Peer Support - a conversation with the experts

Gill Moreton, Clinical Lead for the Emergency Services at NHS Lothian's Rivers Centre,  and Gail Topping, a paramedic with the Scottish Ambulance Service (SAS), discuss all things peer support. This hugely informative chat covers everything from what peer support really means, why it is so important in the workplace, especially in highly stressful roles, the value of informal peer support, and tips for how you can enhance peer support within your organisation.

About the speakers

Gill is the Service lead for Lifelines Scotland, which provides training and online resources to the blue light community in Scotland on peer and post-trauma support. You can learn more about the work that Lifelines do by visiting their website.

Gail co-developed the 'R U OK?' peer support campaign within the Scottish Ambulance Service, which aimed to help promote conversations around mental health and wellbeing. You can read more about the campaign by following this link.

Chapters

• 0:00 Introductions
• 0:53 What is peer support?
• 5:34 R U OK
• 9:15 Knowing what to say and getting conversations started
• 14:12 Developing a culture of peer support and the importance of informal support
• 26:49 Normal reactions to abnormal situations
• 40:24 Looking out for newer staff
• 43:28 Top tips for getting started with peer support in your organisation

Transcript

0:04

- I'm Gill Moreton. I'm a psychological therapist at the Rivers Centre for Traumatic Stress in Edinburgh, in NHS Lothian. And I have a role leading the work we do with the emergency services. And I'm project lead for Lifeline Scotland.- And I'm Gail Topping. I'm a paramedic with the Scottish Ambulance Service, and I helped co-develop a campaign called R U OK? that we launched nationally several years ago trying to promote peer support within the ambulance community.- And my involvement in peer support is as well as somebody who receives it and gives it within my sort of staff group, is running and developing peer support initiatives with colleagues in the Blue Light Services. So will we... What does peer support mean to us, Gail? Do you wanna start off?- I think for me, I think when we talk about peer support, it's very much about people that we interact with on a daily basis. And it doesn't have to be a formal peer support title that you hold, but it's someone that you are interacting with on a day-to-day basis and supporting them through events that are happening. Whether that be positive or negative, I think, do you know if they're going through a life event, whether it's perhaps getting married, or experiencing a bereavement, or something significant, that we support them through that process. And it doesn't have to be organizationally driven, I think it's just something that we do on a day-to-day basis that's natural, it's humane. It's just empathic and just kind, really.- Yeah. And I've been thinking a lot ahead of us having this conversation about what we mean by peer support and even just the two words, like who are our peers and what do we mean when we think about... What do we mean by support in that context? And I completely agree with you, even if I put my kind of academic sort of research-based hat on, when we think about what keeps people well in high risk roles and that's a particular interest of mine and ours together, what comes through consistently is the support they get from their colleagues and also from line management. So we mustn't forget that, but really the support they get from the people they work with. But we also know that peer support can be outside of the work context too, can't it? We think about it for people perhaps who've experienced poor mental health and we have kind of peer support groups where people are... It's about lived experience, isn't it? Or people who are carers, that there's that peer support from coming together with other people who get it. And so that idea of peers is about who is it that has a similar experience to you. Or you see a lot, and I don't know about you, I've been thinking about how does it fit with friendship? What's the difference between friendship and peer support?- I think there's this... We're very keen to label things. So I'm a peer supporter, actually I'm a friend, I'm a colleague. I might be just an acquaintance, but I'm a human being that's recognising there's something perhaps is happening in your life that I can help and we can encourage each other or we might just be there just to support each other and have a basic conversation. It might not be anything too in depth, but that level of support is... That interaction is a peer support when it comes on a day-to-day basis.- Absolutely. Because your peer is the person you spend time with, isn't it? And if we think about it for the purposes of our chat about those people we work with, I mean, is literally that the people we work with, they're our peers. And I love the fact that you were saying it's not just about when people are in trouble, it's about celebrating the good stuff too. It's about, when I think about my peers, so not just about the one I'm trying to support others to be good peer supporters, but they're the people who share the same values, have the same purpose. We're trying to work together to help people who've been affected by trauma. That would be what it is at the Rivers Centre. And also to make sure that we all stay okay doing what can be a demanding job. So that's as much as getting someone... Moving into examples, getting someone a cup of tea when you know they've had a difficult phone call, as it is to knowing if something's gone on in their lives for better or worse.- I think for peer support, it has to involve... From my perception of it is that there's an element of familiarity and if you break that down, you become a family. That you're very much interacting on a day-to-day basis and you shield each other up. And there are times I think certainly in the workplace, it can be very much something that you don't recognise is happening. But actually that element of support, the banter, people who are just interacting and maybe having a bit of a laugh on a day-to-day basis that builds up that rapport and the familiarity. And you then identify when someone perhaps isn't acting as they normally would. And that can then encourage people to step forward and ask, "Are you okay?'Cause you're not acting as you normally would." And it's that level of familiarity , that bond that creates that trust and the ability to have those conversations and support each other through.