Jason Killens KAM

Silence Between Sirens is a suicide-prevention cause for people who serve on the front line of the UK’s emergency services. Our goal is simple: no one in the emergency services should die by suicide. We exist to make it safe to speak up early, so that no one reaches breaking point alone.

We are writing to you because the ambulance sector has started to move, and London has the chance to lead it. We welcome the national ambulance suicide register that AACE is establishing, and the part London can play in it. NHS staff data collection on suicide is not mandatory, and there is still no complete picture across emergency services. We have also written to the Prime Minister, asking for consistent recording across every emergency service.

Hannah Cooper founded the cause after 16 years in uniform. Richard Goold served as a frontline response officer with the Metropolitan Police in Peckham, South London. We both know from the inside what the job asks of people.

The cause is growing quickly. More than 12,000 frontline emergency services workers engage regularly with our content across our social channels. This summer we trained 44 blue light workers in Mental Health First Aid and suicide prevention, and supported 40 officers after the loss of a colleague.

What the job carries

Paramedics and ambulance crew work alongside the call handlers and clinicians in control rooms who hear the worst of it first. In a London study (2016) of 386 newly recruited paramedics followed for two years, 8.3% had an episode of PTSD and 10.6% an episode of major depression. Nearly all episodes had cleared by the next assessment four months later. The job affects people early, and most episodes pass.

The harm rarely comes from a single incident. It builds, shift after shift, carried quietly in the silence between incidents and taken home to families. Some people reach a point where suicide feels like the only way out. It is not. These deaths are preventable, and there are moments along the way when someone can be reached.

What the evidence shows

Ambulance trusts have the highest sickness absence rate in the NHS, at 6.6% in June 2026. Across the NHS, anxiety, stress, depression and other psychiatric illness are the most reported reason for sickness absence, at 30.2%. When Mind surveyed ambulance personnel in England in 2015, 80% said their organisation did not encourage staff to talk openly about mental health, compared with 45% in a 2011 survey of UK working adults. In Mind’s 2019 survey, only 23% of ambulance staff had received induction training on looking after their own mental health, against 69% on supporting the public’s.

For ambulance personnel, we can find no published national figure on deaths by suicide. More widely, an international review (2017) found that, across protective and emergency services, suicide prevention programmes were associated with an approximate halving in suicide rates.

The gap

The sector has taken real steps, and we welcome them: the national register, dedicated crisis support for ambulance staff, and NHS staff data collection, although it remains voluntary. What is still missing is support that reaches people early, before they are struggling, rather than once harm has been done. That is where we believe we can help.

What we are offering

Before Breaking Point, for your new starters, at no cost. A two-hour early-support session for new starters during their initial training, including apprentices and student paramedics on placement. It covers what good mental health looks like, how the job will affect people, recognising the slow slide from coping to struggling, and speaking up early. It is delivered by our facilitators, who have lived experience of the job and its toll, and we return to the same group between six and twelve months later.

The evidence for starting early is promising. In a UK trial of 570 student paramedics, resilience training before frontline work cut the odds of PTSD or major depression a year later by 75 to 80%. It is a single trial, but it points in one direction. Learning also fades without a refresher. In an independent evaluation for Mind (2018), the share of recruits who said they understood ways to build resilience rose from 48% to 93% after training, then fell to 71% two to four months later. That is why we return. We would measure what people know and how confident they feel about speaking up, before the session, straight after it and when we return, and share the results with you, whatever they show.

What we are asking

1. One hour with you and your wellbeing and education leads. We would use it to share Before Breaking Point and what we are learning from the LifeLine Crew. Both are being developed by colleagues from across the emergency services, with lived and living experience of everything we set out to support. We would come ready to agree whether a pilot with a 2027 cohort is right for the London Ambulance Service.

2. Support for anyone under investigation. No one should be told they are under investigation and then left alone with it. Your trust will know the 2019 NHS Improvement letter. It followed the death by suicide of a nurse after an investigation and disciplinary process, where an independent inquiry found he had been “treated very poorly, to the extent that his mental health was severely impacted”. It told every NHS trust that “concern for the health and welfare of people involved in investigation and disciplinary procedures should be paramount and continually assessed”, and that serious harm to anyone in the process should be treated as a “never event”. We ask the London Ambulance Service to make sure that, as a minimum:

↳ people are told of an investigation in a planned way, in person where possible, with a welfare contact identified beforehand, a check on wellbeing at the time, and care over timing, so that no one is told at the end of a shift or before rest days without support in place;

↳ a trained welfare contact, independent of the investigation and ideally chosen with the person, stays in regular contact from the start to the outcome and beyond;

↳ occupational health and psychological support are offered from the outset, not only on request;

↳ risk is reassessed at each pressure point - notification, suspension or restriction, interview and outcome - and whenever circumstances change;

↳ anyone suspended or restricted stays connected to colleagues and support, and is not cut off by default;

↳ updates are meaningful, and investigations conclude without avoidable delay;

↳ support continues after the outcome, including for anyone leaving, and families know what help is available, with the person's consent. We would welcome the chance to help your people and wellbeing teams shape this.

3. Your voice on recording, nationally. Recording will only change things if it is consistent, published and acted on. We ask the London Ambulance Service to take part fully in the national register and the NHS data collection, and to add your voice to the case for consistent, published recording across every emergency service.

We do not claim to have every answer. We do bring lived experience, a growing community across every service and materials ready to share. If Before Breaking Point is not right for the London Ambulance Service, we would value knowing why, so that we can make it better. The people who serve London’s ambulance service hold the city’s worst moments every day. We owe them support long before crisis. We would welcome an hour with you at your earliest convenience.