How do we help the first responders who endure trauma when helping us? (The Globe and Mail)

How do we help the first responders who endure trauma when helping us? (The Globe and Mail)

January 15, 2016

15 January 2016

Late one night in the summer of 2014, Bill Rusk, a police sergeant in Owen Sound, Ont., was crouched on the roof of a downtown store, watching the window of a second-floor apartment in the building next door. His squad had come to bust up a drug deal, and had been told that a violent man was hiding inside with a sawed-off shotgun.

John Lorinc
The Globe and Mail
January 15, 2016

Late one night in the summer of 2014, Bill Rusk, a police sergeant in Owen Sound, Ont., was crouched on the roof of a downtown store, watching the window of a second-floor apartment in the building next door. His squad had come to bust up a drug deal, and had been told that a violent man was hiding inside with a sawed-off shotgun.

A few moments later, the apartment window lifted slightly, and Sgt. Rusk noticed the flash of something silver. “In my mind,” he recalls, “that was like a gun.”

The decorated 29-year veteran – and the senior officer at the scene – trained his rifle on the window. “But there was something that made me wait that extra second, because I have this checklist of what I think of before I pull that trigger.” (On that list: Are my people safe? Are there hostages inside? Bystanders nearby? Do I have legal cause to shoot?)

After taking a second look, Sgt. Rusk reached through the open window and yanked the suspect out; other officers on the scene rushed forward and arrested him. It was only after police entered the apartment that Sgt. Rusk learned that the silver object was a small speaker that the gunman was using to prop the window open.

It was the sergeant’s third confrontation with armed suspects in two weeks and, although the raid ended peacefully, he soon found himself plummeting to the depths of a psychological crisis the likes of which he hadn’t experienced in years.

Most commonly associated with soldiers returning from combat, post-traumatic stress disorder (PTSD) is a condition that afflicts individuals who have sustained a profoundly shocking or traumatic experience, and then continue to endure a range of symptoms – including flashbacks, extreme anxiety, depression, outbursts of rage, and hypervigilance – often, long after the fact. A recent Globe and Mail investigation found that 54 Canadian soldiers and vets who served in Afghanistan took their lives after returning from battle (and, according to updates from the military and further reporting by The Globe, that toll has now reached at least 62).

Far less understood is that PTSD afflicts all sorts of civilian workers – particularly firefighters, paramedics and police officers. While Canadian data is scarce, surveys conducted by researchers in the United States, Britain, Australia and Brazil show that the rate of PTSD among first responders ranges from 5 to 22 per cent, with paramedics reporting the highest levels, according to a 2012 article in the Journal of Workplace Health and Safety by B.C. nurse Cheryl Drewitz-Chesny. A 2009 study, conducted by the U.S. National Institutes of Health, found that as many as one in three police officers in the United States report at least partial PTSD symptoms.

Across Canada, thousands of first responders are struggling, frequently in silence, with the consequences of jobs that expose them to a daily diet of horrors: monstrous violence, suicides in progress, mangled bodies, inconsolable relatives. Last fall, to cite one example, eight of the 15 paramedics who responded to a devastating collision north of Toronto, which claimed the lives of a grandfather and three young children, had to take leave to deal with PTSD symptoms.

And the disorder is not restricted to first responders alone.

Also among the victims are 9-1-1 dispatchers, search-and-rescue workers, and transit operators at the controls when their vehicles strike someone, especially individuals attempting suicide. Often, responders return to work – having coped to varying degrees with their experiences – only to endure traumatic echoes years or decades later.

Back in 1990, as a muscular, 6-foot-4 rookie on patrol in a rough Toronto suburb, Sgt. Rusk was shot five times by a drug dealer he was chasing. One bullet shredded his right hand and the other passed through his face and neck and then out his shoulder. Although his injuries were debilitating, he found himself, just weeks into his recovery, being prodded by divisional commander Julian Fantino (who later led several police services before entering federal politics) to take reporters on a walk around that same neighbourhood – to show the public that the police hadn’t lost control.

He balked at Fantino’s request, and eventually quit the Toronto force, relocating almost 200 kilometres north. The psychic scars left by the shooting lingered for years, in the form of anger, nightmares, involuntary flashbacks and chronic sleeplessness. Although he was formally diagnosed with PTSD in 1993, the Ontario Workers Compensation Board, nowadays known as the Workplace Safety and Insurance Board, didn’t extend benefits to him.

After that summer night in 2014, the nightmares and other symptoms returned, with a vengeance.

Some provincial progress, but it’s decidedly patchy

According to organizations representing frustrated responders, the problem of untreated workplace PTSD has become increasingly dire.