- Why don't you say a bit more about the, RUOK? sort of initiative that you were involved'cause that's what it was about, wasn't it? Literally those words and it being based on that familiarity.- For me, I mean the RUOK? campaign that myself and my colleague had developed came from feeling not recognised as an individual. That there wasn't that recognition that something had significantly impacted. There was a couple of events that happened quite far apart, but the last one, ultimately it was a guy pulled a knife on me and I would expect as any human being that you would be asked afterwards, "Are you okay?" And it didn't happen. And I left shift that morning feeling bereft, and that feeling that I wasn't valued as a member of staff, I wasn't valued as a human being. That there wasn't the recognition that something so significant could have an impact on me. And I think all I wanted was someone to ask, "Are you okay?" and to acknowledge that that had affected me. And when it didn't happen, that profoundly affected me. That feeling that you were just abandoned.- So the kind of absence of the peer support.- The absence of the peer support and that recognition that actually that is what is so essential in keeping me well, is that level of support and feeling valued, and that I'm not just a resource. I'm not just a bum a seat. I am a human being, an individual who's got emotions and will have reactions to events that happen both in workplace but also outside. And I think that my desire to change the culture was born from those type of incidents. And it's such a simple concept just asking, "Are you okay?" But it has had such a significant impact on wellbeing within the workplace. And I think that simple conversation, it's three words, but it has such a profound effect on someone, whether they have dealt with something at work or having to deal with something outside of work. But it's starting that conversation and it enables people to feel that they're being seen as a human being. And it's not just, "You need to get on with it." We recognise as your peers, we recognise that actually this is not... Some of the things that we see are not exactly normal. And some of the experiences that we might go through, having that conversation and starting that conversation just by asking, "Are you okay?", that was what drove me to start the campaign. And it has had a really significant effect. It's about changing the culture. It doesn't happen overnight, but it doesn't cost a lot. And it's actually something that we can do as individuals. We don't need the organisation to do it for us. It's very much a grassroots thing.- Yeah. And I think that's the interesting bit'cause we both... We were joking before we started, but I see you as a peer even though we don't work together because of our sort of shared kind of passion really for trying to think about how we maximise the kind of existing peer support. Those relationships and the camaraderie that's there. But that sense that it can come from grassroots and it doesn't have to be super formal, but it's about, as I say, just almost channelling and maximising the existing peer support. Because that's what the research tells us, that it's those relationships rather than formal as we sometimes say capital P, capital S. And it's that informal peer support, which is what keeps people well. What I was wondering though,'cause I know with the RUOK? campaign, and it's similar to what we've tried to do at Lifelines, is make sure that people feel... they don't worry they're gonna get it wrong. And I wonder whether what you think, whether some of the people who maybe didn't talk to you after your difficult experience, was it because they were... Was it that they didn't care? Or was it that they weren't sure what to say and maybe you don't know, but can you see both of those things could be going on, couldn't they?- I think that there's been a couple of occasions where it's been both things. So once after the knife incident, it was the demand elsewhere that I wasn't aware of, that they got caught up in other stuff and hadn't realised that actually they hadn't spoken to me. And I think other times it can feel quite awkward to start a conversation, particularly if it's someone that you're not entirely familiar with, you perhaps an acquaintance as opposed to a true friend or close colleague. And it can be difficult to start those conversations, but I think the crucial thing is that you make the first step. And the conversation might not happen, but at least the person knows that-- [Gill] You've asked.- You've opened the door.- [Gill] Exactly.- You know the door is open for them to come back if they want to, but at least feeling that they're valued and that you recognise that actually that this is an important conversation you have.- Yeah. And you've noticed, and as you say, sometimes the people working in roles like the ambulance service or the other blue lights, there's people's threshold for what's normal goes really high, doesn't it?- Yeah.- So the idea that somebody having a knife pulled on them might not automatically trigger a kind of... So it's something about the baseline, doesn't it?- Yeah.- So there may be a bit of that going on too, but yeah, that point you're making there about... And you may not have the conversation there or then, but somebody will have heard that you're concerned about them, or that you think what happened to them wasn't okay. You might be thinking,"Oh well it's just somebody pulling a knife on me." But somebody might be saying,"Are you okay after that?" Because somebody pulled a knife on you. Yeah. I think when we do... So with the Lifelines project, as you know, one of the things we do is try and give as many people as possible information on how to be a good... How to be an even better colleague. So we call you a lifeline space supporter, but we're not really kind of... We're trying to train as many folk as possible. So lots and lots of people know how to do that. And we're actually really trying to give that information to line managers too, so they can think about how they support staff. But one of the bits that always comes up is...'Cause the people who come along really want to help their colleagues, so they're really committed and they spend all this time thinking about how to have the right conversation, and to get the right words, and to get it right. And one of the kind of big lessons is, do you remember you've been... They've no idea you've been plotting all of that. They're just tootling along, and they may actually be having a tough time and you suddenly come along with your brilliant intervention.