Tag Archives: stress

PTSD and first responders

2 Oct

“I think I’m too broken to ever be fixed.”
Text from Ken Barker, retired RCMP officer to his sister during a traumatic flashback

Barker was one of the first responders to arrive at the scene of the ambulancehorrific Manitoba Greyhound bus beheading in 2008. This summer, he ended his life. Since April 2014, Barker was one of an unprecedented number of first responders in Canada whose suicides have been linked to PTSD.

Post-traumatic stress disorder, considered an treatable anxiety disorder is a mental illness that can result from a traumatic one-time experience or accumulative trauma and stress on a personal or large scale. PTSD can bring the horrors of past traumas to life and wreak havoc in the minds and the lives of all it touches. PTSD can happen to anyone; the most vulnerable  people are rape victims.

PTSD has its roots and associations in modern warfare, and its incidence rate is highest among people who experience trauma every day – military and emergency services personnel. Symptoms include flashbacks to the traumatic event, nightmares, sleep disorders, and uncontrollable thoughts; anger, fear, distrust, personality changes, and extreme anxiety. PTSD can manifest physically as chronic pain and hypertension, and can induce self-destructive behaviour like drug and alcohol abuse, long-term addiction, and suicide. The collateral damage of PTSD is its effect on relationships, families, finances, and work and social status. It can be devastating on many levels.

PTSD in emergency services

The men and women of Canada’s public safety, military and correctional organizations witness human suffering up close and it sometimes becomes very difficult to cope with the aftermath. There is light at the end of that dark tunnel. There is help available, and we want to make sure these men and women – and their families — know where to find it.
Heroes Are Human

Vince Savoia is the founder of Heroes Are Human and a former paramedic. His organization focuses on PTSD research, education, and training, and acts as a peer and psychological support resource for Canada’s public safety organizations personnel.

Savoia says 16 – 24 percent of emergency personnel suffer from PTSD, but he believes this is a modest number. Paramedics are faced with more trauma more often, and run a risk of PTSD two to three times higher than in any other emergency service. Kim McKinnon, Superintendent at Toronto Emergency Medical Services (EMS), says PTSD predictors for paramedics include their “involvement in a critical incident like a mass casualty event, or an organizational or environmental event such as the death of a service member in the line of duty.”

EMS personnel tend to victims of horrific scenes large and small, they resuscitate the sick, and witness death. At the same time, they form a bond with sick and injured people as they spend time talking and giving hands-on treatment. This one of the reasons why Mr. Savoia believes paramedics are the hardest hit of any emergency service.

PTSD does not discriminate. While it affects paramedics more often, PTSD afflicts 10 – 12 percent of police officers and 6 – 8 percent of fire fighters. According to a recent StatsCan report quoted in the Globe & Mail, PTSD rates among members of the Canadian Forces have nearly doubled since 2002; 1 in 6 Canadian soldiers have mental health problems after ten years in Afghanistan. And the numbers keep growing.

First responder organizations must create programs and supports for their employees, but this takes funding and resources that may or may not be available. Some emergency services have excellent support systems in place for their employees like Toronto EMS’ comprehensive suite of services for employees to proactively manage their health. With a focus on prevention, their resources include early psychological support with a staff psychologist, a peer support team, employee assistance plans, and other community resources.

Canada’s RCMP has nation-wide systems in place that utilize peer support, RCMP doctors, and chaplains. A Regina RCMP sergeant explained that the RCMP wants to make sure it’s there to listen to their officers who respond to major incidents like car crashes, deaths of children, multiple fatality incidents, shootings, and violence.

We’re fortunate that we’re finally acknowledging PTSD as a real illness with real consequences, but despite the good intentions of emergency services to their employees, the question is, are the support systems being utilized, and if not, why not?

Stigma, discrimination, penalization, and the John Wayne Syndromesuffering in silence

In the emergency services culture, there is stigma and perhaps a shame attached to being affected by trauma and asking for help. It is considered a “weakness” and it is the largest problem that first responders face because it is a deterrent to getting help.

Though more women are joining military and emergency services, men still form the majority of employees, and because they’re men, they are expected to adhere to the traditional masculine code that demands they use the “suck it up” method of dealing with harrowing trauma and stress.

