High-profile attacks put psychological safety back into spotlight
There’s an endless list of questions that came along with the recent terror attacks in Paris. How can we prevent similar tragedies from happening in the future? How can we minimize the casualties? But one important question centers around first responders, and it’s a question that’s gained increasingly more traction over the past month in the wake of this type of tragic event: How can we protect the health and safety of those who serve and protect?
First responders who arrive on the scene of an attack or a natural disaster certainly have a great deal of training around how to stay physically safe. But psychological safety is a different story.
"With any sort of event like that, I think a lot of it’s going to come down to the first responder themselves," said Vince Savoia, founder and executive director of the Tema Conter Memorial Trust in Toronto. "Because what normally happens when you have that sort of an event is, there’s this invisible line that’s crossed where people’s morals, beliefs are all challenged — especially if there’s a terrorist attack and a loss of life. And whenever a first responder needs to make sense of a situation and there isn’t any rational reason for why it occurred, those types of events sometimes are really difficult to come to terms with.
"I wouldn’t be surprised if a lot of the first responders — particularly if they did lose someone or they weren’t able to save someone’s life — I often wonder how many of them would have a sense of guilt."
Yet in Canada, many of our first responders receive little to no training around psychological safety and mental health, said Savoia.
Now, mental health activists — and organizations themselves — are fighting to change that.
"In general, it’s been largely a neglected area. Traditionally, occupational health and safety has focused on physical injury, and now employers are recognizing that psychological injury is something that can be very impactful to the organization as well, (and) not only disability leaves and some of the more high-profile stuff," said Ash Bender, staff psychiatrist with the Mood and Anxiety Disorders Program at the Centre for Addiction and Mental Health in Toronto.
"It’s definitely one of the more relevant topics. I think particularly in Ontario, it’s been a focus for the Ministry of Labour. And a lot of that has come out of some special interest in groups, first responders in particular — so police, fire, paramedics — that’s been a more high-profile issue… it’s the most relevant health condition affecting a lot of people that get exposed to critical incidents."
Not just about high-profile events
High-profile, headline-grabbing events like terrorist attacks or natural disasters certainly play a part in psychological safety risks, but so do the day-to-day traumatic exposures people might face over the course of their employment, said Bender — and it’s important to be aware of that.
"What we’re calling them now are occupational stress injuries, and that’s not diagnostic-specific. There’s been so much focus in the media about PTSD, but the reality is that as a result of exposure to critical incidents, people can experience post-traumatic stress disorder but may be just as likely to experience a major depressive disorder, develop some issues with alcohol misuse or other substance use problems as ways to try to manage their systems," he said.
"Occupational stress injuries (OSIs) can be a number of trauma-related ailments such as depressive disorder, anxiety disorders, post-traumatic stress, and the unhealthy behaviours like substance misuse."
There are organizations such as the York Regional Police that are leading the pack in terms of preventing OSIs and providing support should one occur. The service is using the Road to Mental Readiness program, and has a robust peer support program, said Beth Milliard, constable with the York Regional Police.
They also have a "safeguard program" where in certain high-risk units, members automatically have to be psychologically assessed to determine suitability to work in that unit, she said.
"It’s not to single anybody out, it’s just that we don’t want somebody in a (high-risk) unit when there may be other stuff going on — they’re already stressed in their life," she said.
"Basically what we’re finding is, it’s not all about PTSD. PTSD seems to be the buzzword everywhere, and usually we find when people have all these other stressors going on. There’s financial difficulties or there’s aging parents or there’s sick kids that are kind of more of what’s stressing people out."
That’s why York Regional Police provides support to spouses and families as well — not just members.
Milliard also chairs a committee where police services get together to share best practices, she said.
"People are trying — it comes down to a budget issue," said Milliard. "We try to tell people, it’s either you pay now or you pay later.
"The great thing too about our working group is that bigger services try to help smaller services, knowing that they have smaller budgets. We do try to work together to assist them, if that means them coming onto training courses with us or we might have in-house trainers on certain courses related to trauma, and we can even say, ‘We’ll lend them out to you, you just have to pay for their gas and mileage,’ or something like that."
The biggest issue when we think about this is awareness, said Bender.
"There’s an increase in awareness, but you’d actually be surprised how historically low the levels of acceptance and awareness are among some high-risk groups. It partly is traditionally thinking that stress injuries only happen to combat soldiers, for example. That’s a common reaction. The other is the emphasis on just PTSD and not other psychological conditions that can come on slowly and be a result of multiple exposures," he said.
"And often, it’s people just doing their regular course of duty, and they’ve had multiple exposures. So you see this slow, insidious onset and then suddenly they’re finding themselves really struggling to cope.
"The other thing is cultural attitudes that have been barriers… there’s a public perception, and probably a self-perception, that if I chose this job, I am inherently capable of handling everything it throws at me. It leads to attitudes like, ‘That’s just part of the job.’"