- Yeah.- You might not get the,"I'm so glad you asked. I'm ready to spill my heart out to you." What you might get is, "How do you, what do you mean how-", or nothing. And not to be put off by that, as you've said, because people will have clocked that you care.- And I think as a society, we're very... Certainly in Britain, but we are very guilty of the stiff upper lip, and bottling things up. So, when someone asks you initially, "Are you okay?"- I am fine.- I'm fine. It's always the standard response. And I do it like, I don't even have to engage my brain. It's almost like reflex comes in my mouth. Sometimes it is actually the second time of asking, backing it up with the evidence that actually,"Are you sure you're okay because I've noticed that you're a little bit quiet, or you're a bit more withdrawn, you're not acting as you normally would." And having that conversation, and even then there might be some resistance to that conversation, but that's okay because that person then knows that you've noticed them. And if they need time to regroup their thoughts and then perhaps come back and have that conversation when it's comfortable for them, that's okay. But it's starting the conversation and actually making that first step that's the essential part.- And remembering that they're allowed to not to want to talk to us.(Gill laughing)- And you know what, although you may label yourself as a kind of formal peer supporter and, "I've done all these courses." Actually, you might not be the person that they engage with the best, and perhaps historically there has been some friction between you and that's okay, too. Because if they choose to then have that conversation with someone that they're closer, don't feel offended. The important thing is that actually that they're having that conversation.- Exactly. Yeah. So, we're kind of getting into, aren't we, some of the, we've referred to it a couple of times, the difference between what we might call that informal peer support, and more formalised kind of schemes where perhaps there's a certain number of people who are identified as being the peer supporters, and advertised on intranets as these are the people you can speak to. I would sort of say at the other end you've got your friends and then at the other end you've got professionals like me, I guess. People who provide psychological therapy when folk are in difficulty. So, I wonder, if we think about the friends and the therapist bit, the difference really is about reciprocity. It's how much you get back. When I'm meeting with somebody as a clinician, I'm not expecting them to give me something back about how I'm doing.(both laughing) What they're getting is my kind of brain, and my heart or whatever, my attention to help them figure out how we get a resolution for their issue. The space is about them. So, it's collaborative and it's engaged, but it's not really reciprocal. Whereas in friendships it's all about reciprocity, isn't it? Well you hope it is, eh? And obviously that can vary at different times. I just wonder what you think in that sort of spectrum and then we get into these different ideas of informal peer support. Your professional mates.- I think on a day-to-day basis, what keeps people well is the informal peer support. And that is just the day-to-day conversations, and the support after jobs. Some peoples' mental health will decline where to a point where they require more formal peer support and they will require interventions at levels such as perhaps GP with formal counselling therapists. And that's okay too, but I think in terms of resiliency, what keeps people well on a day-to-day basis is establishing the informal peer support that is there. And we don't recognise it, but for me it is sitting around the messroom table with a cup of tea, having a chat about peoples' experiences on that day, whether it's at work or what's going on in their own life. But that level of familiarity then encourages me when I'm feeling a little bit more vulnerable, that I can turn to those people because they already have that established rapport.- Yeah, I agree. I mean we agree on that, eh, that's what we're about, but I think there is a lot of interest isn't there in more when people talk about peer support in the emergency services or within the health and social care community, they tend to be referring to capital P, capital S, don't they? And particularly in the aftermath of trauma exposure.- Yeah.- Yeah. And I think one of the bits that we are keen to do with RUOK? or with Lifelines is not say,"Well they aren't useful," but I know my concern is that if we only focus on those and we don't realise the value of the informal peer support, then we slightly risk undermining that. So, when people are doing more formal peer support, what they're talking about is people having some additional training, and maybe some time in their kind of job plan that they can be approached and provide some sort of help and support.- I think there's definitely a need need for that. I think that it's the formal support perhaps comes after big incidents. So like you say, the easily identifiable ones. For us in the ambulance service, paediatric cardiac arrests, your multiple casually road traffic collisions. Big incidents that hit the media. Things like Don Blaine, Walker Bay, where you're going to be bombarded with those messages through the media. And that does have a role, the formal peer support. But those incidents are the ones that are easily identifiable as the ones that people may be impacted by afterwards. What was less easily identifiable for me are the ones that people identify with on a personal level. So, you go out to a patient who you recognise has the same kind of cardigan as your gran used to wear. And that resurgence of personal emotions that are purely identifiable because it impacts on you as an individual, but it doesn't impact on your colleague. That informal peer support is vital in carrying people through those less easily identifiable incidents.