Vince Savoia says that first reponders work with respect for the public who needs them, but the same respect is not offered to colleagues. “First responders who look for support are bullied by their peers and colleagues,” he says, “they are ridiculed and harassed. Mental health is viewed as a weakness, not an illness, and the expectation is that we should be able to stop it and move on.”

The mental illness stigma exists in all branches of emergency services and the armed forces. David Whitley, a paramedic who suffered his own PTSD from a terrible ambulance accident, now volunteers for a local emergency services support group that checks in with first responders who experience potentially traumatic events like shootings, suicides, crashes, and situations that involve children.

“We give [members of the group] an opportunity to talk because there is a stigma,” he told the Toronto Star. “First responders need to lower the trauma mask, and that’s scary because there are feelings of vulnerability and anxiety. But if you don’t do that it’s a precursor to mental illness, including PTSD.”

Kent Laidlaw, a retired police veteran in Burlington, Ontario, and principal of Canuckcare, a consulting service for people who deal with workplace stress and trauma, says that the systemic corruption that exists in police ranks ensures that officers who ask for help are considered “less than” and therefore a weak link in the chain. They are penalized rather than punished, a subtle difference that speaks just as loud.

New York State police veteran and police trauma and suicide researcher, Dr. John Violanti, observed in the Ontario Ombudsman’s 2012 report that the nature of the policing environment often goes against the goal of improving health: “The police culture doesn’t look favorably on people who have problems… Not only are you supposed to be superhuman if you’re an officer, but you fear asking for help… you may not be considered for promotions and you may be shamed by your peers and superiors. In some cases, your gun can be taken away, so there is a real fear of going for help.”

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Emergency service workers are very well trained but cannot be prepared for every possible situation, so perhaps masking the emotional response to what they experience is the way to cope, but unfortunately, first responders are human, and part of being human is to be emotional. To expect that anyone could not be affected by horrific and traumatic events is ridiculous, and then to believe that there is no emotional aftermath is absurd, even abusive.

The code of masculinity that demands men to be stoic, brave, and in control, subscribing to what Vince Savoia calls the “John Wayne Syndrome”: the tall, rugged, macho cowboy who can deal with any situation and stand up for justice. Savoia believes that first responders have to be this way in order to do their job, but what happens after the mission is accomplished and reality sets in?

On his very first call, a house fire, Vince Savoia lost his first patient, a two-year old child. He wanted to talk to his paramedic crew about it, but when he tried to, “the crew was very stoic –just walls.” If this code prevents men from being able to get support from the experiences of trauma in their jobs, what purpose does it serve? A culture of hyper masculinity is a hindrance more than a help; it creates broken men who can’t do the job as well as healthy men.

Saskatchewan counsellor, Peter Griffith, says that men don’t like to admit, or even recognize when they need help, to the degree that they will ignore their own health problems sometimes until it’s too late. Hospital wards, he says, “are full of men who refuse to go to the doctor when they have physical symptoms and who seem to prefer to pay the price rather than to go for help.”

Anna Baranowsky, a clinical psychologist who works with police officers in private practice, explained to the Toronto Star in 2012 that “people can recover[from PTSD], but if we see ourselves as being strong and we won’t tolerate any kind of weakness, then what we might end up doing is pushing (ourselves) until we are past the point of recovery, and that is really dangerous.”

Experts say that the stigma attached to mental health needs to change for us to get anywhere. It could be as simple as changing our perception of what it is to ask for help and equate it with responsible prevention, with the power to keep oneself healthy, capable, and strong. Putting a positive spin on the consequences of responding to a traumatic situation is much more agreeable than demeaning someone who can’t control their mental health response.

The PTSD misunderstandingshattered glass

There is a very interesting argument happening right now around PTSD. Some, like Vince Savoia, believe that PTSD is responsible for taking the lives of more than 20 first responders since the spring, but some mental health professionals like psychologist, Dr. Paulette Laidlaw, believes that PTSD has become something of a blanket diagnosis for many other problems.

While it’s true that in some cases, PTSD symptoms can worsen after an emergency service employee retires, Dr. Laidlaw wonders why is it when we hear “police suicide”, we make the automatic assumption that it is related to PTSD.

Dr. Paulette and Kent Laidlaw do not believe that first responder suicides are exclusively job-related, but are more likely a combination of many stresses including work, finances, and relationships. They say the individual’s long-term mental health should be examined and more questions asked about a first responder’s life before we slap the PTSD label on them, just because that individual happened to work in the armed forces or emergency services.

