Why emergency services need a 'culture change' to deal with PTSD

Police officers, firefighters and paramedics are still reluctant to seek help with post-traumatic stress disorder because of the stigma attached to mental health issues within their occupations.

"The old 'suck it up, be a man' — that stigma is still very prevalent among emergency services," says  Vince Savoia​, executive director of Tema Conter Memorial Trust, an organization that helps emergency service workers with mental health issues.

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​Over the weekend, Ottawa police Staff Sgt. Kal Ghadban, 43, took his own life at police headquarters in downtown Ottawa. Although the reasons for his suicide are so far unknown, his death marks the 22nd suicide among Canadian emergency responders since April 29, according to Tema.

'At a loss for words'

"I'm at a loss for words," said Savoia, a former paramedic, whose organization started tracking the statistics since April. "We just never expected the suicide rate to be this high."

Savoia said while it's estimated that eight per cent of the general public suffer from PTSD, the rate is double or triple that among first responders. It is not a surprising statistic, given the everyday trauma such workers face.

"It's a combination of things. The nature of the job, the events they attend to, the things they see, the things they smell, the things they hear," Savoia said. "At times you're seeing the worst that society has to offer, and it's hard sometimes to keep that in perspective."

While Savoia said many emergency organizations offer peer support and crisis response teams to their staff, the biggest challenge is the stigma around coming forward and asking for help. Those who suffer are often concerned about how their colleagues will treat them afterwards.

"We need to see a culture change within the ranks of emergency services and the military," Savoia says. "And that culture change not only needs to start at the top, but it needs to start at the bottom as well where we, as colleagues and peers, need to be able to provide support and not ridicule and harass those who do come forward for help."

Signs and symptoms may vary, but most often those suffering from PTSD will seek isolation — withdrawing from friends and family, Saviola says.

Don't assume always OK

Police and other emergency responders "are rushing in when everybody else is rushing out," says Nick Carleton, a University of Regina associate professor of psychology who specializes in PTSD. "As such, I feel that our first responders are taxed quite a bit, and we just sort of assume that the first responders are always to be OK.

"And there's this underlying and incorrect assumption that because you're a first responder, you're somehow superhuman, you're naturally more resilient," Carleton said. "You're stronger than everybody else and some how the things you have to do don't impact you."

A police officer, for example, may spend hours on different elements of a traumatic case — from arriving at the scene of the accident, witnessing a dead body or body parts, to having to be the one to break the news to the family that their loved one is deceased.

"You can't expect human beings to go back home and have a good night sleep without any way of coping with that," said Dr. Ken Welburn, clinical director of the Ottawa Anxiety and Trauma Clinic. 

And those employed in emergency services will be exposed to multiple traumas over years or decades.

"I think where we're really lacking is in the training, where we don't prepare people for repeated traumas," Welburn said. "That's not a discussion we're having yet.

"They train you to be the fittest you can possibly be, spare no expense in that way, and yet we don't train you psychologically if you see body parts, what do you do, or some way of thinking about that beforehand."

Welburn, who is developing a manual to teach first responders to deal with trauma, said some veterans have developed coping strategies to deal with repeated exposure.

"They'll go to an accident and say 'that's not my blood'," Welburn said. "They'll say that to themselves as a way of coaching themselves. And what they're doing there is, they're creating distance, separation. Otherwise you're just immersed in the trauma."

Carleton said many psychologists are supporters of such resilience training for first responders. The significant challenge, however, is the long-term research commitments needed to make it work.

The studies that would be needed "are expensive and they're time consuming," he says. "Although they're critical....it's very difficult to convince a quick fix society, where we really run on three- and four-year cycles, that we need to run an eight- to 10- to 12- to 25-year project in order to solve a complex problem."