Head first: mental wellness resources designed for the ambulance service

Themed around mental wellness, resilience and recovery, this web page includes tips for individuals, teams and organisations.

16 January 2020

At NHS Employers, we are committed to normalising and encouraging mental health discussion to make the ambulance service a place that promotes positive mental wellbeing. We know that support and reliable information can make a real difference, so Head First has been developed in partnership with employers and trade unions and is supported by the Association of Ambulance Chief Executives and the National Ambulance Strategic Partnership Forum.


Whether you’re looking for self care, to find out how you can support a colleague or wish to find out more for your organisation, the Head First web page is a great place to start. Throughout this content when we refer to mental health, we are talking about your overall mental wellbeing, so how you think, feel and behave.

With over 14,000 emergency services staff and volunteers, research shows that it’s particularly important for people in the ambulance service to look after their mental wellbeing.

Mind’s research (PDF) shows that:

  • ambulance service personnel are more at risk of developing a mental health issue than the general population
  • 91 per cent of ambulance personnel have experienced stress and poor mental health at work
  • ambulance service staff and volunteers work hard to prevent mental health problems affecting their performance at work, but this can impact relationships with friends and family.

It is now more important than ever that individuals and teams look after their mental wellbeing. To support staff and employers ensure that they are prioritising their mental health there has been a range of resources that have been created. We have divided this resource into easy sections to help you to access the information you need to rest, recuperate, and support your colleagues.

  • When we work in a caring profession such as the NHS, we often forget the importance of looking after ourselves. We cannot provide high quality care if we are not first taking care of ourselves. Take time to notice how you are feeling and consider these five ways to wellbeing developed by the New Economics Foundation (NEF):

    1. Connect – when did you last speak to friends/relatives?
    2. Be active – how active are you each day?
    3. Take notice – do you make time to stop and notice what is going on around you?
    4. Learn – when did you last learn something new?
    5. Give – how do you show people you care and appreciate them?

    When you’re experiencing mental ill health, it is sometimes hard to notice the subtle changes in how you think, feel and behave. It can also be difficult to admit that you are not yourself and may need support. Making some positive lifestyle changes can help manage symptoms of poor mental health and prevent it from getting worse. Check out the One You programme, which has information and resources on smoking, drinking, eating and sleep.

    The mental health charity Mind has some key tips on how you can look after your mental health:

    • Nourish your social life – are you regularly making time to meet friends and family virtually or in person?
    • Try peer support – when did you last have a chat with a trusted colleague about how you are?
    • Make time for therapeutic activities – what do you do to relax? When did you last make time for this?    
    • Look after your physical health – what do you do outside work to keep active?
    • Contact a specialist organisation – would you know where to go for support if you needed it?
    • Challenge stigma and discrimination – what can you do to create a mentally healthy workplace?

    Explore what support you can access in your organisation

    Most organisations will offer occupational health, counselling, peer support and mental health champions. Your union representative is also a useful source of support and information. Talk to your colleagues and share what you know. You may also want to consider the organisational stance on supporting staff by looking at the health and wellbeing strategy, sickness absence policy, and by chatting to a union rep.

    The NHS Employers emotional wellbeing toolkit provides tools, resources and links to national organisations providing support.

    Make use of available training and resources

    Make the most of any training and resources available to you, as they are provided to help you remain well in your role. Accessing training and resources can improve your understanding and awareness of issues and can prevent problems from escalating. Your ambulance trust staff web pages will have more information about what is available to you locally. Training is also available to you from outside your organisation. You could discuss this with your manager to see if there is anything they can do to support you further.

    To find more information about what is available locally explore your ambulance trust’s web pages/intranet.

    How to support yourself after a tough time

    Following a tough time, it’s important to reflect on how you can prevent mental ill health in the future. This can include assessing what you would do again or do differently that could prevent the same impact reoccurring.

    What have you learned? Review your wellbeing action plan

    When you feel ready it is helpful to reflect on what you have learned about yourself and what you would do differently to maintain good mental health.

    • Consider the following to help you in the future:
    • Can you identify key indicators or behaviours when things were getting tough?
    • Was there a particular thing that happened or was it a build-up of issues?
    • What can you do differently to prevent the same impact occurring again?
    • You may want to share your experience with others as a way of moving forward but also to help others now or in the future.

