Legislative Council: Wednesday, October 18, 2023



Return to Work (Post Traumatic Stress Disorder) Amendment Bill

Second Reading

The Hon. F. PANGALLO (17:40): I move:

That this bill be now read a second time.

I rise to make my second reading speech on the Return to Work (Post Traumatic Stress Disorder) Amendment Bill, which I reintroduced recently. PTSD is a mental health condition triggered by a traumatic event or cumulative exposure to traumatic incidents and is symptomatically manifested through flashbacks, insomnia, hypervigilance and sometimes suicide.

This legislation will make PTSD diagnosed by a psychiatrist a presumptive condition for first responders, emergency workers, volunteers and others involved in time-critical, dangerous, life-threatening and traumatic events and situations, streamlining the often torturous and complicated maze in making out their claims for workers compensation. It reverses the onus of proof from the injured worker to the employer.

I first introduced this bill in 2020, but it lapsed for various reasons, including a lack of support from the then Liberal Marshall government and the onset of the COVID-19 epidemic. There is legislation already in place in Tasmania and Queensland and elsewhere, and the bill mirrors their laws. It is also about to be included in federal workplace laws.

While I am unclear on where the Liberals stand today, I am hoping they will get behind it, considering their ongoing focus on the plight of our paramedics caught up in the ramping crisis. I am also counting on the Malinauskas Labor government, through the Attorney-General as the minister responsible for industrial relations, to endorse the objectives of the bill in supporting the mental health and recovery of our emergency frontline workers and volunteers and to support its passage through this chamber and the House of Assembly.

It would now be utterly hypocritical of Labor in this state to not commit to this important and required initiative, after its election commitments supporting paramedics and its promises to reduce ramping at our hospitals. It is time for Labor to return the goodwill the ambulance officers have shown them.

Another significant move which Labor should consider is the recent introduction of legislative reforms by the Albanese government that will make it easier for first responders who develop PTSD to access workers compensation schemes. The Minister for Employment and Workplace Relations, the Hon. Tony Burke, said the Albanese government will always stand alongside the first responders who keep Australia and Australians safe, while building on their work with firefighters to ensure they have better access to the compensation they deserve.

If it is good enough for federal Labor, it has to be good enough for state Labor. Our communities are so reliant on the incredible and often dangerous and challenging work our first responders carry out. They are often unheralded heroes who go about their responsibilities with diligence and without fuss. In carrying out their jobs they can experience all types of horrific scenes and stresses. At the end of their working day they go home to their families.

It is difficult for any of us to expect them to just totally switch off and erase those memories that can be ingrained for years. These nightmares may not even manifest for years, until they are triggered by some facet or incident in their lives. When they do appear, affected workers may suffer those feelings in silence until it becomes too much to bear.

In 2019, the Senate's Education and Employment References Committee reported on its extensive inquiry into mental health and wellbeing of first responders. It took evidence from a wide cross-section of emergency services and mental health experts and advisory bodies. The University of Adelaide's Centre for Traumatic Stress Studies reported emergency service workers face occupational hazards which present a risk to their mental health, describing the high rates of mental health disorders in this cohort as a predictable phenomenon.

In essence, it is the cumulative exposure to horrific accidents and life-threatening events, as well as the personal threat to their individual officers, that leads to cumulative risk of developing a range of mental health disorders. The report noted there was little actuarial modelling of this risk of mental health disorders during the career of an emergency service worker in any of the emergency services. The report also gave disturbing examples of lived experiences.

One was paramedic Peter James recalling his time as a student nurse. He was tasked to pick up stillborn babies born over the weekend and would have to place each baby in a cardboard box and place them on an ambulance stretcher. On one occasion there were seven babies. He took them to the Royal Hobart Hospital mortuary and placed each box on a sandstone shelf in the mortuary fridge. He says that at the time it did not impact on him, but as the years and decades rolled on he thought about it quite often.

Then there was firefighter Andrew Picker, who said first responders do not work in sterile office environments. Mr Picker said, and I quote:

We put our hearts and souls into our work. We constantly risk our lives at work. We have lost friends in our work. Our families risk losing a son, a daughter, a father, a wife when we go to work. We have had colleagues significantly burnt or injured, shot or wounded, beaten and bashed, fallen from heights and hit by vehicles. We have had colleagues take their lives because of their experiences at work. We have had colleagues suffer and sadly die from significant cancers because of workplace exposure. Our actions or inactions are something we must carry with us for the rest of our lives.

He goes on to say, 'It is an honour and privilege to help others, but just as we care for others we also need to be cared for.'

Another emotive story came from an unnamed police officer. On a road patrol one day he was called to a fatality. He said he had attended many others and had learned to just deal with it, but when he got there he saw two 14 year olds lying dead on the road. It hit him like a brick. He said he was overcome with emotion. Again, I quote:

I did what was needed to be done but I was emotionally numb and I can't get the vision of those two lost lives out of my mind. I always just saw the bodies I never saw them as people. My mistake that night was I saw them as teenagers. Now my heart thumps every time we attend an accident. I just feel I will never be the same again.

