The number of paramedics taking time off with mental health conditions has almost tripled over the last decade, a Guardian analysis has found. In 2019, paramedics took 52,040 days off due to anxiety, stress, depression and other psychiatric illnesses, up from 18,184 in 2011 – an increase of 186%. While the overall number of paramedics has increased slightly over the period, the rate of mental health leave has increased more, resulting in the average number of days taken off per paramedic in a year rising from 2.8 to 5.8. Unison, the public service union, warned that “crisis-level staffing has increasingly become the norm” in the NHS, amid increasing demand, faster turnaround times and a shortage of paramedics in England. Some areas are seeing an average of more than five days taken off per paramedic, according to responses from seven English NHS ambulance trusts to freedom of information requests. The total absence for the first few months of 2020 stands at 21,015 days off, prompting warnings that coronavirus will pile more stress on already stretched staff. NHS trusts have introduced measures such as named psychologists, online therapy sessions, mindfulness training, chaplaincy support and “wellbeing rooms” in response to increased stress levels among staff. But even before the coronavirus pandemic, at least 1,313 paramedics were forced to take time off with mental health conditions in 2019 – up 235% since 2011. This is an underestimate of the true figure, with five of Britain’s 12 ambulance trusts, including the ones covering London, Wales and Scotland, failing to provide full data for the whole period. Unison’s head of health, Sara Gorton, said: “Crisis-level staffing has increasingly become the norm within the NHS in recent years, even before the pandemic. Working long hours without breaks, in demanding conditions, it’s no wonder it’s taken a toll on the mental health of workers across the health service. And the coronavirus challenges have piled on more pressure.” Of those providing data, the trusts with the highest number of stress-related leave days per paramedic were the East Midlands Ambulance Service (EMAS) NHS trust, East of England Ambulance Service NHS trust, and North East Ambulance Service NHS foundation trust. EMAS saw an average rate of seven days off for stress per paramedic in 2019, with 8,412 days taken off altogether. This has increased from 3.7 days per paramedic in 2011. Neelesh Sutaria, head of wellbeing and inclusion at EMAS trust, said: “The role of our frontline clinicians has always been physically and mentally demanding and the traumatic incidents that they respond to can be extremely challenging, as well as personal issues which everyone experiences. “Mental health is often seen as an invisible illness that carries a stigma, and so over recent years we have worked hard to break that stigma by encouraging our colleagues to talk and to be open and honest about how they feel.” Pointing to the fact that nine in 10 ambulance staff have experienced stress or poor mental health, Liz Harris, head of professional standards at the College of Paramedics, said: “We are very concerned that the mental health of our paramedic members and ambulance colleagues appears to have been deteriorating for many years, with a lack of sustained or systemic action to slow and halt this trend.” According to NHS Employers, which represents hospitals and other providers of care, stress accounted for a third of sickness absence in the NHS, costing the service over £300m per year. NHS trusts said that various factors contributed to the rise in stress-related leave, including growing demand, increases in staff, improvements in mental health awareness and more staff feeling able to open up when they need help. But long hours, changes to shift patterns, fatigue, low levels of perceived autonomy, low levels of trust in organisational management and a blame culture have also been listed as causes. The College of Paramedics called for better management training, the providing of sufficient time and space to reflect on work experiences, improvement in preparation for trainee paramedics, and a wholesale change in the cultures within ambulance trusts. Harris said: “There has been a range of free mental health support resources throughout Covid-19 for NHS staff but we are unsure at this time whether they will remain, and if so for how long.” A Department of Health and Social Care spokesperson said that supporting staff mental health was a priority, adding: “The NHS has published a framework to help employers plan and deliver a staff health and wellbeing plan and we have a range of services available to staff including a mental health hotline, practical and financial assistance, specialist bereavement and psychological support. We would urge anyone struggling to come forward to a colleague, their occupational health team or call the helpline so that they can get the help they need.”