- Yeah. And I guess, and it's interesting you're making the distinction between those lower-key but nevertheless potentially high-impact jobs where it is something that gets through your protective armour as we kind of talk about our lifelines are things that keep us well most of the time and allow us to distance ourselves sufficiently to be okay if we're dealing with potentially hazardous stuff psychologically, emotionally, and the kind of big, sort of obvious kind of challenges. I think for me it's less about who is your formal peer supporter or not, but how do you best maximise and provide peer support? You've hit on it whether it's about creating space over breaks and stuff, and how do you give people skills to know what to do? In the same way as you wouldn't have, and obviously in the ambulance service and the healthcare, everyone, lots of people are first aiders, but in lots of roles you have physical first aiders, you have to have a certain number of those. And it's almost like have you got enough people who understand a bit about psychological first aid? About, what are helpful things to do in the aftermath of a major incident? What are helpful things to do when someone's had a knife pulled on them? But that we make sure we don't only develop a scheme that fits that, but as you say, fits all of those lower key things. That may be about bereavement or separation.- Because I think when you wear a label, or you wear a badge that says, "I'm a peer supporter," there is an element of creating a level that distinguishes that person. You're the supporter. And you're the-- That's interesting.- Person that's being supported, almost like the,"I'm the manager, you're the employee." And that level then can, in some instances, create a little bit of a barrier that is not...- They're not your peer.- No.- I mean I think that's... When we've been talking we've been thinking about professional friendship and you've been coming, but that's lovely, isn't it? So, we're talking about are you the supporter or the supportee, rather than are you the peer?- Yeah.- And what you're doing is looking out for each other and you've got each other's backs.- Yeah. And I think when it comes to the informal, the lower case peer supporter, actually we're all in a level playing field. There's no hierarchy there, and there's no hidden agenda. There's no looking at tick box, and that some people could perceive a more formal peer supporter being there to do. I have offered this, I have asked these questions. That may be the perception for some people. And actually the informal peer support doesn't have that. And that conversation happens naturally as opposed to in a more formal pre-organized-- I'm now being your peer supporter.- I'm meeting you here as a peer supporter, and we're going to have this conversation.- It comes back to what you said earlier about familiarity. I mean, are these actually your peers?- Yeah.- Are they people you know and who know you, and that you work with? And again, although we don't work with each other, I do see you as a peer'cause we're in touch enough. I wouldn't know 'cause I don't see you enough to know what's happening with your mood, but I certainly see you as a kind of peer and an ally in some sense. But most of the time our peers are literally that, they're the people we spend time with, and work alongside.- I think the organisation definitely, whoever it is, they have an obligation to look after their staff. It would be lovely if we had enough psychological first-aiders to be in every workstation across the country. But in the financial climate that we're in, that's probably not going to be the case. And when you have informal peer support, that actually costs nothing, but that comes down to a culture of empathy and understanding, and just human kindness, that costs the organisation nothing. But if we foster those kind of relationships and afford people the time to sit down and build up conversations amongst each other as opposed to you're just out working all the time, but if you have that time together, whether it's at work or you create time away from work together, then those informal peer supports are actually, I find what keeps people well and keeps people at work.- Yeah. I think I would add into that, and of course I would as a trauma therapist, which is that I think that you can do, you can supplement that with a little bit of extra knowledge. That doesn't have to be super high cost. Whether that's about listening skills, about helping people... We were joking earlier about you might ask the question and people might not want to talk, but the other bit is the other worry the peer supporter has, or the the colleague who comes along and wants to help them, their colleagues is they think,"I've gotta get it right. I've gotta work out what to do, how to fix it." So, the other key message is you don't have to; Just listen. Just being there showing that you're interested, letting somebody speak, genuinely being interested, and paying attention is really powerful. As a top secret from the world of therapy that actually it's all about the listening rather than having any solutions.(Gill laughing)- I think part of the things that perhaps some people might get wrong, and I have encountered in the past is that when someone presents to you a problem that they've got, so, "I've been at a bad job." The person who's there is a sounding board, really. There is almost this innate desire to share experiences. And therefore, it then loses the focus away from the person that's came up with the,"I've had a real bad job." And to the person actually having a conversation about jobs that they've had that are of similar, and it removes the focus away from the person that's having the difficulty at that time. So, what I've tried to learn from it is that the best thing is to, don't talk about yourself.'Cause you are not really the focus at that time. This person is having difficulty. And it's not to say that you can't share your experiences, but really the focus has to be on them, and your job might not actually be anything like what they've encountered.