Ambulance workers' trauma.

Ambulance workers and other paramedics are twice as likely to suffer mental health problems than the wider public and much less likely to seek support, according to mental health charity Mind.

Those who have to respond to an emergency, such as the Grenfell Tower fire or the Manchester Arena bombing in 2017, must live with how it has affected them.

One ambulance worker, Dan Farnworth, 32, who joined North West Ambulance Service in 2004, says a 999 call he attended as an emergency medical technician to the scene of a child’s murder in 2015 changed his life radically.

He says: “Before this happened, I thought I was immune to mental health issues and that work would never affect me.”

At first he just felt low but, after 24 hours, he realised he was still struggling. He found that the trauma changed how he behaved at work and home and he suffered nightmares.

He eventually spoke to his friend, fellow paramedic, Rich Morton, which spurred him to get help and he was signed off work for five months with post-traumatic stress disorder (PTSD).

He and Rich Morton eventually to set up their own charity, Our Blue Light, which simulates discussions about mental health in the emergency services, and makes sure people know what to do when a colleague is suffering a mental health crisis.

Dan Farnworth says: "We may learn CPR but not what to do when there is a mental health problem, and it is so important."

He has also worked with the Duke and Duchess of Cambridge and Prince Harry as part of their Heads Together campaign and was recently awarded a Churchill Fellowship, to visit the US and Canada to research a report for Parliament about how their emergency services tackle mental health issues.

He said: "I feel quite good at the moment, I have taken a lot of comfort from being able to help other people. I've also built up my own resilience and have been able to accept that it isn't always going to be OK. I'm more self-aware, which is a great thing.”

Esmail Rifai, 52, who has spent 27 years with North West Ambulance Service, says: ”People see us as superheroes, that we can do anything but we can go home and, quite often, have a massive breakdown."

He had a mental breakdown two years ago and spent time off work from his role as a paramedic to receive one-to-one counselling.

Esmail says: "My breakdown was a combination of lots of different things: pressures of work and the knock-on effect to your personal life. You can't help but take things home."

Shortly after Esmail returned to work, a colleague killed himself and he felt he was at fault. "I could have spoken to him, could have helped him. I was upset that he didn't open up to anybody, or felt he could not open up to anybody.

"I realised I need to do something, to avoid them getting to that stage in life where they feel they have nothing to live for."

Esmail now works for the ambulance service as a clinical safety practitioner and with the charity Mind as one of its Blue Light Champions.

He adds: "Being involved has also given me some solace. Knowing that I'm helping others makes me feel good, gives me a sense of achievement.

"There is no shame or stigma attached to experiencing mental health problems. It is just the same as breaking a bone, except no-one can see that you are suffering. We are not superhuman and are just as prone to illness as anyone else.”

London Ambulance Service’s head of training, Jules Lockett, 48, who started as a call handler 18 years ago, says: "I think there is always a call, or a handful of calls in your career, which remain with you.

"You get a response when you can relate it to your nan, aunty or uncle. Some of the calls are really distressing: people hanging, or in cardiac arrest. Those calls still stay with me.”

Ms Lockett says she has seen greater pressures on staff with the average number of calls reaching 5,000 in a 24-hour period.

London Ambulance Service has promoted discussion about mental health and provides workplace support including resilience training, counselling services and a peer support network. The service has also recently set up quiet zones near its control rooms in Waterloo and Bow, where staff can go when they need time to reflect.