Not that the disorder itself isn’t on at least some politicians’ radar. During last fall’s federal election campaign, Justin Trudeau pledged to develop a suicide-prevention strategy for Canadian Forces personnel and veterans. And after being elected Prime Minister, he gave Public Safety Minister Ralph Goodale marching orders, in a mandate letter, to create “a co-ordinated national action plan on post-traumatic stress disorder, which disproportionately affects public-safety officers.” As well, the Liberals say they’ll spend $20-million to build two PTSD research centres – although as Scott Bardsley, a spokesperson for Mr. Goodale, acknowleges, specific details have yet to be worked out.

But for the most part, as a health-care and workplace-safety issue, the treatment of first-responder PTSD falls to the provinces, which regulate labour conditions. And only two – Alberta and Manitoba – treat work-related PTSD as an occupational injury automatically eligible for worker’s compensation benefits. Such “presumptive benefits” laws require compensation boards to automatically provide sick-leave benefits to first responders with PTSD (just as firefighters diagnosed with certain types of cancer are now presumed to have been exposed to carcinogens during fires).

Alberta introduced such measures specifically for first responders in 2012. On Jan. 1, Manitoba launched an even broader workplace PTSD policy, which applies to any worker in any profession. Erna Braun, Manitoba’s labour minister, says that the province changed its laws in response to feedback from a wide range of employee groups as part of a comprehensive rethink of its workplace safety rules.

Angry at the pace of change, and worried for their members, first-responder groups are calling on other provincial governments to follow suit.

In Ontario, Kathleen Wynne’s Liberals have been promising to introduce reforms for months, but have yet to deliver anything concrete. Labour Minister Kevin Flynn has insisted the government is “taking a very serious look” at presumptive benefits, and continues to promise to deliver a plan this year – but has yet to reveal details of what it might look like.

In the meantime, the only faint glimmer of hope for those affected by on-the-job PTSD in Canada’s largest province is a private member’s bill, tabled by NDP MPP Cheri DiNovo, and based on Alberta’s law, that is to be debated in the Legislature next month. In Nova Scotia, the opposition New Democratic Party tabled a private member’s bill last fall; the government says it’s studying the idea.

But while politicians drag their feet, the Ontario Human Rights Commission has upped the ante, filing a discrimination allegation in November against the Toronto Police Service for failing to include on its memorial wall the names of officers who took their own lives because of a mental-health disability. Indeed, the Human Rights Tribunal of Ontario in 2014 began to clamp down on employers like police services that fail to adequately accommodate the needs of officers with PTSD, including those who don’t realize they’re suffering from the condition but have been reprimanded or fired for erratic stress-induced behaviour, such as excessive use of force.

‘People will say, that’s what you signed up for’

As politicians dither, the consequences of untreated PTSD continue to prove devastating for those on the front lines of emergency response. U.S. researchers have found links to heart disease and metabolic disorders related to chronically elevated levels of cortisol, a hormone secreted by the adrenal glands in times of severe stress, that can, in excess quantities, increase stress-related symptoms. Unrecognized and untreated, PTSD also often wreaks havoc on the families of those affected – most notably in the form of higher divorce rates, and a tendency among sufferers to silence their demons with drugs and alcohol.

PTSD sufferers also are alarmingly prone to taking their own lives. In Canada, according to the Tema Conter Memorial Trust, which provides support, family assistance and training for public-safety and military personnel affected by operational stress and PTSD, 39 first responders took their own lives in 2015. Police officers, in fact, are more likely to die by suicide than in the line of duty.

For many years, mental-health professionals and workers’ compensation officials believed that PTSD was triggered by a single harrowing event. But researchers have now begun to discern the cumulative effects of sustained exposure to intense workplace pressures. According to the 2009 study at the National Institutes of Health, among police officers such pressures “may play an important role in the development and maintenance of psychological distress.” And the latest Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013, stated that PTSD can occur after sustained exposure to disturbing incidents over many years.

The upshot: First responders, whose jobs commit them to persistent, repeated exposure to potentially triggering incidents, are at ongoing risk of developing PTSD. “Generally,” says Donna Ferguson, a psychologist who specializes in PTSD at the Centre for Addiction and Mental Health (CAMH) in Toronto, “what I see is that these are not one event but a culmination of traumatic events.”

Complicating matters is the fact that an individual occurence of the disorder is “very, very difficult to predict,” says Tom Gabriel, a retired police officer who provides peer counselling for the Toronto Police Association. Two people may react to the same event differently – and there is no way to prepare adequately for some of the experiences that first responders encounter on a near-daily basis.