- You know, it's a bit of a spectrum though, isn't it? We talk kind of on our courses about the idea of different kinds of listeners or non listeners, and that's a lovely one, which is like, wait till I tell you about what happened to me, so you join in and take over. But on the upside, if you do that, if you share a little bit of your experience, it can actually challenge some of the stigma or the shame, and validate that, yeah, these things are difficult, aren't they? As long as it doesn't become then about you, you don't become the talker, but you're still interested in what people have to say. The other is that balance between, you don't need to tell me, that kinda whole mind reader thing where you say,"I think what you mean is..." and it's like, no, no, no. What you might want to do is ask a question that suggests that you get it. But really again, your focus is on them at that point. Yeah. It's that idea. The reciprocity bit, isn't it? Yeah. I also think, Gail, that this, again, I would, but you know, as a trauma therapist, but I think we could all value from understanding a little bit about normal reactions to horrible things. And if that was in the kind of public domain as just information that people had, it would make a massive difference to peoples', how people recover after they've experienced something awful.- Absolutely. Yeah. I think a lot people expect that when the... Certainly for us we wear a uniform, and that then becomes our shield. So, when we experience human emotions, there is this feeling that,"Wait a minute, I'm, I've... I'm not able to do this job." And in the past there have been some people who have said,"Is this really kind the job for you?" Actually underneath this green suit, I am a human being, and acknowledging that actually it is very normal to have human reactions to abnormal situations.- Even when its your job and you've done it lots of times.- Yeah. And it doesn't matter. It could be that just that one time, for whatever reason you've not slept well, whatever, you've responded to something that has triggered you, that's absolutely fine. And it might be having an impact on you for two or three weeks afterwards. And that, again, is also fine. Because these type of human emotions are very, very normal. It's also normal to not react. If it doesn't impact on you, then that's okay. It doesn't make you abnormal, it doesn't make you inhuman. It just means that for whatever reason that job hasn't affected you or your level, your resilience is greater than-- And you've been able to stay in that professional detachment, and your training's kicked in, and it's not the first time you've had to deal with it, so you've had all of that expectation and readiness, all that stuff we talk about.- Yeah.- So, that bit about people understanding what are normal reactions. Whether it's, well maybe not bad about this, but things like bereavement, or you know, if people have got a family member who's sick, or their marriage is broken down, or the relationship's broken down, were maybe okay about understanding that people might be upset, worried, kind of preoccupied. I think what you were saying there about after sort of potentially traumatic events, what some of those reactions might be. And it's probably worth,'cause I think as a trauma therapist as I say, I think it'd be just helpful for people to know these things, you know, so that they're not so taken aback when it happens.- I think that the key probably things that would be things like them not sleeping, they're perhaps calling in sick more regularly, short notice.- These are the changes you might see?- Yeah, some of the changes that, perhaps not taking as much pride in their appearance; They start to let their personal hygiene go a little bit. Sometimes at work there might be more mistakes happening.- Irritability is the big one, isn't it?- Yeah.- Well the people around you notice.- Yeah. But that also, that irritability and that angry outburst can make people take a step back, when actually they need to take the step forward. I think I look at some of the people in the workplace, and perhaps the most belligerent members of staff are the ones that have perhaps been most traumatised, and least helped at certain key stages. I think when you get a member of staff who is having angry outbursts, or short tempered, a bit irritable, they're perhaps the ones that need the conversation.- The check in. The, "Are you okay?"- Are you okay?- Ask twice. Yeah.- Yeah.- And similarly I guess people who are just more withdrawn, we're looking for sort of changes, but in the aftermath of something horrible or shocking of course people are... our alarm systems are still firing, aren't they? Wouldn't it be jittery and-- It's normal to be constantly thinking about the event that's triggered it. It's normal to have almost flashbacks to that.- Your brain's just trying to make out...- When you think about those events to have the bodily reactions of the fast heart rate, the sweating, do you know that, that can be normal and that can be normal for a certain period of time afterwards. And people aren't going crazy, when they're thinking about stuff like that.- And that is the thing and that's the, within the kind of framework of psychological first aid from a lot of which isn't psychological at all, it's about caring for people's immediate needs, making sure they're safe, connecting them with others.'Cause I guess we've not used the word"connection" that much, have we? But that's what we're talking about here is, it's about being, what keeps us well is being connected to other people.- Yeah.- Like in evolution terms as well as fight or flight, we had to learn to connect and be able to be in groups. But in amongst that kind of spectrum of non-psychology stuff, the stuff that is there is about understanding common reactions. And if you understand that you're not going off your head, that there's a logic to why you're on edge, or why you're thinking about it, or dreaming about it, that it's all about your system rebooting, after having such a shock.- And I think that's where part of that level of training has to happen, where people understand that someone having those reactions doesn't automatically require referral to a more formal peer support therapy. It is normal for them to have those reactions, and not to panic when someone comes to you and says that they've not slept for three days.- [Gill] Absolutely.- Do you know that? That's entirely acceptable after something like that.