implicit mental health stigma. The only consistent predictors of mental health stigma were attitudes and future behavioural intentions, whereby increased stigma was predicted by increased fear, reduced sympathy and greater intended discrimination. Conclusions Our findings suggest that levels of mental health stigma have improved over time, but there is room for improvement in emergency services staff. Interventions to improve mental health stigma may be most effective if, in line with the cognitive–behavioural model of stigma, they target attitudes and behavioural intentions.

Suicide among emergency service workers: a retrospective mortality study of national coronial data, 2001–2017

“…as registered healthcare professionals, paramedics face barriers to disclosure and help-seeking for mental health problems and suicidality, including concerns around confidentiality and mandatory reporting. Of note, previous studies have found ambulance personnel report low rates of help-seeking and high levels of stigma (Haugen, McCrillis, Smid, & Nijdam, 2017;Hazell et al, 2021;Rikkers & Lawrence, 2021). Further research into occupation-specific risk factors for suicide among ESW is needed and will be essential to inform future suicide prevention efforts for these groups.…”

“…Both workplace trauma exposure (Harvey et al, 2016; Milligan-Saville et al, 2018) and reluctance to seek help (Carlan & Nored, 2008) have been highlighted as significant contributors to these elevated rates. Whilst there has been improved awareness and provision of mental health support to ESW in recent years (Lawrence et al, 2018; Varker et al, 2018), stigmatising attitudes and low rates of help-seeking still persist among the emergency services (Hazell, Koc, O'Brien, Fielding-Smith, & Hayward, 2021; Rikkers & Lawrence, 2021).…”

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma

“… 1 The effects of mental health stigma are pervasive: stigma reduces help-seeking, 2 , 3 has adverse economic implications via increased unemployment and healthcare costs, 4 and worsens both the mental 5 and physical health 6 of the stigmatised individual. Although mental health stigma may have improved over time, 7 , 8 current levels are still problematic. 9 …”