Deanna Lennox, a member of the RCMP in rural Alberta and B.C. from 1997 to 2013, says she entered the service with little appreciation for the scope and severity of the kinds of things she would see and do – which ultimately included, among dozens of other upsetting incidents, breaking in on a woman violently beating her daughter while the girl’s father looked on placidly, and having to empathize with a child molester to extract a confession.

To cope, Ms. Lennox writes in Damage Done, her memoir published last spring, she and other officers jam such experiences into “an internal dumpster – and we keep on piling stuff in there even when the dumpster is clearly overflowing.” Writes Ms. Lennox: “People will say, that’s what you signed up for. But it’s not the case, because we’re not told about that part of the job.”

After years working as a paramedic in Ontario’s Huron County, Liz Black-Petrie found herself taking PTSD leave after a devastating incident in her private life. At a family gathering last spring, she ended up riding in an ambulance with her severely injured mother. (Due to an ongoing legal action, she couldn’t disclose details of the precipitating incident.) And, once at the hospital, and despite Ms. Black-Petrie's own wounds, she instinctively began delivering emergency first aid to her mom – until an ER physician found her weeping inconsolably.

Her psychologist has warned her that when she returns to work, she may experience triggers when attending to “mother-like” accident victims.

"A lot of police departments end up throwing officers under the bus." John Violanti, professor of public health and epidemiology, University of Buffalo

Institutional pushback, and bullying from peers

Admitting you have a problem is supposed to be the first step toward recovery. But first responders often avoid treatment for PTSD, which may include time away from the job, out of fear they’ll be labelled weak or damaged. Indeed, while changes to labour laws are important, they don’t get at the root of the issue: First responders work in organizations that prize strength and resilience, and often ostracize those who seem, in any way, to fold under the pressure of the job. As Sgt. Rusk puts it, co-workers and supervisors often tell struggling colleagues, “Suck it up, buttercup.”

Indeed, although first responders are grappling with a workplace injury as genuine as any other, they face daunting cultural hurdles, including institutional denial, bullying or ridicule, pushback from workers’ compensation officials – and, all too often, indifference from the general public they serve. As a result, men and women who do difficult front-line jobs day after day often openly reveal as little of their turmoil as possible.

Bruce Kruger knows the toll exacted by long-term trauma. When The Globe and Mail asked to meet with him to discuss his battles with PTSD – which had prompted a hard-hitting 2012 review of the disorder’s impact on the Ontario Provincial Police – the ex-detective said it would have to be somewhere with no curtains or blind spots, and where he could sit with his back to the wall. Long retired, he continues to suffer from severe anxiety and a related condition that makes him easily startled.

His story, like that of Sgt. Rusk, begins long ago. In 1977, as a young member of the OPP, he found himself in a shootout near Bracebridge. A fellow officer died during the exchange of bullets, but Det. Kruger killed the gunman – and afterward was treated like a hero.

He didn’t feel like one. “I was devastated,” he says, “at having taken a human life.”

Det. Kruger carried his pain around for seven years, becoming ever-more withdrawn with family, friends and colleagues. Finally, he sought help from an OPP peer-support group.

But when he showed up for the first session, his case worker told him his supervisor had to be given a “verbal briefing.” So, says the former detective, “I shut my mouth from there on, until I retired.”

Tough questions about a link to police violence

In policing, the stakes expand beyond individual officers and their families, and may have implications for entire communities.

In the wake of shootings in places such as Ferguson, Mo., and in New York, Baltimore, Chicago and Toronto, police violence has become a hot-button issue across North America. And while such incidents have rightly placed a focus on how citizens can become the victims of those charged with protecting them, they also raise tough questions about whether there’s a connection between extreme untreated occupational stress and violent conduct by police officers.

There’s a dearth of clinical research – in large part because police supervisors investigating use-of-force incidents do not have access to officers’ medical history. Still, some experts and law-enforcement experts feel that a link exists.

“Sometimes police officers relieve their stress by becoming increasingly violent toward citizens, suspects and even their own families,” former Colorado police officer Paul J. Brown wrote in an oft-cited 2003 paper on PTSD in law enforcement. In a more recent op-ed piece in the Washington-based political newspaper The Hill, Renee Behinfar, an Arizona clinical psychologist who has treated first responders and SWAT team members suffering from work-related stress, contended that untreated PTSD has the potential to lead to excessive use of force.

Observed Mr. Brown, “After many years of seeing things on a daily basis that would make most people cringe, police officers begin to feel numb. Morale goes down and sometimes police officers relieve their stress by becoming increasingly violent toward citizens, suspects and even their own families.” Although there’s clearly no excuse for such violence, ignoring one of its possible causes does neither the police nor the public a service.