    A wellbeing action plan focuses on overall wellbeing and should include what keeps you well at work, what has a negative effect on your wellbeing, and how to address health issues. Mind has developed an ambulance-specific guide, seeking help for a mental health problem that you might find useful and also provides free guidance and templates for staff and managers on wellness action plans (WAPs).

    You can also look at creating a wellbeing menu. Blue light champions recommend a list of actions that make you feel good. This menu can be used to support your mental health as and when needed. 

    Look after yourself - focus on getting well again

    Be patient with yourself, it can take time to fully recover. It is important to prioritise looking after yourself and focus on your physical and emotional energy. You can do this by:

    • taking regular breaks
    • responding to challenges
    • connecting with others
    • eating healthily
    • making time for exercise
    • taking breaks from social media
    • ensuring you have enough sleep.

    Be aware of your feelings and monitor your emotional reactions

    Going forward it may be helpful to regularly check in on how you are feeling. Take a look at the NHS Employers how are you feeling toolkit, which looks at emotional wellbeing and the impact this may be having on you, your colleagues and on patient care.

    This tool encourages you to consider how you are feeling day to day and track whether you are having more good days than bad. This has been proven to help monitor mental health and enables you to take steps to support yourself when needed.

    Talk about it

    Sometimes the most helpful thing you can do is to talk to someone you trust. This could be a friend, family member, colleague, union rep, or your manager. It doesn’t have to be an in-depth conversation about your mental health, but just making a connection and talking about not feeling yourself can be helpful.

    Sharing your experience with someone you trust can help in the future, as they may be able to help spot when you’re struggling.

    Read about paramedic Neil’s story to see how talking to someone helped. 

    Continue to access support

    Continue to access any support that has enabled you to improve your mental health. This might be continuing occupational health reviews, counselling or GP appointments until the agreed end date.

    If you confided in a friend, family member or colleague it can be helpful to continue to have those conversations. You could suggest discussing more general wellbeing to maintain this support.

    To find more information about what is available locally, explore your ambulance trust web pages.

    Additional resources

    You might also find the following links useful to support you with your own mental health, resilience and wellbeing:

  • It’s important to talk about mental health with your staff and colleagues, and this can be as simple as asking how they are. The key to normalising mental health discussions is to make conversations about mental health a part of everyday life. You are not expected to have all the answers but opening a conversation about general wellbeing can be a great help.

    Line managers play a key role in improving the mental health and wellbeing of NHS staff, however, many managers within the NHS do not feel confident in speaking to their staff about mental health as it's often perceived as a challenging issue.

    It is not expected for managers in the NHS to be mental health experts, but an understanding of how to support staff and how to have open conversations about mental health problems will help create a positive culture around mental wellbeing. Line managers can do this by:

    1. Knowing your team and colleagues

    Notice changes in your colleagues and team. Even if you don’t work face to face with your team you will still be able to notice if they don’t sound or seem themselves.

    • Check this out by asking if they are OK and listen to their response. Showing you care and have noticed can make a real difference to their mental health.
    • Make it a priority to ask your team how they are doing. Getting to know your colleagues can create a more supportive and caring team environment. Introduce ‘check ins’ at the start of meetings or one-on-one opportunities, this will give you an indicator as to how people are feeling and if any additional support is needed. Take a look at our guidance on how to hold a successful wellbeing conversation.
    • Lead by example. What do you do if you are having a tough time? Be more open and honest when things are difficult, your team will feel more comfortable speaking up when they’re not OK. Listen to our podcast to hear from Gloucestershire Hospitals NHS Foundation Trust's chief executive, Deborah Lee who lead the way by talking about her own experience of mental health.

    2. Knowing what is available and where to access support for your staff

    Be informed. There are many avenues of support for staff, the key is knowing where to signpost staff to.

    • Speak to your staff side representative, HR or health and wellbeing lead to find out the support available within your organisation. This could include a counselling service, mental health champions or fast-tracking to local support.
    • Encourage staff to have a good work/life balance including facilitating flexible working where possible. Make staff aware of your organisation's flexible working policies.
    • Encourage staff to have a good work/life balance including facilitating flexible working where possible. Make staff aware of your organisation's flexible working policies.
    • Occupational health provides confidential support for staff so it is helpful for you to know how to contact them.
    • Mind’s web pages on how to support staff who are experiencing mental health problems (PDF).