- That's the other unintended consequence. If we think about the things that we kind of learn, we do the peer support training is that people forget that listening is doing something.(both laughing) They forget that people might not be ready to talk just 'cause they're ready to ask. And the other is that they assume if someone tells them that they're having a difficult time, that they have to refer them to a professional. When all that's done is they've done a good intervention, they've checked in with somebody they've called it right. The person actually is having a difficult time, and that's great 'cause now you can try and get alongside them, and help them. And getting people to think as a colleague, and as a friend, that if your automatic reaction to someone telling you that they're really crab it with their family at home, or they're not sleeping is to say,"We need to get you some help," then you're doing the opposite of reassuring. You're saying, "Oh heck, you are not right and I need to get you something." I think that is one of the, again, the unintended consequences of the formal peer support schemes is people feel slightly disabled to just be a good colleague and a good mate. And they, you know, it's a little bit of knowledge is a bad things and they sort of think, "Oh, I have to kind of get them somewhere else." And as someone who's supervised people involved in peer support schemes, a lot of what I've done is said,"That's fine. You can do that. You know why people have bad dreams after they've had a... You go and tell them that rather than bringing them up to see a therapist, a mental health service. You do that bit."- Yeah.- Because the risk is that we pathologize kind of what are actually normal responses, and that's a really unintended consequence, isn't it?- Yeah. Because I guess subconsciously what you're saying to someone when you make that referral is that we are not able to cope.- There's something really wrong here.- There are some cases where it may go on for a prolonged period of time, or escalate to such a level that more formal intervention is required. That's absolutely fine too. But initially when you're having that conversation, if your automatic reaction is to make that referrer, you're no longer a peer supporter. You're a peer referrer.- Yeah.(both laughing)- Yeah. And that's lovely 'cause I think we talk in our thing about the idea of being... I love that peer referrer, I'm gonna use that.(both laughing) But is that you don't wanna just be a sign poster to help. So, when people do need something, you wanna be a bridge. And I guess we say again, if there's somebody you are in touch with, a colleague or a mate who does need some additional help, professional help, what's your role then?'Cause they still need peer support.- Yeah.- They still need someone who's in their corner, who's asking how things are going, asking what else they can do to help, seeing if they want a coffee, celebrating the good things with them, and that it's about being a bridge and then staying in touch, you know?- Yeah. You've not to almost dust your hands off,"Well I've done that."- "I've done a bit, I've done my peer support. I'm off to find somebody else to peer support."- Yeah.- Slash refer. Yeah.- But sometimes part of that is just even sending a text when you know that maybe somebody's had an appointment.- [Gill] Absolutely.- And just checking in and saying,"Do you need me to go with you?"- [Gill] Absolutely.- "Do you want to meet for a coffee afterwards, or do you just need some time on your own? Do you want me to check in tomorrow?" And just even if they don't acknowledge it, just knowing that-- Somebody's in your corner, got your back, remembered that you had an appointment. It's all of that stuff about being held in mind, and about kind of kindness and connection, isn't it?- [Gail] Yeah, absolutely.- Can you think, I'm just... If you could tell us, because I'm remembering you saying to me the other day about that example of the thing that happened on Facebook, which was just a lovely example of peer support.- [Gail] Yeah, so lovely. It was so nice. And so, one of the members of staff was experiencing difficulty, and he had reached out through Facebook and automatically there were a pile of people who were offering direct messages of support, and they were signposting them alternative services. And then consequently that person came forward later and said it was all sorted, that they were getting the help that they needed, and that they had good support locally. I just thought that the culture had changed so much. And it's taken a few years, but I think as a society but also as an organisation, that to see that in the workplace where someone feels comfortable coming forward and saying,"I'm struggling and I need a bit of help here." And for then that level of support to come from people that they don't even know, but-- Other "peers" in terms of the ambulance services.- We have a collective. We are a travelling family. Do you know? And the familiarity doesn't necessarily come from day-to-day engagement, but just simply, I'm familiar with what's occurring in the workplace because we wear the same uniform. So, we are, we're colleagues. It was just so nice to see that level of support being offered. Whereas years ago people would've felt ashamed to come forward, would've felt scared to come forward and say,"I'm really struggling."- Although I suspect if they had, they might have still got people trying to help.- [Gail] Yeah.- And I think that's the bit, although there have definitely been challenges, haven't there around culture, and stigma, and keeping your head down in case people think you can't do your job. But actually we've always cared for the people that we spend time with mostly.- Yeah, absolutely.- We're not societies of raging kind of narcissists and psychopaths. People like other people most of the time, and they want to be connected to other people. So, what was lovely when I remember you telling that story the first time round or hearing about that was obviously the individual who needed help benefited from the peer support. But I think probably everybody who was responding in that social media forum got the benefit of peer support. Because you got a bit of a warm glow from thinking,"Look at that." All of all these people pulling together to help a colleague. And I think it's a hold onto that, isn't it? That what keeps us well most of the time is that sense of being in it together, being part of a group, of a community, of a network of people who perhaps know each other quite well, and are familiar, and work alongside each other, and like each other, and are professional mates. But then that sense of feeling valued by the organisation and that you've got common interests, and common purpose.