Dr. Laidlaw explains that PTSD is not as commonplace as we are led to believe. “PTSD affects only 8 percent of the population,” she says, “whereas depression affects 30 percent and anxiety touches 20 percent. We’re in murky water trying to distinguish PTSD from burnout, acute stress, trauma, grief, or clinical depression”.

We see PTSD in the news a lot and it has become something of a “trendy” disorder. Media reminders of the illness can cause people to self-diagnose via the Internet, and all hell can break loose. Dr. Laidlaw suggests that PTSD is the “sexy” disorder of the day, and with any popular disorder, like we saw with childhood ADHD, suddenly there are specialized medications and “PTSD therapists” come out of the woodwork. PTSD can only be diagnosed by registered psychologists and medical doctors.

How will change happen?fireman

“I wish I had cancer because then people would understand.”
-Veteran paramedic Ken Barker communicated to his sister shortly before taking his life

Mental illness is not something tangible, something that hurts, something that can be fixed with a cast or a bandage. It affects the brain and though it may not show on the outside, it can torment the mind from the inside.

Regard for mental health is changing, albeit slowly, but Vince Savoia believes that cultural change in PTSD acknowledgement has to come from the top down, and says that “we must respect mental wellness as an issue and stop the harassment and bullying from the bottom up. It has to be a grass-roots movement to encourage people to take responsibility about how they treat themselves and their colleagues.”

Dr. Violanti agrees:  “If I tell you that the first time you see a dead body or an abused child that it is normal to have feelings of stress, you will be better able to deal with them; exposure to this type of training inoculates you so that when it does happen, you will be better prepared. At the same time, middle and upper management in police departments need to be trained in how to accept officers who ask for help and how to make sure that officers are not afraid to ask for that help.”

This means changing the culture from one that ridicules people who need support to one that supports and embraces human vulnerability.

Dr. Jeff Morley, former RCMP officer and psychologist for Canadian Forces and Veterans Affairs says “Canada needs a national mental health strategy for first responders, but the political will does not exist right now.”  He says that to change the system, we need a high-profile person to promote the cause, like Romeo Dallaire who played a big role in the beginning but retired from senate this year.

“That, or if the government clues in that the high financial cost of not doing anything (i.e. disability costs, sick time, leaves of medical absence) exceeds the cost of early intervention, education, and prevention.” He says that the RCMP spends tens of millions of dollars per year on PTSD disability claims, but asks how much they’re willing to come up with to prevent it.

The Globe & Mail reports that global estimates for antiviral drugs have run close to $10-billion since the SARS outbreak of 2002.  The authors of the original report in the British Medical Journal acknowledged that the “important benefits have been overestimated and harms under-reported”. Imagine if the Canadian government spent the same amount on long-term mental health as it spends on stockpiling useless drugs for unlikely flu epidemics. Imagine if people shrugged off the toxic masculine codes that keep men from flourishing and actually paid attention to what they need. And can you imagine the tremendous benefits of supporting the mental health of the people we depend on to take care of us?

 

Stress and the man

28 Mar

stressWe all experience stress in our lives, but we don’t talk about it enough – men especially – but there is growing interest in the topic – upon this writing, “men and stress” catches 239,000,000 Google results.

I spoke to a couple of stress experts through the Distress Centres Ontario (DCO),  a provincial organization that provides support services to lonely, depressed, and suicidal people, often via a 24-hour crisis line.

DCO presented “The Good, The Bad and the Ugly of Stress”, focusing on how to shift from a stress reaction to a support response in our body.

Asha Croggan and Arianne Richeson co-presented the learning event – Asha provides support to crisis lines and suicide networks across Canada and is the Provincial Programs Manager for Suicide and Mental Health Networks, and Arianne Richeson is the Manager of Educational Service at Distress Centre of Ottawa and Region. Below are some of their findings from the presentation:

1) Men and women respond to stress differently – the difference between “fight or flight” and “care or share”.

2) Our autonomic nervous system is responding in every second to every feeling we experience. This means that even when we feel we are “handling it well”, our bodies may still be experiencing a stress response.