    3. Knowing how your organisation and team support the mental health of staff

    All ambulance services have signed up to Mind’s Blue Light Time To Change pledge. Your organisation will have made its own individual pledges, but they are likely to include commitments such as:

    • demonstrate senior level buy in
    • demonstrate accountability and recruit employee champions
    • raise awareness about mental health
    • policies to address mental health problems in the workplace
    • commitment to sharing staff stories and experiences
    • equipping line managers to have conversations about mental health
    • provide information about mental health and signpost to support services.

    You might want to consider how you can put the pledge into practice within your team. Knowing what you can expect from your colleagues and what is expected from you is important.

    • Talk to your colleagues about how you all want to respond if one of you isn’t having a good day.
    • Discuss lines of communication. Face-to-face time isn’t always possible, so find out if your colleagues would be happy to chat over a call, email or text.
    • Add wellbeing conversations to team meetings agendas. A quick chat on your colleagues’ physical and emotional health will help normalise the mental health discussion.
    • View the Mental Health Foundation's web pages on supporting someone with a mental health problem.

    How to support a colleague or a member of staff after a difficult time

    Our mental health can be affected by any number of reasons including both work-related and non-work-related issues. The impact this has and length of time this lasts depends on many factors, including the resources that are available to help us deal with the issue.

    When things are tough the greatest support can come from those around us and so it’s important to support each other on an ongoing basis.

    Here are some key steps to help your colleagues through a difficult time.

    Take action

    If you have noticed that a colleague doesn’t seem to be their usual self you will need to decide on the best way to approach them:

    • Ask if they are ok and listen to their response. Showing you care and have noticed can make a real difference to their mental health. If you don’t feel comfortable doing this then flagging to a colleague who works directly with them, in confidence, can be helpful.
    • Don’t worry about not having the answers, supportive listening can provide exactly what is needed. Take an objective approach as this enables people to disclose more without fear of being judged and promotes a healthier mental health culture.
    • Be mindful of your circumstances. As a manager you may be responsible for covering vacant shifts if a staff member needs a break. Try not to allow your personal frustrations to affect the way you handle the situation.
    • Know the support available. As a manager you need to be familiar with your organisation’s policy and signpost to support services such as occupational health. They will be able to provide further support and advice on any appropriate reasonable adjustments needed.

    Check in with each other and provide support for ongoing needs

    Once you have spoken to a colleague about their mental health it can be helpful to continue to have those conversations.

    You could suggest discussing more general wellbeing to maintain this support. Knowing they have support available can often have a positive impact. Remember to listen without judgement or assumptions to provide the best support.

    Here’s some questions you could ask:

    • Social life – are they regularly making time to meet friends and family?
    • Therapeutic activities – what do they do to relax? When did they last make time for this?
    • Physical health – what do they do outside work to keep active?
    • Sleep – how is their sleep health? Are they getting enough sleep?

    As a manager you could suggest a wellness action plan (WAP). This focuses on what keeps you well at work, what has a negative effect on your wellbeing, and how to address health issues experienced at work. This can also help with future discussions and ongoing support.

    Take notice

    Make time to notice how your colleagues are doing. In our busy roles it is easy to prioritise getting the job done but it is just as important to connect with our team mates.

    When someone in the team is suffering from mental ill health it can also impact on others around them. It’s important that you can identify this quickly and support your colleague to prevent issues from escalating.

    The more you demonstrate to your colleagues that you are observant and you care, the more this behaviour will be reciprocated. Together we can create a more supportive culture that is open to recognising, talking about and supporting mental health.

    In addition to the above steps, as a manager you should ensure that your staff member is continuing to receive support either from yourself or another party such as occupational health. Be sure to explain that the role of occupational health is to provide support to them with their health needs in the workplace as opposed to it being part of a management process.

    We know that taking care of our mental, physical and emotional wellbeing is essential to our ability to work productively and efficiently. Yet when someone returns to work after a period of mental ill health it is often easy to get back into the habits of prioritising work over wellbeing.

    The individual wellbeing of team members can have an impact on the team’s overall performance so it’s vital we support each other every day. Here are four things you could do to support your colleagues or staff after they have been through a tough time.