- And I think if we feel like we belong and we walk alongside each other, that you're not walking on your own. That we are surrounding you. And some incidents I respond to and I'll go to by myself, but when I return to the station, I know that I have a family of support there because everybody can identify and empathise with some of the experiences that you've had.- They get it.- [Gail] Yeah.- And it doesn't mean that they... And that's what it comes back to that is it okay for them to say something about what they've been to? And I think obviously it is'cause it's a way of showing they get it, as long as it doesn't then become over here rather than right now the person who's just come back from a difficult job is this person. So, let's see how they're doing rather than all that other.- I think for new people coming in as well, there is this sense that... I've been in the job over 20 years, so I have developed a slightly thicker skin, but I wasn't always that way. So, when young people come through, as an older member of staff, having that empathy that they've not encountered the same level as I have and being able to-- In terms of becoming accustomed to it.- Yeah.- Accustomed and familiar with it, yeah.- So, I've responded to a lot of jobs, but having that awareness that they're still quite fresh at this and having the conversations perhaps more regularly to start with a bit,"Are you okay with what we've just witnessed? Are you okay with what we've done?" And as they become familiar and their level of resilience is going to build up, but we also need to ensure that they're supported while they develop that experience.- I think that's, as a trauma clinician, as someone who works with blue light staff in a clinical role, one of the big drivers to some of the training work and sort of the Lifelines projects is about saying,"Let's help people understand that it's not an accident that they're okay." So, what is it that protects them, and how do you as a more experienced paramedic share with people starting how it is they're going to be okay. Often folk think, "Well I'll just get used to it or I'll harden, or I'll cut off." And actually it is to do with becoming accustomed. You do become familiar with it, so it's not as shocking. And you've had to sort of get your head around it, and your heart around it, and that you're buffered by feeling competent, and feeling that you know what to do, and feeling that your colleagues are doing the same thing, you know?- Yeah.- I remember someone from a parallel profession actually, but doing a really lovely example where they were describing being in the kind of canteen afterwards and noticing that a junior colleague looked pretty shaken, and turning to them and sort of saying,"It's okay, that's how you're meant to feel." And that the message of that isn't, and I'm just like all hardhearted and I don't care anymore, but it's okay, and you'll get your head and your heart around it at some point, but there's always, as you say, there's always the potential for something to affect any of us at any time. Whether it's a work challenge that could be a difficult job or it could be bullying, and that's why we know problems within relationships at work are so difficult, aren't they? Because it's not just that you're dealing with the difficult thing, but it's taken away that big protective thing. Or it may be something at home. But any of us could be affected at some point. And that's okay, but the thing that's going to help us get better is usually the support of the folk around us. So, if we had to give folk tips of what to kind of think of, because we've covered a lot, haven't we? If you're thinking about how to improve peer support, how to have good peer support in your workplace or organisation. What would our tips be?- I think recognising that people need the time and space. It's not just about continuous working people over and over. That they also need time to take a step back. And that might just be five minutes having a chat amongst each other, but it may require a little bit more formal extended time away from the workplace. But we need to afford people the time to decompress after incidents. We can't just continue to expect them to be exposed, and exposed, and exposed. When someone has been affected, taking that time in the long run, will pay back dividens.- Absolutely. So, mine would be the same. It's a slightly different angle, but exactly that. I think if you're interested in improving peer support, you need to create the space for peer support to happen.- Yeah. Yeah.- So, there's no use having a formal peer support scheme with like 50 folk trained as peer supporters if there's never an opportunity for people to be with their colleagues in an informal way. Actually if we had enough time for people to have breaks, and to go on training together, and to have, I don't know, events, away days, or team meeting, whatever. If you create the spaces for peer support to happen, it'll happen. So, there's no use having a formal scheme if there's never an opportunity for people to come together and decompress and look out for each other.- I think people need to understand that they shouldn't underestimate the small gestures, and how the cumulative effect of those overall contributes to someone's wellbeing in a way that you can't measure.- [Gill] Exactly.- And the little instances of, "Hi, how are you? What's happening at home?" Those little day-to-day interactions, you can't quantify them because they're immeasurable. They have such an impact on people's wellbeing, and little gestures of kindness of,"I've made you a cup tea." Taking time to recognise when people achieve something well at work and recognise the value in what they're doing. That contributes to that importance of feeling good about your work. And having the opportunity to just, I guess sit down, and interact with people that's not in a formal business-like manner.