Post-Traumatic Stress Disorder in Maritime SAR Search and rescue workers often face stresses that are not present in many other fields of work. A job that requires a person to put themselves in harm’s way repeatedly carries a high risk to their physical and mental health. Research indicates that Post Traumatic Stress Disorder (PTSD) amongst first responders is comparable to that of combat veterans. But first responders rarely seek help, because of concerns about appearing weak or what their fellow SAR colleagues will think, or because they think they can handle it. PTSD is not uncommon amongst maritime SAR professionals, Enrico Menezies, a full-time practical training instructor with National Sea Rescue Institute South Africa talks about his experiences and how he thinks this important issue should be approached… Do You Think PTSD Is an Issue for Maritime SAR Professionals? Yes, it definitely is an important issue. We work with volunteers from all kinds of cultural backgrounds, walks of life and different circumstances. Many already have traumatic situations stored in their memories and all it takes is some event or training session, or even a smell or eating something to unleash it and send them over the edge. We expect our volunteers to be tough with no emotions or feelings, but that’s not fair or realistic, and too often when a person or volunteer becomes emotional or breaks down it’s seen as a sign of weakness. Before Working in Search and Rescue, Had You Heard of PTSD? I have known about PTSD for many years. Even before it was given the name PTSD. I served in the South African defence force during the war in the early 80’s and one of my very close friends was a Vietnam veteran. How did we deal with it then? We drank beer, when the beer didn’t work, you drank brandy, when that didn’t work anymore you drank rum, when that did not work anymore many took their own lives or ended up on the streets. It was an embarrassment to yourself and your family to seek help for PTSD, which is why so many people still refuse to deal with or openly speak about mental health. Have You, or Someone Close to You, been Affected by PTSD? Yes, I came unstuck in 2015. The tell-tale signs were all there - detachment from others, anger outbursts, short tempered, taking it out on loved ones, mistrust of crew close to me, nightmares, not washing myself, loss of interest and kicking the dog when all he wanted was some attention. But I didn’t see the signs and refused to listen when family and friends told me that I needed help. I thought I was rough, tough and of all people I didn’t need help, I thought I could deal with it in my own way… WRONG VERY WRONG!! Then one day I woke up and realized something was wrong, everything including my family was gone. I was out in the street sleeping under a box. All my supposed friends were gone, my child feared me, my partner did not want anything to do with me and the dog ran away soon as he saw me. I was on the verge of losing my job. Fortunately, I was strong enough within, I swallowed my pride, dropped my ego and went for help. Luckily, I knew where to go and from there I had one friend who picked me up, believed in me and gave me a second chance. It has been five years and I still struggle from time to time, as I said it never goes away you just got to have that support and understanding of caring people to help you manage it properly. You cannot do it on your own. I still work with that friend today, we tell our story, teaching others how to deal with stress and PTSD and go out on rescues - thank you Graeme Harding. How Does PTSD Differ from Something Like Anxiety or Stress? Stress is anything that has the potential to upset our wellbeing and balance. Stress refers to the initial response that arises immediately after a traumatic event, while PTSD refers to the long-term aftermath of that traumatic experience. Anxiety can persist for individuals with a history of trauma, and will affect the way they handle stressful situations, even their everyday life. PTSD could result from living through dangerous or traumatic events, getting hurt, seeing someone else injured or dead, trauma associated with children, having little or no social support, substance abuse, mental illness and I am sure there are many more. Have Any of Your Previous Jobs Offered Mental Health Support? No, none of my previous employers ever offered help. We do not speak about it at work, but SAR organisations definitely need to consider it. As an organisation you take your staff or volunteers into unknown traumatic situations. The least we can do is to put in place appropriate systems to help and support them. If you have a headache you can go to the pharmacy, buy a pill and the headache goes, with PTSD there is no magic pill. It is very long journey of recovery and some never recover. For many, PTSD can be triggered again at any time, but it can be managed. What Would You Like to See Happening to Protect the Mental Health of SAR Volunteers? I would welcome training sessions and open discussions on PTSD, tips for dealing with it and how to spot the signs of PTSD. I’d like a better consideration of who will go on the call out, better briefing beforehand and proper debrief afterwards regardless of the time it takes. Often, we find people are in a hurry to go home and debrief sessions are rushed. Closure is vital and during a debrief it is possible to spot if one of your crew is struggling and may need further help. At NSRI South Africa, the training department does a presentation on PTSD and we cover ‘dealing with stress’ in many of our courses. We also encourage all the stations to have an open policy on this subject. How Easy Is It to Get Help for PTSD in the Worldwide SAR Community? At NSRI it is easy to get help. Funding is available and we take the matter very seriously. At every presentation I have delivered on dealing with stress and PTSD, several people have approached me afterwards asking for help. A lot of times all it takes is for a person to identify the illness during a presentation, for them to realize they have a problem and then they break down. I have seen many very tough men cry. Real men do cry, and it is nothing to be ashamed off. I don’t think the wider SAR community realises PTSD is a problem, too often people don’t know how to address it or think it’s easier to let you deal with it yourself. Does Work Culture Influence the Handling of PTSD? Yes, definitely. In my experience the approach is usually to toughen up - if you are weak you don’t belong here - is normally the attitude. But it’s not a weakness; it is an illness or injury that needs to be dealt with very carefully. It never goes away but with help and support you can manage it effectively. Do You Think People in SAR Are Comfortable Talking About Mental Health or PTSD? No, at NSRI, our turning point was after a plane crash in 2011 where several people were killed and dismembered. It took quite a while before our volunteers could speak about their experiences and it highlighted how we had never prepared them for such a situation. We all understandably, focus on the happy ending, but actually the rescue might be very traumatic, and it might just be a body bag that you bring back. Are There Any Cultural Factors Involved in the Way People View PTSD? Yes, I think so, cultural factors can modify the response to trauma. Many cultures believe strongly in fate or accept the role of divine intervention on top of an individual’s own psychological response. Added to which there are so many misconceptions about PTSD, that only soldiers get it, people with PTSD are weak, people with PTSD are dangerous, PTSD cannot be treated, everyone who experiences trauma will develop PTSD, everyone with PTSD have the same experiences and symptoms and PTSD will just go away. Do You Have Any Advice for People, to Help Them Understand Post-Traumatic Stress in SAR? Do what we have done in NSRI - anyone who has experienced it shares their experience with others. We discuss the signs, and the symptoms but most of all we work to maintain an open discussion and a supportive environment without stigma. What is the Best Way to Show Support for a Diagnosed Friend or Co-Worker? You don’t always have to say anything, sometimes all it takes is just to be there for them and their loved ones. But do encourage that person to seek help, and get to know them and what triggers it, so you can judge if they are the best person to take on a call, if not there are many other key roles they can fill and still be valued. What Would You Like to See Moving Forward to Address this Issue? Every SAR community needs to address this nationally, and then with other SAR teams from around the world, internationally. Hopefully one day a cure or magic pill can be found to assist all those that are suffering from PTSD. But, in the meantime, SAR organisations must accept responsibility and be accountable for exposing their crews and volunteers to traumatic events. We must educate ourselves, put safety precautions in place and where this fails - provide our crews and volunteers with effective trauma counselling. PTSD is an important issue and the IMRF is creating a forum to allow members to share any resources on this subject and to discuss experiences, best practice, training and what might be needed for our industry moving forward. To get involved and find out more, just e-mail [email protected].