And this from paramedic Malcolm Babb, who had responded to thousands of cardiac arrests, from newborns to the elderly, and was actively involved in resuscitation attempts. He managed something like 2,500 motor vehicle accidents and had to declare that there were no signs of life in many hundreds of cases. He personally had to inform the parents of a deceased child that their child had died. Malcolm says, 'That is very difficult to do (however it is part of the job), but it is even harder to inform a child that their parent/s are deceased.'

Mr Babb mentioned that he had been assaulted multiple times, was shot at, involved in knife fights and feared for his life on many occasions. He also had his own family threatened on numerous occasions. He witnessed a murder and suicide. Mr Babb's story might sound like you are watching a TV show but it is real and raw and happens each and every day in emergency services.

The Royal Australian and New Zealand College of Psychiatrists concurs that most first responders are repeatedly exposed to trauma. Research on Australian firefighters provides a valuable snapshot of trauma exposure in emergency services. A study on South Australian metropolitan firefighters found that 76 per cent of the workforce reported exposure to 10 or more critical incidents throughout their career, and almost all of those involved reported witnessing death on the job.

The South Australian Centre for Traumatic Stress Studies reported that the hazards and risks of exposure to trauma cannot be understated. It said there is an extensive body of literature documenting these hazards and risks and that the combined literature would suggest that ambulance officers and paramedics are a group at highest risk. In general, the risk is highlighted by the positive linear relationship between the number of fatal accidents attended and the rates of post-traumatic stress disorder, depression and heavy drinking independent of the emergency service in which the individual serves.

Emergency medical dispatchers are also prone to mental stresses and challenges and PTSD. It is important to know that emergency services officers do not become unwell after just one single traumatic event, it is often the repeated exposure to trauma over time. The United Firefighters Union Australia reported that firefighters are very well trained and while you can train a firefighter, and this country certainly has great firefighters, you cannot condition them from the accumulated exposure to the trauma. They have looked at programs where recruits get some education and promotional courses but you cannot inoculate them from the accumulated exposure.

There is also a stark warning here for the Malinauskas government, as it tries to grapple with ambulance ramping and reducing response times. The South Australian Ambulance Employees Association told a Senate inquiry in 2019 there needs to be a rethink of the pressure crews are placed under. It creates a risk for paramedics themselves and the community they serve.

Safe Work Australia has also done extensive research into mental health in the workplace, finding mental health conditions for first responders include depression, anxiety and PTSD. It can also lead to comorbidity issues, alcohol and drug abuse. The Centre for Traumatic Stress Studies pointed to emerging evidence indicating that PTSD is a systemic disease and emphasised the need for those managing the mental health of first responders to understand this.

Senator Andrew McLachlan, a former President of the Legislative Council, is a fierce supporter of paramedics and the perils of their job. He spoke passionately about them in the Senate in 2020, aptly describing them as one of the most noble of professions while advocating for committed support from governments. He said:

In leading a life to keep our community safe—especially during the pandemic when they walked willingly out of their own secure homes to an uncertain day—made them truly exceptional people. Angels who walk among us.

Senator McLachlan said a paramedic's mental health was adversely affected not only by the trauma they constantly experienced but the pressures of their job. As an active Army Reservist who has done tours of war-torn Afghanistan and Iraq, he also saw firsthand the stress associated with the service of veterans that led to PTSD. I thank Senator McLachlan for his unwavering commitment to the cause of first responders and also his support for my advocacy in South Australia.

For this bill, I have consulted widely with many, including Professor Alexander 'Sandy' McFarlane AO of the Centre for Traumatic Stress Studies at the University of Adelaide; the Police Association of South Australia, which endorse this legislation; the Ambulance Employees Association; the South Australian branch of the Nursing and Midwifery Federation; the CFS Volunteers Association; the SA SES Volunteers Association; and the United Firefighters Union of South Australia. They are all supportive.

This bill will cover a range of professions, including paramedics, police, firefighters, nurses, doctors, train drivers and correctional services officers. During a recent speech to set up a select committee looking into the mental health and suicides among first responders, I read sections of the harrowing statement given to me by Aaron, a police officer who narrowly escaped with his life after being shot in the face. I will finish here by quoting Aaron's heartfelt message on the necessity of legislation like this:

Until our emergency services can count on legislation that supports and promotes their mental health, then no amount of work by the organisations themselves will alleviate the stigma and fear of coming forwards about mental health. No employee assistance program or peer counselling will dispel the fear of losing our identities. No well-intentioned case manager will mitigate the dread of losing our livelihoods.

We often talk in this place about our admiration and support for those brave men and women who confront danger on a daily basis. I urge members to also consider the hidden emotional and physical costs of what we expect them to do. Shame on any government that puts dollars ahead of the wellbeing of these fearless angels among us. I commend the bill, which I intend to bring to a vote in November.

Debate adjourned on motion of Hon. I.K. Hunter.