Written by Munis Topcuoglu, Editor at EHN Canada.
First Responders Are More Likely to Develop Post-Traumatic Stress Disorder (PTSD)
Though precise estimates vary, researchers agree that the prevalence of PTSD is much higher among first responders than among the general population. While the definition sometimes varies, “first responder” (or “public safety personnel”) usually includes firefighters, paramedics, and police officers; it also often includes correctional workers, emergency dispatchers, and other similar professions.
PTSD is caused by exposure to trauma
PTSD is caused by an experience, or threat, of severe trauma such as death, serious injury, or sexual violence. PTSD can also be caused by indirect exposure to severe trauma, such as when a person witnesses it happening to someone else, finds out that it happened to someone close to them, or learns the details of a traumatic event.
First-responders’ work frequently exposes them to trauma
First responders often witness death and serious injury as part of their daily work. Police officers and correctional officers are particularly likely to experience threats or actual serious injury themselves. Emergency dispatchers, while sheltered from direct experience, must frequently learn the details of traumatic events.
Post-Traumatic Stress Disorder (PTSD) Symptoms Are Chronic and Cause Distress or Functional Impairment
PTSD symptoms are severe enough to cause a person distress or functional impairment in important areas of life such as close relationships, social interactions, or occupational performance. PTSD symptoms last for longer than a month and include the following:
- Frequent re-experiencing of the trauma through memories, nightmares, and flashbacks; also through negative emotional or physical reactions to reminders of the trauma.
- Avoidance of reminders of the trauma; also avoidance of thoughts and feelings related to the trauma.
- Having negative thoughts and feelings about oneself and the world; frequently being in a bad mood; having decreased interest in activities; feeling isolated from others.
- Being more excitable or reactive than usual, including increased irritability or aggression; increased risky or destructive behavior; being more easily startled or always on the lookout for danger; having difficulty concentrating or sleeping.
- Depersonalization or derealization: feelings of detachment from oneself or the feeling that things are not real.
Post-Traumatic Stress Disorder (PTSD) and Addiction
PTSD increases the risk of developing addiction or substance use disorders because people often try to manage PTSD symptoms by using addictive substances with a number of different intentions, such as the following:
- To reduce the intensity of re-experiences of the trauma such as flashbacks and nightmares, and of reactions to reminders of the trauma;
- To improve their mood and to have more positive thoughts and feelings;
- To be more calm and less excitable or reactive;
- To feel more sociable or socially competent.
Unfortunately, when a person with PTSD develops an addiction, he or she usually experiences a further decline in physical and mental health, and an increase in psychological distress. As the combined disorders produce more severe negative effects on the person and on his or her life, recovery becomes more difficult and the need for treatment becomes more urgent.
Workers’ Compensation for First Responders Who Develop Post-Traumatic Stress Disorder (PTSD)
Workers’ compensation provides benefits for individuals who become unable to work because of an injury that occurs while working or because they develop a medical condition related to their jobs. Benefits include payment for healthcare (including equipment and supplies), payment of a portion of lost wages, and services to help the person return to work or find new work.
Some provinces presume that first-responders’ PTSD is job related
In the majority of provinces, when a first responder makes a workers’ compensation claim related to PTSD, it is presumed that the PTSD is a result of a trauma experienced while working as a first responder. This means that if an employer wishes to dispute a claim, the burden of proof is on the employer to establish that the PTSD was not primarily caused by a trauma experienced while working as a first responder. The following provinces presume that first-responders’ PTSD is job related, which makes it much easier for first responders in these provinces to get workers’ compensation for PTSD:
- Manitoba: presumption for all workers, not just first responders
- New Brunswick
- Nova Scotia
- Prince Edward Island: presumption for all workers, not just first responders
Other provinces do not presume that first responders’ PTSD is job related
In the few remaining provinces, a causal relationship between working as a first responder and developing PTSD is not presumed. This means that if an employer disputes a workers’ compensation claim related to PTSD, the burden of proof is on the first responder to establish that the PTSD was primarily caused by a trauma experienced while working as a first responder. The following provinces do not presume that first responders’ PTSD is job related which makes it relatively harder for first responders in those provinces to get workers’ compensation for PTSD:
- British Columbia: presumptive legislation was proposed in 2018
- Newfoundland: presumptive legislation was proposed in 2018; if approved, would take effect July 1, 2019
- Northwest Territories and Nunavut
Workers’ Compensation for Chronic Mental Stress
Some provinces recognize that disability can result from chronic mental stress related to one’s job. In these provinces, people making workers’ compensation claims are not obligated to identify a single acute traumatic event at work that caused their condition. They can instead make the alternative claim that their condition resulted from the cumulative effects of frequent stressful events that occurred during work over an extended period of time. A person must be diagnosed with one of the following disorders to be eligible: PTSD, acute stress disorder, adjustment disorder, or an anxiety or depressive disorder. The following provinces accept workers’ compensation claims related to chronic mental stress, which means that workers in those provinces, including first responders, can make workers compensation claims even if their disorder did not result from an acute traumatic event.