    Check in with the team

    Make it a priority to ask your team how they are doing. Getting to know your colleagues can create a more supportive and caring team environment. Introduce ‘check ins’ at the start of team meetings or one-on-one opportunities and acknowledge their response, as this will give you an indicator for how people are feeling and if any additional support is needed.

    Learn, review and change

    Consider what have you learned from the support you have provided. Reflect on whether it was helpful for your colleague.

    It’s important to remember that with mental health there is no single approach for everyone, so it is helpful to review what steps you take as a team to support each other’s mental wellbeing.

    Keep learning from experiences and focus on what you and the team could do next time to support one another. You could look at Mind’s how to support staff who are experiencing mental health problems (PDF) or NHS Employers’ team section in the emotional wellbeing toolkit for further exercises to review with the team.

    Be sure to take action and change anything that would improve the way you and your team can support a colleague through a period of mental ill health. Consider how this fits in with the wider organisational commitment and the Mind’s Blue Light Time To Change .

    Share your story

    Stories can be a very powerful way to engage with the team or wider workforce. Staff stories in particular enable people to connect, understand and learn new ways to improve.

    Not all staff will be comfortable to talk about their experience around mental health in the ambulance sector, but if you encourage and support those who are willing to share, their story might help someone else to talk and get support.

    Here are some examples of staff who have shared their story:

  • A comprehensive strategy is essential to tackle the root causes of work-related mental health issues and ensure staff get the appropriate support for their mental wellbeing. Senior leaders, wellbeing guardians, wellbeing leads are responsible for ensuring that their organisations are championing the health and wellbeing of your staff.

    Many measures that can be out in place can be small and inexpensive, however, they can make a huge difference to the wellbeing of your staff. For example ensuring that:

    • regular catchups with managers are out in place
    • providing training for line mangers on how to have difficult wellbeing conversations
    • ensuring that regular wellbeing conversations
    • discussing flexible working hours
    • championing for a strong work/life balance
    • providing peer support.

    It is important that your organisations strategy creates a culture where staff feel able to talk openly about mental health with colleagues, line managers and senior leads.

    There are four steps to take when establishing the support needs of your staff:

    1. Know your staff and organisational data

    First, establish your organisational picture through an internal audit, reviewing your levels of sickness absence in relation to mental health, analysing the current interventions in place and the uptake and effectiveness of these interventions.

    You are likely to have a range of data to collect in order to do this, including:

    • number of staff accessing your employee assistance programme
    • number of staff accessing your counselling services
    • number of staff accessing support via your blue light champions
    • episodes of mental-health-related sickness
    • satisfaction levels of staff accessing counselling services.

    Mind’s introduction to mentally healthy workplaces (PDF) and how to take stock of mental health in your workplace (PDF) resources can also help you with your internal audit. Analysing this data, qualitatively and quantitatively is an important step in forming what support you should provide. Collecting staff views through a generic survey will also help inform your strategy.

    An independent external audit will often provide more reassurance to staff that mental health is a priority for your organisation. Mind’s workplace wellbeing index is a robust benchmark of best policy and practice. It will help you find out where you are doing well and where you could improve your approach to mental health.

    2. Provide information on what support is available

    With staff often geographically dispersed it can be difficult to effectively communicate information on what support is available, so make sure it’s clearly signposted.

    You might want to consider promoting Mind’s Blue Light Infoline, which is a confidential, impartial support line, as some staff may still not feel comfortable about seeking support within their own organisation.

    Take a look at our health and wellbeing top tips to support line managers at work and keep them well.

    3. Set out your expectations and measurements

    Think about which support is optional and which is mandatory. For example, you could make it mandatory for every staff member within the organisation to have a wellness plan. Often the support provided by managers has a huge impact on staff and can affect the outcome and overall experience staff have, so consider training for all line managers on promoting good mental health and supporting staff. It is also helpful to be clear what support is available specifically for line managers and how they can access this.

    You could create an expectations framework so that all staff know what they can expect from the organisation and also what is expected of them. This enables them to be fully aware and engaged with you on how the mental health of staff is prioritised and supported.

    4. Set out your approach to supporting staff wellbeing.

    It is key to ensure that all existing initiatives promoting mental wellbeing in ambulance trusts are brought together under one clear approach so that this can be clearly communicated to your staff.