- It's almost as if we prepared this, girl.(Gail laughing)- 'Cause that's really similar.'Cause my second one would be is to remember what the research and the evidence tells us, if we're gonna stay evidence-based is that it's that informal support, camaraderie, knowledge of each other. That's the stuff that has the evidence base for keeping people well. There's a much smaller evidence base for formal peer support schemes, yeah? And so, it is about recognising and appreciating all of those things that you've said. All of that, all of those every day. Simple essential gestures about people being in it together, and being connected. So, I suppose linked to that I would have a kind of warning really, which is one of the reasons we've really pushed to try and train as many people in peer support and in psychological first aid is to channel and maximise your existing peer support. That would be my big message. Don't assume that you have to introduce peer support as a new concept to your workplace.- It happens anyway.- Because that's actually quite insulting, and risk undermining folk. What you have to think about is peer support is what's keeping people well at work. If we're talking about the workplace, that's what's doing it now. So, is there anything we can do, whether that's about creating space or giving people some additional knowledge, whether it's about listening skills or understanding trauma reactions. What can you do to maximise the existing peer support? And don't risk doing something that turns people into paid referrers or undermines-- I think there has to be, from an organisational point of view, there has to be consistency in that. That when things are going well, affording people the time to sit down and have a cup of tea, that's great. But when things are going badly, when people are under significant levels of support, it is even more important to find that time. To take the time away, and I get it, that the business, the organisation is under significant pressure. But our staff members deserve that opportunity regardless of what's going on outside. That has to be a consistency of approach. And from that consistency, people then start to trust the organisation. They trust what's going on around them, and that they won't just be abandoned. And I think, I remember you quoting Maya Angelou,"People will forget what you said. They might forget what you've done, but they will never forget how you made them feel." And if you feel supported, and valued, and recognised, then people walk away with that sense of wellbeing and belonging.- Yeah. And actually, it makes really good business sense too. quite apart from it being the right thing to do and the decent, sort of people's human rights. But actually it does mean that people, particularly in some of these roles where it's all about people's commitment, and going the extra mile, and all of that, if you help people, if you value people, help them look after themselves and their mates, then they're going to be in their work. They're gonna do the best job they can.- They'll always go the extra mile. If they feel supported and valued, then they will go the extra mile. And then from that it reduces the risk to the individual in terms of their mental health, their ability to carry out their duties, but also at an organisational level.'Cause they're less likely to have mistakes made. They're less likely to go off sick, and they're less likely to have complaints made against them from unhappy service users.(both laughing)- Exactly. The business case of it, too. And I just think it feels like I spent the last, gosh, it is coming up kind of nearly 15 years banging on about this. But sometimes the things, it's how do we make the stuff that sounds so simple, and so obvious, and so kind of common sense and how do we make that the shiny thing that people want to do more of? The risk is if we think we have to invent something extra that we sort of undermine and forget, and come away from the core of what it is that's working most of the time. I think one of the tasks for us is to help everybody understand that and articulate, that's why we're doing this, is help people articulate those really sort of misleadingly simple kind of messages about how do we operationalize that? How do we make valuing people and respect and kindness...- I think just, and for me, RUOK? was born from people not completely understanding the detrimental effect not asking would have on an individual. And having that understanding of me sharing my story about how it impacted in my mental health, and the long journey it took to get back to recovery, that actually simple interventions are the easiest means to to prevent that. And people might not have that full level of understanding, but if you share what it means when they do have that level of support, then people are more likely to continue on and be reassured that that's the right thing to do.- Yeah, exactly. So, I think maybe the third message, I've lost count where we're at, but will be something about if we are going to do, if there is gonna be some sort of implementation plan, that it's about how do we improve peer support, and that that might be about making sure people understand the value of asking rather than assuming, and helping people recognise the value of being heard, and listening skills. And I would chip in helping people understand what are some common reactions to difficult events, whether they're in our personal lives or whether they're work related trauma stuff. So, there are things we can do to make peer support even more effective. And folk do an even better job of looking after their mates and their colleagues at work. And line managers. I guess my last thing will be, line managers are so essential in this. We need to make sure if anyone gets formal training, it ought to be them to help them do the best job they can to support their colleagues.- And I think also recognising that line managers also require peer support.- Peer. Exactly. Yes, see?- They're not immune because they are managers, they're not immune to succumbing to...- The stress.- The stress, yeah.- So, who is your peers? Always, who are your peers, and who's looking out for you. Exactly. You don't stop needing that peer support and feeling valued in camaraderie just because you're moving up a sort of promotional ladder. Yeah.- Yeah.