Our heroes are hurting... Will Government listen?

First responders risk their lives to protect us. But the Government, they say, won’t answer their own calls for help. Jehan Casinader investigates. Warning: This story contains references to suicide.

If you ask Dave Rose to tell you about a bad day at the office, he’ll find it hard to pick one. In 30 years as a firefighter, he has more stories than he cares to remember.

‘‘Sometimes, I’m trying to save someone’s life. I’m jumping up and down on their chest, breaking their ribs and shoving airways in, while I’m looking up at photos of them on the wall – and their kids might be running around. Or I’m doing CPR on an old lady after we’ve cut her clothes off.’’

Industrial accidents, car crashes, fatal house fires and suicides – Rose has seen them all. After three decades on the frontline, the accumulated trauma made him anxious and depressed.

‘‘I was haunted by everything I had seen throughout my career. As a resilient person, you just ignore that stuff and accept those negative feelings as being a normal part of the job. Eventually, it’s too much to handle, and you become unwell.’’

At 47, Rose had plenty of the symptoms of post-traumatic stress disorder (PTSD). He applied for workplace injury cover under ACC. To his surprise, he was told he needed to prove that his PTSD was caused by a ‘‘single event’’.

An ACC case manager instructed him to pick just one incident from his career. ACC would conduct an investigation to establish whether that single event was severe enough to cause PTSD.

‘‘That really pissed me off. I said, do you want me to tell you about a dead kid? Do you want me to tell you a story about when I watched someone die? Do you want me to tell you about a body spread out over a large area because it came to pieces as it hit the ground? What kind of story do you want me to tell you?’’

Rose began volunteering for his local fire brigade during high school, and went to his first double-fatality at 18. Three years later, he became a career firefighter, and has worked in South Auckland ever since.

‘‘We cut three dead bodies out of a car. After cleaning all the blood off the gear, not a word was said about what we had just done. By the time you come back to work the next day, you’re slammed with something else and you’re onto the next trauma before you’ve even processed yesterday’s one.’’

In 2014, Rose was part of a group of long-serving firefighters who were sent to a lecture about PTSD – a condition that is triggered by exposure to shocking, scary or dangerous events. For some, it can be mentally and physically debilitating.

‘‘I just sat there, thinking,

‘Holy s…’’’ says Rose. ‘‘I identified with so many symptoms: trouble sleeping, alcoholism, getting irritable, not liking being in small spaces, and avoiding large groups of people. I realised something wasn’t right.’’

In 2019, his symptoms escalated. After a string of sick days, Rose’s boss asked if he was OK. He admitted he was not coping. Rose says Fire & Emergency (FENZ) did a great job of connecting him to professional support, and gave him time to recover before coming back to work.

But ACC, the agency responsible for workplace injuries, was nowhere to be seen.

‘‘People aren’t getting the help they need,’’ says Rose. ‘‘As a result, they’re getting sick, drinking too much, leaving their partners – or ending their lives.’’

New Zealand is lauded for its world-leading ACC system, which offers no-fault cover to anyone who is injured, including at work. But if your injury is mental rather than physical, you may be out of luck.

When it comes to physical health, ACC recognises ‘‘gradual process’’ injuries – those that occur over time. For example, a person who develops hearing loss while working in a loud factory, or repetitive strain injury caused by years of manual labour.

But for mental injuries like PTSD, the law says the injury must be caused by a ‘‘single event’’.

If a firefighter develops PTSD after attending just one suicide, they will receive ACC cover. But if they develop PTSD as a result of 10 suicides, they won’t be covered.

Why is there a discrepancy? Quite simply, successive governments haven’t updated the 21-year-old Accident Compensation Act to reflect modern psychology. That means ACC staff are forced to apply narrow, outdated criteria.

The baffling reality is: the more trauma you’ve been exposed to, the less likely you are to get cover. It’s ‘‘illogical’’, says Josh Darby, a career firefighter and trauma researcher. He’s working with lawyers, psychologists and first responders to campaign for a law change.

‘‘That would benefit firefighters, police and paramedics, but it would also apply to Corrections workers, doctors, nurses and journalists. There are so many professions where there’s a real risk of repeated exposure to trauma causing a psychological injury.’’

People with PTSD often need much more than a handful of counselling sessions. They may also need specialist support, longterm income cover while they’re in recovery, or to retrain in a whole new industry. ACC spends millions providing that kind of support to those who are physically injured at work.

But Darby is supporting many first responders with clinically diagnosed PTSD, who are desperately trying to get comprehensive cover from ACC.

‘‘They’re already struggling to cope, and then ACC forces them to try and justify their psychological injury. Many people have to go through an arduous, adversarial process, with the help of a lawyer or union. This adds to their distress and may increase their risk of suicide.

‘‘When people do get cover, it’s often in spite of the legislation, not because of it.’’

In some cases, that’s because clinicians are bending the truth, says Dr Paul Skirrow, executive advisor at the New Zealand College of Clinical Psychologists.

