Spate of suicides among profession highlights need for culture change
Advocacy groups for first responders are fighting for a variety of changes around mental health and post-traumatic stress disorder (PTSD) supports, following a number of recent suicides by emergency personnel.
At least 25 Canadian first responders have committed suicide since last April, according to statistics tracked by Vince Savoia, founder and executive director of the Tema Conter Memorial Trust (TEMA), based in King City, Ont.
Two of those suicides occurred in just one week — Cpl. Ron Francis of the RCMP committed suicide just days after Ottawa police officer Kal Ghadban took his own life.
Mental health issues and PTSD are often discussed in regards to military personnel, but they can and do affect all types of first responders — police, paramedics, firefighters — as well as other occupations dealing with trauma, such as social workers, emergency room nurses or subway drivers.
In October, the Ontario government released the Roundtable on Traumatic Mental Stress to address job-related traumatic mental stress. The Ontario legislature is also considering a private members’ bill that would require the Workplace Safety and Insurance Board (WSIB) to presume PTSD in paramedics, police and firefighters is job-related.
In 2015, Ontario will host a follow-up conference on the issue. But in the meantime — as the news stories of suicides continue to pile up — what supports, resources and changes are experts advocating for?
What’s missing?
It’s not that there’s necessarily a lack of support for first responders, said Savoia.
"A lot of organizations do have support systems in place. For example, I would say all first responders — unless they’re volunteer-based — do have access to employee assistance programs," he said, although counselling sessions through an EAP, or even through extended health-care benefits, are often limited to three to six sessions and $500 a year, respectively.
"Whether or not they’re utilized is the question, and how effective they actually are. It’s nice to have access to EAP, but does the counselor on the other side of the phone truly understand the culture and the subculture of emergency services?"
The workplace culture for emergency personnel is a key factor, because even if the services and supports are there, PTSD sufferers may be hesitant to access them.
"Those climates in those careers tend to be very macho… it’s a tough, kind of stoic profession," said Ken Welburn, clinical director of the Ottawa Anxiety & Trauma Clinic.
"Because of the culture they work in, there’s just an expectation that they ‘man up’… so what you do in that environment is you just kind of shove things away and don’t talk about them."
People often won’t seek help until they reach some sort of crisis point, he said.
"I rarely see people where the trauma has just happened… generally, it’s been people who have suffered for many years, and have only come in because something else has kind of fallen apart."
A culture change is definitely necessary, said Nick Carleton, associate professor of psychology at the University of Regina.
"But it’s very challenging to do that. Changing a culture isn’t something that you can simply decide one day you want to do, and the next day it’s instantaneously completed. Culture change usually follows a generational shift," he said.
And it’s not just about the leadership, he said.
"The culture change doesn’t just need to happen internally to these organizations — it also needs to happen externally with our expectations of our first responders."
Workers’ compensation
Another change advocates in Ontario are pushing for is that PTSD sufferers receive WSIB coverage without having to "prove" the condition was caused by the job.
"Right now, if an emergency service worker in Ontario applies for WSIB benefits related to PTSD, they’re automatically denied unless they can specifically prove (it was caused by the job)," said Geoff MacBride, director of government relations, Ontario Paramedic Association in Toronto. "And it’s essentially not provable, initially — it’s a long, drawn-out process which is not good for recovering from PTSD."
Formerly known as Bill 67, and now known as Bill 2, the private members bill has died on the floor four times — not because of any opposition, but because of the government turning over, said MacBride.
If passed, the bill would remove the provision of having to prove PTSD is caused by the job.
"We want to change that so it’s an ‘implied diagnosis.’ If you are employed in this type of service, and you develop that type of illness, then yeah, you probably got it from work," said MacBride. "And certainly, there’s still going to be the whole WSIB process — investigation, diagnosis by a physician, et cetera — and if it comes out not to be (PTSD) then they wouldn’t get that kind of coverage. But for those that PTSD is the case, we want to ensure that the coverage is there.
"The only opponents to this, their concern is increased costs and increased number of claims. And we’ve had the same or similar legislation in Alberta for the last two years, and there’s been no increase in the number of claims and no increase in costs — costs have gone down."
There are misconceptions and misinformation around PTSD claims, said Welburn.
"There’s this idea that people with PTSD are trying to milk the system somehow, or they’re trying to get out of something, or have some sort of unfair advantage or something like that — that they’re kind of lazy. And it’s actually the exact opposite of that. You see people who have gone to work with PTSD for 10 years, 20 years," he said, adding that every time they experience another trauma, they’re changed in a negative way.
Other key changes
In addition to the culture change within organizations, provincial governments should add psychological care to health benefits such as OHIP, said Savoia, who is himself a survivor of PTSD.
"The other thing I’d like to see is a best practices program across the country as to how best to deal with peer support within an organization — what sort of training would be most beneficial," he said.
"Right now, departments are left to themselves to decide how to support their staff. But the evidence out there about the different types of therapies is so varied, and there isn’t a best practices protocol. And many organizations that are trying to deal with that just walk away because they feel so overwhelmed."
Organizations also need to be proactive about preparing emergency responders for trauma, said Welburn, who is working on a mental health manual for first responders.
"We know these people, when they come into these fields, they’re going to witness and be exposed to multiple traumas. So why don’t we prepare them for that?" he said.
"The idea that, ‘We’re paying you to do it so just go and suck it up,’ is like (saying) we’re paying you to be a firefighter so just go a breathe the smoke. There’s not a logic to it. We have to give you the training and preparation, psychologically, that would be equivalent to the physical training and the physical equipment that you have."
It’s important to design mental health supports while being mindful that heroes are human, said Savioa.
"Under the uniform, we’re just regular people," he said. "In the minds of first responders, (the) expectation is they should be immune to this stuff; that when they attend to tragedies, that they should not be affected whatsoever. But at the end of the day, they’re still regular people."