    All ambulance trusts have signed the Blue Light Pledge to show commitment to challenging mental health stigma. Promoting this within your organisation will help staff to feel supported. A pledge or commitment is only useful if it is actioned and if the impact is felt by staff across the organisation at all levels, so speak to your staff to find out what it means to them. This will help you to understand what actions your organisation may need to take. Having one clear, well-communicated and robustly evaluated action plan will enable this agenda to be continually delivered, reviewed, and improved to ensure the mental wellbeing of staff is truly being prioritised.

    Protecting the health and wellbeing of your staff is vital - without staff being well at work, your organisation could not deliver quality and effective patient care. As decisions made at board level can often impact staff, it’s important to have a member of the board whose role is to ensure any significant changes improve the wellbeing of staff. Take a look at our guidance on what organisations need to do to implement wellbeing guardians as part of the NHS People Plan.

    Additional resources to support organisations:

    You may also find the following links useful in supporting the mental health and wellbeing of your staff:

  • Reviewing and developing the mental health of your workforce is essential to sustaining a responsive, supportive culture and meet the changing needs of your staff.

    Often this is a stage that is also missed as it is easy for the day job to take over, but the positive mental and physical wellbeing of staff should be central to the daily working of your organisation.

    Review against monitoring framework

    Review your organisation’s progress against your monitoring framework on a regular basis. Assessing how you are performing against your expectations and measurements will enable you to know how mentally healthy your staff are and identify further work you need to do. How often you review this may be decided by existing internal structures, but having clear review points will help you keep on track.

    Review of support services offered

    Reviewing the support offered will provide a good indication of whether your staff value the support you provide or whether you need to make further improvements, so it is important you gather staff views during your review.

    Here are three key things you may wish to consider when reviewing the support on offer:

    1. What initiatives are you currently delivering?

    Carry out an audit of the current support on offer, who is delivering the support and how many staff are accessing it? This will include an audit of your employee assistance programme, occupational health services, HR support, blue light champions and any other support you offer.

    2. Through what channels are these initiatives being promoted?

    It is also important to review how you are communicating your initiatives, to make sure your staff are aware of the support available. Take time to think about the effectiveness of the channels you’re using and whether staff and volunteers can easily access them.

    3. Can staff and volunteers provide feedback?

    Think about how staff and volunteers can give feedback on the support you provide as this should form a key part of your audit. You need to ensure that the initiatives you provide are valued by staff and demonstrate that your organisation is making mental wellbeing a priority.

    Review / refresh your Time to Change action plan

    All ambulance trusts across England and Wales have signed the Time to Change pledge. Reviewing and refreshing your action plan on a regular basis alongside your pledge lead and blue light champion will show your staff that you are continuously committed to tackling mental health stigma and discrimination.

    Review your approach to wellbeing

    Your support for staff wellbeing should be documented in your strategy. Where changes are made to your strategy, whether it is to your pledges, actions or initiatives, make sure this is clearly communicated to your staff. Reviewing national frameworks, guidance and evidence to ensure you are incorporating good practice and top tips will also ensure you are supporting staff in the best way possible. Reviewing the core and enhanced standards in Stevenson and Farmer’s Thriving at Work report would also be beneficial.

    Communicate to staff

    Make sure you know about the good practice going on within your trust and communicate it across your organisation. Send frequent communications around the work you’re doing around mental health so you can let your staff know what’s available to them. Ongoing communications will help staff to know you are open to their views and are continuously working to make improvements for them.

    Developing and sharing staff stories is also a really powerful way of raising awareness and showing staff what the organisation can do to support them.

    Ambulance services have recently shared with Mind some of their top tips for communicating to staff:

    1. Having a dedicated intranet page for wellbeing.
    2. Having posters, leaflets and other materials available across all sites.
    3. Running internal events to promote the support on offer.
    4. Setting up dedicated social media.
    5. Using blogs and storytelling of staff who have received support.
    6. Using videos and podcasts of people who have lived experience of mental health issues.

    External reviews

    The independence of an external audit will often provide more reassurance to staff that mental health is a priority for your organisation. Mind’s Workplace Wellbeing Index is a robust benchmark of best policy and practice. It will help you find out where you are doing well and where you could improve your approach to mental health.