"You're not going to go home and say, 'Dad had a roof collapse on him today' ... You go home and lie on the couch and take some drugs." Former Mississauga firefighter Norman Traversey

‘You go back to the firehall and suck it up’

In quasi-militaristic organizations, the stigma associated with mental illness or perceived weakness can be especially crushing. “A lot of police departments end up throwing officers under the bus,” says John Violanti, a professor of public health and epidemiology at the University of Buffalo, who has been studying PTSD in the city’s police department for a decade. Says CAMH’s Ms. Ferguson, “It’s a culture of, ‘You have to be strong, you have to be on point.’ You can’t be weak in any way.”

In that professional atmosphere, the path of least resistance is often to bottle up the daily stresses on the job – and off. “You’re not going to go home and say, ‘Dad had a roof collapse on him today,’” says former Mississauga firefighter Norman Traversy, who was once named his city’s firefighter of the year. “You go home and lie on the couch and take some drugs.”

Many end up in messy marital battles. Kathryn Hendrikx, who practises family law at Brauti Thorning Zibarras, a firm that represents many Toronto police officers, says she tries to evaluate whether her clients may be experiencing intense workplace stress that has spilled over into their private lives. “When I see a first responder, I ask, ‘What kind of stuff have you seen? What do you do with it?’”

Mr. Traversy began battling for PTSD compensation years ago, after his physical and pyschological problems accumulated, and were compounded by an off-the-job back injury. He recalls one particularly terrifying incident during which he was crawling through the attic of a burning house when an axe crashed through the roof, narrowly missing his head; others in his crew hadn’t known he was up there. When he emerged and vented at a superior, recalls Mr. Traversy, “He said, ‘You’ve got the rest of your life to sort it out.’”

In that kind of atmosphere, says the former firefighter, “You go back to the firehall and suck it up. You don’t talk about it.”

Some years later, Mr. Traversy was trapped in yet another burning house. When the trucks arrived, a child was still inside – and because the resulting steam would have been as lethal as the flames, crews couldn’t start extinguishing the blaze. Mr. Traversy, already inside the building, tried to make his way out – but became entangled in wires in the dark, smoke-filled basement, quickly losing his oxygen supply.

He did escape, but couldn’t shake a sense of panic: He began waking up at night, shouting and gasping for breath. Such episodes persisted for more than two years, he says, but he didn’t tell his co-workers, even though he was fighting flashbacks on a daily basis.

“My wife was terrified,” he recalls. Finally, “She said, ‘That’s it, you’ve got to see someone.’”

A focus on changes that save both lives and money

For those suffering from PTSD, seeing someone is crucial. Paulette Laidlaw, a Burlington, Ont. psychologist who works with many police officers in her clinic, says that the increased public and media focus on first-responder suicides may give sufferers the impression they’re “doomed.” But, she hastens to add, “That’s false – PTSD is quite treatable."

With that idea in mind, when first responders and their advocacy organizations talk about reform, they focus on changes that will save both lives and money by destigmatizing the condition, through the development of policies that recognize it as an occupational hazard and that help its victims get back to a productive work life more quickly. Chief among those changes: more generous employee-assistance plans to cover psychological services; improved training for new recruits on how to develop coping strategies that help them become more resilient; routine use of “critical incident debriefings” for first responders involved in traumatic situations; and presumptive-benefits laws.

The long-term effectiveness of early treatment is widely recognized, but many emergency-service organizations still offer as little as a few hundred dollars, through their employee-assistance plans, to cover sessions with a psychologist – barely enough money to pay for an initial assessment. “They’re set up to fail,” says Ms. Laidlaw, because adequate therapy can take months, and cost thousands of dollars.

What’s more, those who need time off often find themselves dragged into protracted disputes with workers’ compensation boards. Claimants are required to prove an injury that is invisible; the stress of trying to do so, and of having their injuries dismissed out of hand, can add to their trauma, say both psychologists and victims.

“Most people don’t believe an awful lot of us,” says former detective Kruger. “If we smile or happen to have a good day, then everybody says, ‘Not a damn thing wrong with you.’ They don’t understand the intricacies of mental illness.” As one frustrated colleague put it to him, “I wish I had scars for my PTSD.’”

The high cost of the status quo

Sufferers such as Mr. Kruger and Sgt. Rusk are themselves intensely frustrated by the reluctance of governments to pass laws that would, in effect, normalize first-responder PTSD by formally acknowledging that such jobs come with a real risk of mental illness – and that seeking treatment shouldn’t involve fighting with skeptical, or simply stymied, workers’ comp officials.