3) Science has shown that we actually transmit these feelings through the electromagnetic field of the heart.  The brain has an electromagnetic field of 1″ from the body … the heart’s electromagnetic field is 4 feet from the body.

4) Cortisol, a hormone released in response to stress, continues to cycle up to 12 hours after a stress reaction in the body. This results in poorer/disrupted sleep which in turn lowers our ability to respond effectively to stress.

5) Emotions that have a depleting effect on our bodies – worry, frustration, and anger –  create cortical inhibition (cortical = cerebral cortex – the brain’s outer layer central to memory, attention, perceptual awareness, language, thought, and consciousness) which in turn diminishes the brain’s capacity to problem-solve, recall coping strategies, and effectively communicate. Renewing feelings such as gratitude, joy, and enthusiasm that have a supportive effect on the body and helps to open the mind. (It also draws good things to you.)

Men and women not only experience stress differently, they are subject to gender-specific stresses. In Is stress harder on men?, Ottawa psychotherapist Wesley Moore says that especially at work, “men often feel they have to outperform everyone else. This can be a huge source of pressure, especially if there is also an internal dialogue that he must be the ‘breadwinner’ for his family.”

Women often have support networks for times of stress, but men are less likely to ask for help or talk about their situations, which makes them vulnerable to stress-related problems; not feeling that he has an outlet to release his stress will keep it trapped in the mind and the body.

To dodge the stress in their lives, men are more likely to engage in some kind of distraction – amusement of new toys or hobbies,  or the darker road of pornography and chemical distraction – alcohol, drugs, and tobacco; a friend of mine told me he got over the grief of a break up by “going to sleep” when he felt overwhelmed by sadness, as he was unable to process the emotions.

Distracted or not, men experiencing stressful situations like interpersonal problems, financial difficulties, and violence “were linked to psychological problems, such as anxiety, mental distress, and lack of coherence,” according to a 2002 Finnish study.

Quite often, stress is in the eye of the beholder – it is something perceived in the brain, not necessarily real in 3D reality. A stressed brain can be overwhelming, but there are lots of easy ways to cope with it and calm it down. Asha and Arianne compiled some simple ways to deal with stress, beginning with becoming conscious of it:

1)      Be aware of your stress alarms and triggers.  Your body uses symptoms to express when it is in a stress response.  Once you understand this “language” you can become more aware of how often you are under stress, and recognize the alarms when they go off. Common stress alarms are headaches, digestion issues, irritation, withdrawal, over/under eating.  Reflect on the stress alarms you experience physically, emotionally, and behaviourally. This will help you to better determine the triggers in your life, so you can prepare for them.

2)      Take your “emotional pulse” throughout the day.  The body is responding in every moment to how you “feel”. Your emotions set off a cascade of over 1,500 biochemical reactions and responses in the body. Pause throughout the day to take your emotional pulse and see whether you feel a depleting or renewing emotion.

3)      Shift through breathing.  A critical tool you have in your “stress toolkit” is your breath.  Calm yourself by simply becoming aware of your breath.  Slow the breath down so it is deeper than normal.

4)      Choose healthy debriefing. It is important and healthy to recognize when an event has affected you, and to reach out to share how you are feeling.

5)      Use the P.A.U.S.E. Approach:  When you recognize you are experiencing stress:

  • Pause.  Catch your breath.  Take a moment so you can choose to respond rather than react.
  • Ask yourself. Is this true?  Is this important?  Is this something I truly need to deal with now?
  • Use your tools.  Utilize your coping and communication skills, breathing exercises, and if need be, take some space so you can calm yourself and assess next steps.
  • Self-care.  A stressed mind is a closed mind.  Practice self-care so you can slow the stress reaction in your body.  A coherent, calm body supports stronger memory, creative problem-solving and communication – all important skills in responding to stress.
  • Express yourself.   Express how you feel, set your boundaries, debrief with someone you trust, or reach out for professional support.

We all feel stress weighing heavily upon us for all sorts of reasons, but please don’t be afraid to reach out for help when you’re in need. There is support all over the world, and volunteers eager to listen without judgement.

Some distress organizations in Canada and worldwide:

Distress Centre British Columbia

Inform Alberta

Reason to Live Manitoba

Distress Centres Ontario

Chimo Helpline, New Brunswick

Northwest Territories Help Line

Samaritans UK

Befrienders Worldwide