‘‘Our members are caught in an ethical dilemma. If they follow the science, they often determine someone’s PTSD was caused by multiple events over time. But if they put that on paper to ACC, the person may be turned down for cover, and not get psychological or financial support.

‘‘To get around this, some members may bend the truth and only report on a single event. But there still may not be enough evidence for ACC to provide cover. And if there is, the person may not receive the full range of support they need.’’

It was dinnertime. Auckland firefighter Luke Farrell climbed into a truck, heading to a ‘‘code purple’’ callout – a life-anddeath situation. When he arrived at the house, he found a woman’s body. She had killed herself.

‘‘It was a nice house. The husband kept saying, ‘She’s gone. She’s gone’. There were Mother’s Day cards on the dining room table. I was standing there thinking, ‘S…, those poor kids. This is an absolute nightmare.’

‘‘We removed the body. Then we went back to the station, ate dinner and watched TV. That’s what happens on those jobs. Noone ever says, ‘Hey, that was terrible, let’s talk about it’. You just move on. It seems surreal.’’

Farrell joined the fire service at 18. He speaks highly of his colleagues, and says he ‘‘absolutely loved’’ the job. But that changed when firefighters began attending callouts that were traditionally covered by paramedics and police – like drug overdoses, medical events and suicides.

‘‘When the bells went off, I’d get a massive sinking feeling of anxiety. My brain would start reminding me about all the other callouts I had been to, and I was filled with dread. But I’d think, ‘I’m a firefighter, I should be able to deal with this’. My anxiety started creeping into my home life. I felt so depressed, I struggled to get out of bed most days, and my partner noticed my mood had changed. I knew I wasn’t enjoying work, but I didn’t even contemplate that I had PTSD.’’

A tipping point came when Farrell found himself doing CPR on a boy with special needs who had a medical event at school, while the other kids watched. He thought: ‘‘I don’t want to do this anymore.’’

After eight years of service, Farrell left the fire brigade to

train as a professional golfer. But he continued to be plagued by anxiety, stress and negative thoughts. His doctor was certain he had PTSD, and encouraged him to apply for ACC cover.

‘‘ACC called me,’’ says Farrell. ‘‘The man said, ‘You need to tell us about one event that was traumatic, and we’ll see if we can make your claim work’. So I told him about the woman who killed herself after Mother’s Day. He said, ‘You’ll need to date it’. I said, ‘Oh man, I can’t remember the date – I’ve been to hundreds of callouts over my eight years’.’’

‘We cut three dead bodies out of a car. After cleaning all the blood off the gear, not a word was said about what we had just done. By the time you come back to work the next day, you’re slammed with something else and you’re onto the next trauma before you’ve even processed yesterday’s one.’ DAVE ROSE

Farrell provided his best guess. For six months, ACC went back and forth with FENZ, trying to confirm the incident that Farrell had described.

Frustrated, he decided to contact his old boss and do his own research – digging through incident reports to find the exact callout. He says he felt like he was ‘‘going crazy’’, and even wondered if the woman’s suicide was a figment of his imagination. Eventually, he found the proof.

In January, Farrell was assessed by an ACC-appointed psychologist. Two months later, ACC confirmed that he does have PTSD. Farrell’s first treatment session took place in June – more than a year after he first contacted the corporation.

While he is now healthier, Farrell is astonished that ACC made him jump through bureaucratic hoops.

‘‘I have a supportive wife, family and friends. But what if I didn’t? What if I was really struggling, and I had to wait a year to get assessed and see a psychologist? Honestly, it’s so f… ing dangerous.

‘‘When you roll your ankle, ACC gets back to you within a week and it’s all sorted. When you have PTSD, they put you through the wringer.’’

The Government has been aware of the anomalies in ACC’s mental health framework for many years. In 2020, police officer Matt Davis launched a petition to extend mental injury cover for PTSD. It gained 7277 signatures.

In a statement to Sunday News,

ACC Minister Carmel Sepuloni agrees the system needs to change – but she won’t do it in a hurry.

‘‘It is time we take a deeper look at how ACC covers mental health. I have agreed to add a review into our work programme.

‘‘This work will begin next year, and I intend it to be a comprehensive and reasoned look at how ACC covers mental health.’’

Sepuloni says any changes to ACC entitlements could increase the levies paid by all workers, and may also require a larger mental health workforce. As a result, the review ‘‘will not be a fast process’’. To those on the frontline, that’s a slap in the face.

‘‘When someone calls 111, we respond with absolute urgency in a person’s time of need,’’ says

Josh Darby. ‘‘We don’t wait for years to take action – otherwise the house would burn down.

‘‘We would love it if the Government responded to us with the same urgency.’’

Last year, Sepuloni moved quickly to fix a different problem with ACC rules. After reading an RNZ report about women who were injured while giving birth, she began a law change to extend ACC cover.

On Twitter, the minister trumpeted how fast she had acted. ‘‘I began the process [in March], the policy work began in June, and Cabinet signed off on it in August,’’ Sepuloni wrote.

‘‘Wouldn’t it be great if the same efficiency and leadership can be shown here?’’ asks Darby.

