This Lifelines Quick Guide gives an overview of depression and what helps.

All of us feel down from time to time, especially after stressful life events, but depression is different. It is an illness that affects how we feel (both emotional and physically), how we think and how we behave.  You can find more information the symptoms of depression and what helps on this NHS website but things to look out for are:
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Psychological      
- Persistent feelings of sadness or low mood      
- Loss of interest in things we usually enjoy      
- Feeling hopeless     
- Can’t make decisions or think clearly
- Feeling a failure or worthless
- Wanting it all to stop / thoughts of suicide

Physical
- Sleep difficulties, especially getting off to sleep and waking early
- No energy
- Changes in appetite (eating more or less)
- Loss of interest in sex
- Aches and pains

Behavioural / social
- Withdraw from family and friends
- Disengage from social activities
- Use alcohol or substances to cope (self-mediation)
- Self-neglect and self-harm  

One of the hardest things about depression is the fact that often we blame ourselves for feeling this way. We don’t realise that feeling like a failure and having thoughts of suicide are as much a part of depressive illness as high blood sugar levels are a part of having diabetes. It is important to remember that we are not our thoughts. And that when we are unwell with depression it can be a bit like wearing despair-tinted glasses. This wee animated film, Depression is a black dog is a good description of how it feels and what we can do to manage it

‍Suicidal thoughts are scary. They can trigger feelings of guilt and shame and be very hard to talk about. That’s why we have a national campaign Ask, Tell, Save a Life. to make them easier to discuss. Please don’t give yourself a hard time for having them but do keep yourself safe and reach out for help. We think you may find the booklet Suicide.. living with your thoughts from SAMH helpful.

‍We have effective treatments for depression, including antidepressant medication and talking therapies like Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT). Medication helps because if re-sets the hormones which regulate our mood and which are depleted when we’ve been under stress or feeling low for a long time. Exercise really helps here too. CBT and IPT work because they help us to challenge negative automatic thoughts and reconnect us with the people and activities that give us purpose and pleasure.  

Your GP can prescribe antidepressant medication and can refer you for a talking therapy. You can also access these through the EAP, the Rivers Centre and the Fire Fighters Charity. Find their contact details on the  Welcome page.

There are also self-help courses available online including Silvercloud, a structured programme based on CBT that focuses on supporting your wellbeing, including managing your mental health, resilience, stress and sleep. Use code Scotland2020.

Burnout is when people feel physical and psychological exhaustion related to their work over a long period of time. In some jobs, including in the emergency services, this exhaustion may be combined with exposure to distress and human suffering. When this happens, we are at risk of experiencing feelings that have been called compassion fatigue. You may struggle to feel empathy or compassion for others, might question whether you can do your job or feeling detached, shut-down or even angry.  

It is not unusual for people in helping roles to feel some of these things sometimes. It doesn’t mean that you’re not a good person or a competent worker.

If you are experiencing any of these feelings it is important to recognise that they are another occupational hazard of working in a helping role. We are at risk of post traumatic stress if we’re exposed to potentially traumatic events and we’re at risk of compassion fatigue if we’re exposed to human suffering.  Please be kind to yourself and take time to rest. When you are not in work, try to do things that give you pleasure and connect to the people who are important to you. As much as possible, try to maintain a balance between your work and home life.  You can also get support from one of the services listed on the Welcome page.

This Lifelines Quick Guide gives an overview of anxiety and what helps.

We all feel anxious from time to time, often in response to stressful life events. Anxiety involves a range of physical and emotional responses triggered by the stress response which is activated when we’re worried or nervous about something.  

If we continue to be under pressure then our body's stress response doesn’t switch off and this then affects how we think and feel.  When our body is tense and ready to respond to threat, our mind thinks there is a threat to respond to. This can become self-fulfilling: the more anxious we feel, the more adrenalin our body produces, so we feel more anxious and overestimate the challenges and underestimate our ability to deal with them.

Feelings of anxiety can spiral until we feel panicky and out of control. We feel anxious about being anxious. We worry other people can see that we're anxious. It's horrible.

Living with constant anxiety is exhausting and will have a huge impact on your quality of life. Try using exercise and relaxation to get your stress response under control and do things that keep your mind focused on the present moment.

The best treatment for anxiety is cognitive behavioural therapy where you will learn:

You can find tips for coping with anxiety in this NHS Scotland self-help guide or you can try the  Daylight app, an evidence-based anxiety management programme based on CBT that is free to Scotland’s emergency responder community.

A panic attack happens when our body experiences a rush of intense psychological (mental) and physical symptoms. We may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, we may also have physical symptoms such as:

Panic attacks are not dangerous, but they can be very frightening and cause us to feel even more anxious and panicky. How often they happen varies from person to person.  You might have one panic attack and never have another, you might have an attack once a month or have several a week. They usually last between 5 – 20 minutes but if it feels like they go on for longer, then you may be having one attack after another, or feeling frightened after the first one.

The best treatment for panic disorder is cognitive behavioural therapy where you will learn how:

Sleep problems can be caused by lots of things including stress and physical health conditions, and when that’s the case the best plan is to address these things first. However, sometimes we’re doing OK, but we just can’t get a good night’s sleep. Shift work doesn’t help with this!

If you're having problems with insomnia please try Sleepio, an evidence-based sleep improvement programme (based on CBT) that is free to Scotland’s emergency responder community.

For more information on improving your sleep you can also look at this NHS guide on how to improve your sleep, the Sleep Council's 10 Commandments or this NHS24 video on how to improve your sleep.  

