This blog was written by Dr. Vivien Lee and originally posted on the official blog for the Centre for Addiction and Mental Health.

By: Dr. Vivien Lee, Dr. Lisa Couperthwaite, Dr. Niki Fitzgerald, Psychologists at CAMH

There has been increasing media coverage about PTSD over the past several years, particularly with the number of Canadian and US soldiers returning from the Middle East reporting high levels of psychological distress. Highly-respected Canadians such as Lieutenant General Romeo Dallaire and Lieutenant Colonel Stéphane Grenier have courageously opened up about their own battles with PTSD.

PTSD however, is not a new concept. Although not an official diagnosis until 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), descriptions of clusters of symptoms in response to trauma have been noted for many years. It is not limited to soldiers – PTSD symptoms can develop in individuals from all walks of life exposed to different types of traumas (some examples include motor vehicle accident, assault, natural disaster).

So, what exactly is PTSD? As per the DSM-5, symptoms can be grouped into clusters, which include:

  • Intrusive – these might include memories, nightmares, triggers
    Avoidance of memories or triggers
  • Negative changes in thoughts or mood – these might include negative beliefs about self or others, blaming of self or others, forgetting parts of the trauma, persistent negative emotions, emotional numbing, detachment from others, loss of interest in things normally enjoyed
  • Marked changes in arousal and reactivity – these might include irritability, recklessness, hypervigilance, strong startle response, concentration or sleep difficulties

What constitutes a “trauma” can vary somewhat, but it typically involves witnessing deaths of others, or experiencing or witnessing violence or significant threats to the safety of oneself or another. The very nature of first responders’ work lends itself to exposure to potentially traumatic incidents on a regular basis.

First Responders: They run in when everyone else runs out

First responders are people who respond to the scenes of emergencies, and include police, firefighters and paramedics, among other emergency personnel. Because their work by definition often involves witnessing deaths and injuries, the number of potentially traumatic scenes they attend to in one week may be more than what some people experience in their lifetime! While they may become used to such scenes, particular calls may cause more distress, such as the deaths or major injuries of children. First responders have typically worked in a “suck it up” culture – not only for others, but for themselves as well. Thus, various types of stress reactions or even posttraumatic symptoms can gradually and progressively build up over time. Increasing numbers of traumatic incidents can result in cumulative trauma. The stigma associated with being a “helper” who then asks for help has tended to be prevalent in first responder organizations and can be a significant barrier to seeking much needed help.

Other factors can impact distress in first responders as well, including shift work, disruptions to family and social lives, and organizational support, which we’ll discuss in a future blog.

Often, first responders may have continued to work for a long time despite reduced ability to cope, and continue to be routinely exposed to potentially traumatic situations. Eventually, they may reach a “breaking point”, even after what may appear to be a relatively minor event. A comparison can be made to injuring one’s ankle. If one continues to walk on the ankle without allowing it to heal, the ankle may become vulnerable to re-injury, even to lighter levels of stress.

Historically, first responders have, at times, experienced difficulty having this cumulative impact of stress recognized by employers and worker’s compensation boards. Some have even had compensation claims denied due to difficulty identifying one single event that could be considered atypical in a first responder’s work duties that contributed to the PTSD.

Important changes and new legislation to help First Responders

Several weeks ago, we took part in a week-long training session for Road to Mental Readiness (R2MR), a program that seeks to decrease stigma and increase resilience and mental health training for first responder organizations. This was the first R2MR training for paramedic services in Canada, and we were happy to take part. We met several passionate, hard-working First Responders like paramedic Natalie Harris, who have been amazing advocates for greater mental health support for those in her profession.

And their advocacy has been successful!

On April 5, 2016, the Ontario government voted unanimously to pass Bill 163: Supporting Ontario’s First Responders Act (Posttraumatic Stress Disorder), 2016. This bill presumes that PTSD (as diagnosed by a psychologist or psychiatrist) is a direct result of a first responder’s work duties; thereby, taking the onus off the first responder to have to prove that the development of PTSD was directly related to one specific workplace incident. The Act will also allow the Ministry of Labour to request PTSD prevention plans from employers.

Dr. Lisa Couperthwaite and I were invited by Natalie to attend the Ontario Legislative Assembly when the third reading of the bill was passed. Seeing each MPP, one by one, stand up and vote YES to the bill gave us goosebumps! It was amazing to see progress in how our First Responders are treated, and a personal win for us who are in contact with many of these brave people on a regular basis.

This is just the beginning of a conversation that we hope to continue, and we look forward to sharing more about our work with First Responders in future blogs. PTSD continues to be a growing topic of concern in the world, and we have to support those whose job it is to bravely go where few will venture, in order to save lives.