- British Columbia
- Northwest Territories and Nunavut
EHN Canada Provides Integrated Programs for Treating Concurrent Addiction and Post-Traumatic Stress Disorder (PTSD)
As previously mentioned, individuals with PTSD are more likely to develop addiction or substance use disorders. The distressing and disorienting nature of PTSD can make addiction recovery much more difficult and, similarly, the cognitive and emotional impairment that result from addiction can make it much more difficult to recover from PTSD. For these reasons, we believe that an integrated treatment program that addresses the PTSD and the addiction together, at the same time, is the best approach. Our experience supports this belief, as we have found that integrated addiction and PTSD treatment programs produce much better outcomes for patients compared to programs that attempt to treat the disorders separately.
We can still help you even if you don’t have a PTSD diagnosis
If you are a first responder and you have made a successful workers’ compensation claim for chronic mental stress, you may be eligible for one of our addiction and trauma treatment programs even if you do not have a diagnosis of PTSD. Alternatively, one of our other treatment programs may better serve your needs. Please contact us for more information.
EHN has Addiction and PTSD programs in Nanaimo, BC, Toronto, ON, and Montreal, QC
EHN has three integrated treatment programs designed for first responders with PTSD and addiction disorders:
- Concurrent Trauma and Addiction Program (CTAP) at Edgewood Treatment Centre in Nanaimo, BC;
- Concurrent Trauma and Addiction Program (CTAP) at Bellwood Health Services in Toronto, ON;
- Programme de Traitement Concomitant—Trouble de Stress Opérationnel et Dépendances program at Clinique Nouveau Départ facility in Montreal, QC.
They all have similar objectives and use similar methods to achieve them. The program at Clinique Nouveau Départ is in French language but can accommodate English speakers.
EHN programs provide education, therapy, and skill development
Our treatment programs teach essential knowledge, incorporate a wide range of therapies, and help you develop important skills for reducing the severity of your PTSD symptoms and for abstaining from substance use. Our programs are administered by a team including trauma counsellors, occupational therapists, and medical doctors; access to our psychiatrists is available as needed.
Our programs begin by teaching you about your conditions; this knowledge provides you with context for understanding the therapies in which you will engage and the skills that you will develop. For both addiction and PTSD, this includes teaching you about what causes the disorders, how they develop, their symptoms, and how they affect your mind and body. Additionally, regarding addiction, we teach you about risk factors for relapse. Throughout the program, we emphasize the importance of maintaining a healthy lifestyle that includes eating healthy, being physically active, getting good quality sleep, and having supportive relationships.
EHN programs include a range of evidence-based therapies
We use a number of different therapies that have been demonstrated to produce positive outcomes for treating addiction and PTSD, they include the following:
- Cognitive behavioural therapy (CBT): by guiding you through the process of questioning and examining your own experiences, this therapy incrementally brings your belief system closer to reality.
- Cognitive processing therapy (CPT): teaching you skills to change your understanding or way of thinking about your trauma, this therapy helps change how you feel about your trauma.
- Dialectical Behavioural Therapy (DBT): this four-stage therapy helps you develop the skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.
- Prolonged exposure therapy (PE): involves breathing techniques and careful, systematic exposure to trauma-related stimuli, followed by a discussion for you to process the experience of exposure.
- Group therapy in small, intimate groups helps rebuild your relational skills and reduces your feelings of isolation as you share experiences in a safe environment with other people who have had similar experiences and who face similar challenges.
- Physical exercise rebuilds your physical health, which is a prerequisite for mental health.
EHN programs help you develop the skills you need to get better
While you will develop many skills through the therapeutic processes above, other skills are taught in workshops outside of therapy. Our aim is for you to develop the following skill set that will allow you to reduce the severity of your PTSD symptoms and improve your self-efficacy, which will in turn reduce your need to rely on drugs or alcohol:
- Symptoms management;
- Emotional awareness, self-regulation, and distress tolerance;
- Stabilization and grounding techniques;
- Trauma, emotional, and cognitive processing;
- Interpersonal, social interaction, and community integration;
- Relapse prevention;
- Healthy lifestyle planning.
The program at Bellwood also includes anger management workshops that teach you how to experience and process anger in balanced, constructive, and healthy ways.
By the time you complete one of our programs, you will have the knowledge and skills to independently build upon the progress you made during the program and continue getting better on your own.
Meet Us and Learn More About Our Trauma Programs at the BC First Responders’ Mental Health Conference
ENH Canada will be attending the BC First Responders’ Mental Health Conference, January 31st through February 1st. We would be very happy to see you there and meet you in person! Come visit us at booth #13 and talk to us.
Call Us If You Have Any Questions
If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.
- 1-800-387-6198 for Bellwood Health Services in Toronto, ON
- 1-587-350-6818 for EHN Sandstone, in Calgary, AB
- 1-800-683-0111 for Edgewood Treatment Centre in Nanaimo, BC
- 1-888-488-2611 for Clinique Nouveau Depart in Montreal, QC
More Information About Workers’ Compensation
You can find phone numbers and websites for all provincial workers’ compensation boards on the Canadian Centre for Occupational Health and Safety website.