At some point we will all lose someone we love. Bereavement can trigger lots of different emotions from grief and longing to fear, confusion, guilt, anger or numbness. We may feel all these things at the same time or none. They are all normal reactions to the pain of loss.

Our bereavement may be complicated by being unexpected, sudden, prolonged or perhaps happening when we’re estranged from the person who has died. Child deaths and those involving a traumatic incident are always harder to cope with, not least because other people don’t know what to say to us when this happens.

It’s also difficult if we’re not able to be with our loved ones as has been the case for some of us during COVID19. Bereavement and grief are difficult enough in any situation but if you’re cut off from the people who would normally support you, or you haven’t had the chance to say goodbye to your loved one, this is going to feel even harder.

If you've experienced a bereavement, please don’t be telling yourself that there’s a right way to be or a time when you should be “over it”.  You’ll grieve in your own way, at your own pace. There is no “grieve by date”.

Often one of the hardest things for the bereaved person is dealing with other people’s reactions; often they struggle to know what to say and might even try to avoid talking to you in case they say something wrong. This is hard, particularly if you want to talk about your loved one or about the circumstances in which they died.

If you don’t find the support you need from family and friends, and you want to talk to someone in confidence, you can access help through the SFRS Employee Assistance Provider (details on our welcome page) or the bereavement charity Cruse. ‍

We all have a set of values that help us function in the world and many people working in the emergency services have deeply held personal convictions about duty, service and helping others. Moral injury is the psychological distress we feel if our actions, or lack of them, go against our ethical values or moral code.  

This injury might be triggered by something we did or didn’t do, or something the service did or didn’t do. For example, a feeling that a body recovery wasn’t done with dignity or that organizational decisions prevented us from responding in the way we think we should. If this happens, we may feel guilt or anger which can lead to more distress and shame.

Moral injury isn’t a mental health condition but it increases the risk of PTSD and depression because it makes us less likely ask for support, because we feel morally culpable or because we’ve lost trust in others.

The things that will help a moral injury are similar to those that work for PTSD. We need to find a way to “process” the experience and to make some sense of it. It may be that we’re judging ourselves or others too harshly, but it may also be that we need to find a way to right the wrong, to learn from what’s happened so that things are different in the future.  

Another kind of moral injury is the one staff can experience if they feel betrayed by the organization. Examples of this might include bullying by colleagues of feeling let down by a manager after confiding that they have a psychological injury. This “service injury” can be devastating for staff who have put their lives at risk for the organisation in the belief that it “had their back”. It is important to access support from someone you trust if you're experiencing these feelings.

Our relationships are central to our wellbeing and when they're not going well we struggle. Separation, custody battles, step-families, whatever the relationship issue, there will be help available through your EAP (details on our welcome page) or the services below:

• Relationship advice
• Parenting advice

If you’re concerned about an abusive relationship please have a look at the help and advice available from the organisations listed under National support services
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This Lifelines Quick Guide gives an overview of what helps us recover after a traumatic experience.

In the days and weeks after we’ve experienced something frightening or shocking, we go through a natural recovery process. Our body’s alarm system re-sets, we file the experience away in our memory and gradually we come to terms with what has happened. While this is happening, we’re likely to feel more emotional than usual, find ourselves frequently thinking and dreaming about it and may have some unpleasant physical sensations. To understand more about these normal reactions to trauma exposure have a look at Understanding my response to trauma and stress.

Emergency responders are at risk of post traumatic disorders because you have repeated exposure to potentially traumatic incidents but don’t always have enough time in between to recover and “process” them.  

Post traumatic stress disorder (PTSD) is only one of the injuries people sustain after trauma exposure. Others include post traumatic depression, traumatic bereavement and anxiety or panic. You can find out more about coping with these on this page.

PTSD is sometimes described as a disorder of memory. It develops when our brain can’t fully “process” the trauma experience leaving the memory of it vivid and fresh, as if it’s just happened or is happening again. This means the instinctive / survival part of our brain don’t know the threat has passed and keep us either in fight or flight (ready to respond to danger) or freeze mode (to avoid harm). We’re either on red alert or numb and detached with the associated biological and psychological reactions.

Our brains are complex machines and even when part of it is stuck on red alert, another part knows that time has passed and there’s a memory to be processed. That’s why it brings the details of the trauma experience into our minds during the day and when we’re sleeping. Sometimes there’s a reminder that prompts this remembering. Other times the memories just pop in as our brain tries to process and digest them.  

Sometimes we can’t bear to remember the traumatic experience. Perhaps it was too frightening or distressing. Maybe we thought we were going to die or witnessed the death or injury of others. Perhaps we’re blaming ourselves for what happened or are ashamed of how we reacted. When there are these kinds of thoughts and feelings, coupled with super vivid memories, then it’s not surprising we avoid remembering, thinking and feeling them.  Unfortunately, the more we try not to remember, the more frequently and powerfully the memories will intrude as our brain tries harder and harder to process the experience.

PTSD is when this process is stuck on a negative feedback loop. Our brain tries to process the memory (re-experiencing), we try to avoid this (avoidance and numbing) and our alarm response stays switched one (hyper-arousal). To recover we need interrupt the feedback loop and help our brain process the memory.

Our 5 steps to Recovering from PTSD are detailed in the section below. Please contact the Rivers Centre if you have post traumatic symptoms that don't settle down in the weeks after a challenging incident.