That reluctance may have at least something to do with cost. Ontario police organizations have warned of a “financial tsunami” should PTSD become a presumptive benefit, and have argued, as well, that when first responders go on leave to be treated, their employers may be hard-pressed to find replacements.

But André Marin, the provincial ombudsman who conducted the 2012 review of PTSD in the Ontario Provincial Police, notes that the outlay would be “a drop in the bucket” compared with the price of PTSD left untreated. It costs tens of thousands of dollars to train a paramedic or a police officer, notes Mr. Marin, and “you want to maintain that investment.”

Alberta’s experience suggests that financial fears may be overblown. Its Workers’ Compensation Board says that it received 75 such claims in the two years before the legislation came into effect in 2012, compared to 131 in the two years after – and that the money paid out grew by only $600,000, to $1.7-million. “Clearly, more first responders experiencing psychological injuries are coming forward to get the help they need, and we believe that’s a good thing,” says a spokesperson for the board.

Manitoba Labour Minister Braun says her government doesn’t expect to see a huge spike in costs even if more victims come forward to make claims under the new law, because the province’s compensation board already covered the condition; the key difference with the new law is that those experiencing PTSD will be automatically eligible for benefits instead of enduring a time-consuming and intrusive application process. “Our goal,” says Ms. Braun, “is getting people back to work.”

Turning to each other, and to innovative therapies

Such policy changes, however, pale in comparison with the problem of bringing about the necessary shifts in first-responder workplaces. And although Prof. Violanti observes that “there’s nothing harder in this world than changing police culture,” fire departments and emergency medical services may be little better. Mr. Traversy, the former firefighter, recently appealed to the Ontario Human Rights Commission to investigate how the Workplace Safety and Insurance Board has handled his claim; he says he’s been isolated and belittled by his former employer. Liz Black-Petrie, the paramedic, has heard from some co-workers that others in their ranks dismiss her illness as a joke. “I don’t know,” she says, “why it’s like that.”

In some cases, the disdain seems to flow from the top. Ms. Lennox, the former RCMP officer, had crucial support from one senior officer, but points to a disturbing incident in which RCMP Commissioner Bob Paulson referred during a speech to officers with PTSD claims by twirling a finger near his temple in the familiar gesture. The speech, recorded on a cellphone, was posted online, and he later apologized.

Yet Mr. Marin insists that it is, in fact, possible to bring about a substantial shift in organizational culture. When he released his 2012 report, which drew on 140 interviews with OPP officers, the agency’s management initially reacted with denial – but later embarked on a process of far-ranging reform. “We saw some pretty drastic changes,” he says, including the hiring of seven full-time counsellors. “They really pulled up their sleeves. Right now, the OPP is in the top tier in terms of taking PTSD seriously.”

Other agencies claim to have made similar changes, although Mr. Marin says that far too few have adopted reforms on the scale of the OPP. At the Toronto Police Service, Deputy Chief Mike Federico says that the 5,000-officer agency provides wellness and fitness programs, peer-support groups, and generous cash allowances for psychological counselling for first responders and their families. He adds that supervisors are trained to look for signs and symptoms among officers who seem to be having trouble coping. “I’d like to think the TPS is on the leading edge,” he says.

Mr. Kruger isn’t impressed. “Flowery bullshit” is how he characterizes the TPS claims. “Believe me, the effects are horrific.”

As first responders increasingly talk publicly about their struggles, some have concluded that solutions won’t come only from their employers or their governments, whatever right noises are starting to be made. Instead, they are seeking out one another, through social-media networks, in informal meet-ups and at formal conferences.

Several foundations now provide support as well. After she left the RCMP, Ms. Lennox discovered the therapeutic value of interacting with horses, which are exceedingly sensitive to their riders’ stress. She now runs the War Horse Awareness Foundation in Alberta, an organization dedicated to providing “equine therapy.”

Bill Rusk, who owns a service dog that’s trained to wake him up if he appears to be having nightmares, is now the executive director of Badge of Life Canada, a national non-profit that helps provide various types of therapy, including service dogs and equine therapy, for police officers. In fact, he and his wife, Lynn, a retired police officer who also suffers from PTSD, recently started a small and informal yoga and peer-support group for other first responders in the Owen Sound area. Reaction, he says, has been “tremendous.”

“That’s what my doctor was hoping for,” he says. “Being able to help others helps me.”

Sgt. Rusk may be luckier than many. But he maintains his caution. Currently on leave because of his PTSD diagnosis, he notes, with a sigh: “You don’t tell anybody. Because the minute you tell anybody, your career is over.”

John Lorinc is a Toronto freelance writer.