Fight or flight: focus on medics’ mental health

Emotional stress

According to Miles Randell, owner of SARMed School, medics are by their nature likely to be affected by what they encounter in their work. “At our core, medics care about the people we are providing medical support for. That is why most medics got into the field. Also, many medics come from childhood trauma, and chose the medic trade as a way to give back and to feel their efforts are making the world a better place than the one they grew up in,” he said.

Routinely experiencing critical incidents, enduring moral trauma and betrayal trauma all add up to stressors and trauma that need to be supported and treated appropriately

Frequently seeing and experiencing significant traumas, particularly involving children or people they know well, can be very damaging for a medic’s mental health, pointed out Randell. “Routinely experiencing critical incidents, enduring moral trauma and betrayal trauma all add up to stressors and trauma that need to be supported and treated appropriately,” he said. “In my personal history, attempting to resuscitate my team leader and friend of 20 years amplified all the traumas that I had endured. When I reached out for help, for example, I was stigmatized, gaslit, discredited, driven to attempt suicide, and my career ended.”

When a medic’s career ends due to mental health injury, they suffer a loss of identity, loss of community, and isolation, affirmed Randell. “We also suffer the loss of what support networks might have been available while being employed. This is often a direct pathway to suicide. Physical strains are very real and do take their toll on a medic, and there is a wealth of support to treat and rehabilitate physical injuries; however, mental health injuries are not viewed with the same lens as physical injuries,” he said. “There exists a massive stigma with mental health injuries that often creates a barrier that prevents medics from seeking mental health support and treatment. Fear of loss of career advancement, complete loss of career – which is a tragic reality – shame, and being viewed as weak by colleagues frequently prevent medics from asking for help. This is in stark contrast to the support available for physical injuries.”

Signs of mental health issues

Signs of mental health injury can present as hypervigilance, nightmares, flashbacks, paranoia, insomnia, trouble concentrating, irritability, loss of or excess of appetite, withdrawing from social situations, anger management issues, divorce, substance abuse, risk taking, and suicidal ideations, explained Randell. “Often the diagnosis alone is challenging to hear and understand. Being diagnosed with post-traumatic stress injuries (PTSI) most often also means a diagnosis of severe depressive disorder, anxiety, and insomnia, and all of these are particularly hard to accept as a medic,” he highlighted.

According to Randell, helping someone who is enduring mental health injuries is very challenging. “The stigma and shame make it very difficult to persuade someone enduring mental health injuries to reach out for or accept help,” he pointed out. “I endured 20 years of mental health injury without seeking help because I felt that my career would be impacted if I went on the record as having a mental health injury – and that feeling was correct.”

Return on investment

The stigma and shame make it very difficult to persuade someone enduring mental health injuries to reach out for or accept help

In April 2024, the UK’s Royal Aeronautical Society (RAeS) issued a briefing paper entitled ‘Psychosocial Risk Management and Mental Health: the mental health challenge to civil aviation safety in the 21st century’  with the goal “to contribute to the discussion around the inclusion of the management of psychosocial risk in the workplace, as it impacts all aspects of the mental health and wellbeing of safety critical groups, within a proactive safety management perspective for the industry”, the paper said.

There is a body of evidence that shows that investing in mental health and wellbeing programs provides a positive return on investment (ROI). The European Union (EU), International Labour Organization (ILO) and World Health Organization (WHO) have produced information demonstrating that investments in organizational mental health programs have a positive ROI in addition to other gains, according to the RAeS briefing paper. “This information would suggest that there are positive ROI benefits to organisations from investing in comprehensive mental health programmes which would translate into civil aviation,” the briefing paper said. “The financial evidence from other sectors would suggest that there could be clear financial benefits when implementing a comprehensive psychosocial risk management solution addressing mental health challenges. It could also be an integral part of organisational risk management if integrated into an SMS [safety management system] in aviation stakeholder organisations.”

Services and support

According to Randell, a workplace program that pairs a medic with their best work buddy, a little like a soldier’s battle buddy, is an effective practice. “This person is often the first to notice symptoms of mental health injuries and can provide support or reach out for formal mental health treatment if it is needed,” he explained. “There is a growing amount of support for mental health injuries, which is a very positive change; unfortunately, however, there are still challenges with stigma that are barriers to reaching out for that support.”

Progress has been made on reducing the stigma, pointed out Randell. “Mental health advocates are helping reduce the stigma, but unfortunately it still remains, and a diagnosis of PTSI cripples some potential future careers, such as becoming a pilot, law enforcement and others.”

Mental health treatments such as eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), and groundbreaking pharmaceutical trials are showing great success

He added that the range of treatments available for mental health conditions has also improved: “Mental health treatments such as eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), and groundbreaking pharmaceutical trials are showing great success. And post-traumatic stress index-specific service dogs make a huge difference.” 

Under existing health and safety (H&S) legislation, EU member states typically require employers to conduct risk assessments that encompass psychosocial risks, affirmed the RAeS briefing paper. “These assessments help identify potential stressors and provide a basis for implementing preventive measures. Employers are, based on the assessments undertaken, expected to take appropriate measures to prevent or mitigate psychosocial risks,” the paper said. “This may include improving workplace conditions, addressing workload issues, and providing support mechanisms, like employee assistance programmes.”

Within the EU H&S legislation, workers have a right to participate in decision-making processes related to their health and safety, including those concerning psychosocial risks, reported the RAeS briefing paper. “A possible solution approach lies within ISO 45003, which is a framework which supplements the widely used ISO 45001 in terms of workplace Health and Safety,” the paper said. “ISO 45003 is an international standard published by the International Organization for Standardization (ISO). It specifically addresses the management of psychosocial risks in the workplace. ISO 45003 provides a framework for organisations to manage and promote psychological health and safety at work. The standard outlines a systematic approach to identifying, assessing and managing psychosocial risks. This includes considering factors, like workload, job design, workplace culture and employee wellbeing. In total the Standard identifies typically 13 risk categories covering organisation structure, culture and interpersonal issues.”

Summing up

Psychosocial risk management will be a core element of creating successful, sustainable organizations in 21st-century global civil aviation, according to the RAeS briefing paper. “The sector has faced similar challenges in the past and met them with adaptable approaches within a clear international framework that contributes to the safe and efficient operation of key stakeholders,” the paper said. “An example of this is the evidence-based and data-driven approach taken to Fatigue and Fatigue Risk Management for pilots which offers lessons relevant to both how to, and how not to implement a programme of this nature.”