‘‘We understand the need to do things thoroughly. But I don’t see why the PTSD work can’t be prioritised.

‘‘The policy work to amend the legislation could begin straight away.’’

Across the country, emergency services are under pressure. They’re facing increased callouts, violence and mental health events – all while operating with stretched resources.

When Amanda Bird became a paramedic in 2008, she usually had some downtime in the middle of a 13-hour overnight shift. Now, if she’s lucky, she’ll ‘‘crash in a La-Z-Boy and hope for half an hour of sleep, before being called out again’’.

Bird has PTSD, and says it was caused by her repeated exposure to two things: the violence people inflict on each other, and the violence they inflict on themselves.

‘‘The beatings are just horrific. Years ago, I would see someone who had been beaten up, but these days, it’s a pummelling. They’re unrecognisable. Sometimes, when a person has been horribly assaulted, I don’t even know where to start.’’

Like Rose and Farrell, Bird carries a catalogue of traumatic memories in her head, including assaulted babies, women hit with hammers by their partners, the murder of elderly people, and child suicide.

Paramedics are unarmed. Often, she and her colleague will arrive at a scene before police. Bird sometimes fears for her safety. What’s more, she works in the same community she lives in – so even when she’s off the clock, it’s hard to clear her head.

‘‘There are very few places I can go without having a memory triggered about something bad that happened there. One guy killed himself violently in a supermarket carpark. That was my local supermarket.

‘‘For a long time, I couldn’t go back there, because of the horror.’’

In 2015, Bird started having flashbacks, heart palpitations, night terrors and insomnia. She decided to keep it a secret from her bosses.

‘‘I thought getting PTSD was a sign of failure, and I wasn’t strong enough. These days, I know better. But back then, I was embarrassed.’’

While emergency service organisations offer wellbeing support and a limited number of free counselling sessions, some aren’t equipped to identify or treat complex PTSD.

Privately, Bird worked hard to find mental health professionals who could help her, but she struggled to find someone who was experienced in treating first responders. For three years, Bird cycled through periods of ill health. Usually, her symptoms abated – but at times, they were crippling.

‘‘I decided to take my own life. I wrote my kids a letter, and went on my way. Then I thought, ‘Hang on, this isn’t you, Amanda’. I recognised that my PTSD hadn’t gone away, and I needed help.’’

During a lockdown in 2020, Bird had a bad bout of symptoms. Her GP suggested applying for ACC cover. She was sceptical, but was willing to give it a go.

ACC’s case manager said they would have to obtain records from Bird’s previous counselling. Having been a paramedic for 12 years, she couldn’t even remember the names of all of the counsellors she had seen.

‘‘The ACC person asked me, ‘Was there a particular episode that triggered this? Can you point to one event?’ There was no point ACC investigating my case, because my PTSD wasn’t caused by a single event. I didn’t want them rummaging through my work history, because I knew there was no hope. So I gave up on the whole process.’’

The Government is waiting until next year to begin its review of ACC’s mental health rules. In the meantime, Sepuloni says she doesn’t want to create ‘‘inequities’’ in the ACC system by fixing one area without fixing another.

But advocates say the system is already profoundly inequitable. They’re worried about first responders who are suffering in silence, especially those who are at risk of suicide.

‘‘People will say, ‘Oh, they can still get help from the DHB or primary care’,’’ says Dr Skirrow. ‘‘I would strongly refute that. Our mental health services are so stretched. Unless you’re seriously unwell, you probably won’t get into the DHB. Even if you do, there’s a pretty small chance of getting to see a psychologist who can treat complex PTSD effectively.

‘‘Something needs to happen quickly for people who aren’t getting support right now.’’

Dave Rose managed to get back on his feet without the help of ACC. Instead, he relied on his colleagues in the fire service.

‘‘I’m still quite withdrawn, and I don’t like people being in my personal space.

‘‘I don’t go out unless I have to. But I feel good about myself again, I’m loving my job, and I’m glad I’ve been able to return to work.’’

Last month, ACC told Rose that it had granted him cover for PTSD. That wasn’t because ACC had relaxed its rules – it’s because Rose had proved that at least one ‘‘single event’’ was bad enough to give him PTSD.

‘‘The process was a complete f…ing nightmare,’’ he says. ‘‘But my successful claim is another step forward for emergency workers across the country.’’

In addition to extending PTSD cover, Rose wants ACC to invest money in educating emergency workers about the signs and symptoms of psychological injuries.

‘‘Prevention is what ACC raves about. Where are they at the beginning of first responders’ careers? They should be saying, ‘Hey, here are some of the things that could happen to you, here’s how you recognise them, and here’s how we can support you early’.’’

Rose knows the devastating consequences when someone doesn’t get the help they need. Some years ago, one of his friends in the fire service felt unsupported while experiencing mental distress. He ended his life.

‘‘Suicide of colleagues has always happened throughout my career. I never asked too many questions about why.

‘‘I used to think, ‘Oh, that guy must have been f…ed in the head’. But when I went through my own struggles, I thought, ‘Someone has to stand up and talk about this’.

‘‘I hope the Government will listen.’’