THE TOLL OF TRAUMA
When the helpers need help — but are afraid to ask
There is a push on in British Columbia to provide more mental health services to first responders, the people we depend on to help us in times of trouble, but who often shun asking for help themselves.
Adding to the traditional grimness that B.C. paramedics, police officers and firefighters endure — fatal accidents, devastating fires, murder scenes — is the opioid overdose crisis that has killed more than 3,500 people since January 2016.
Thousands more have been saved by injections of the overdose-reversing medication naloxone.
“We will go to a call involving a fentanyl overdose, we will give the person naloxone. When they regain consciousness, they will have no idea what happened. They are often combative and often will refuse hospitalization. Sometimes they are in hospital gowns with the hospital tag still on because they just got released,” says Matt Johnston, a firefighter in Metro Vancouver.
“You go back to these repeated customers, and pretty soon it will wear on your spirit and you (think): My ability to be compassionate against this patient is next to nowhere.
“So when you are going to three or four calls of overdoses per shift, all of a sudden the world doesn’t look as shiny any more. And it has a way to generalize to other areas of your life where you are more cynical about human nature.”
Johnston is acutely aware of the effects of trauma on first responders. Before becoming a full-time firefighter in 2012, he graduated from UBC with a masters in counselling psychology and opened a local
You go back to these repeated customers and pretty soon it will wear on your spirit.” Matt Johnston, firefighter
practice that helped at-risk youth. Even though he worked as a registered clinical counsellor, he still occasionally struggles when responding to calls in his new profession.
Combining his two worlds, Johnston now sits on the B.C. First Responders’ Mental Health committee, which has brought together management and workers from a variety of agencies to develop a province-wide best practices guide and online resources for problems such as suicidal thoughts and depression.
Research has shown that first responders are at an increased risk of mental health problems. A 2017 national study by University of Regina psychology professor Nicholas Carleton that surveyed nearly 6,000 dispatchers, correctional workers, police, paramedics and firefighters found 44.5 per cent showed signs of at least one mental health disorder, much higher than the average of 10 per cent in the general population.
In April, the provincial government announced it was removing barriers to helping first responders get mental health help. PTSD and other mental health conditions are now presumed to have been caused by the nature of their work, so first responders no longer have to prove such illnesses happened on the job.
“First responders, sheriffs and both provincial and federal correctional officers who experience trauma on the job and are diagnosed with a mental disorder should not have the added stress of having to prove that their disorder is work-related in order to receive support and compensation,” Labour Minister Harry Bains said at the time.
This is a significant policy change, said Sean Gjos, owner of Boreal Wellness Centres in Yaletown, which is developing a new trauma counselling program for first responders.
“For many of these individuals, their normal day-to-day work life is dealing with situations that, for most of us in the general public, is one of the worst days of our lives. … And over a period of years, all of those experiences can accumulate and be a really heavy burden for first responders,” said Gjos.
“So making it easier for them to access appropriate care is a huge win, and long overdue.”
The mounting number of suicides by first responders in British Columbia showed that change was desperately needed.
A website kept by retired paramedic Lisa Jennings counts nearly 60 suicides by police and corrections officers, paramedics and firefighters over the past three years.
And yet, for a province with about 17,000 police officers, firefighters and paramedics, the number of claims made to WorkSafeBC for mental health problems is low. There were 269 claims in 2017: 84 allowed, 41 refused, and the rest abandoned.
The Labour Ministry said it is too early to know whether April’s rule change will substantially boost these numbers.
Why are there so few claims if research suggests almost half of first responders have some type of mental health injury? Stigma.
This stops many in paramilitary, “tough guy” careers from asking for help, experts say.
“We did a survey to find out what first responders’ current attitudes were about mental health, about seeking help, and about stigma. And the response we got back from that was: Yes, stigma does exist in these organizations,” said Trudi Rondou, WorkSafeBC’s senior manager of industry and labour services, who chairs the First Responders’ Mental Health committee.
Last year, the committee launched the “Share it. Don’t Wear It” campaign, featuring the stark faces of first responders covered with chilling words, such as: “There’s this heavy feeling. It’s more than a bad call or a bad day. It’s like all the time.”
In a survey this year, 62 per cent of respondents said they were more likely to speak up for help as a result of the campaign, said Rondou.
That’s a promising sign for first responders, whose most common mental health diagnosis is depression or anxiety, with PTSD making up seven per cent.
But to whom do they turn for help once they are ready to ask?
Johnston, who has done mental health outreach work with firefighters, has designed a two-day course for mental health professionals interested in working with first responders. Over the past year, 250 clinicians in seven B.C. cities have taken the course.
Given how hesitant first responders are to seek help, the course gives clinical counsellors tips on the appropriate language and approach to use so that these workers will continue to return. Through his website First Responder Health, Johnston has also created a telemedicine option that links first responders in rural communities with trained clinicians.
“First responder jobs can be brutally difficult,” said clinical psychologist Mary Ross, who has taken Johnston’s course and whose expertise includes PTSD.
“And more than I think the public appreciates, there are very kind, well-meaning, sensitive people joining these organizations and some of what they deal with impacts them hugely and, unfortunately, makes some really, really sick.”
Responding to the increased number of calls where people have died or are in need of repeated intervention because of the opioid crisis makes it even more difficult for first responders to find a balance between staying emotionally unattached at work and being emotionally open in their personal lives.
“You create the barriers you need to stay sane (at work),” said Ross, who works at
Boreal.
“Then how do you go home and be a dad and a husband when you’ve been building walls all day?”
Gjos, who worked in financial management and had several health-care organizations as clients before opening Boreal, said first responders, veterans and nurses make up 40 per cent of the clinic’s patients.
He expects that the 10-week, outpatient trauma program that Boreal is developing will be popular with first responders, and could also help emergency-room doctors and nurses, dispatchers, correctional officers and Crown attorneys.
Gjos is in discussions with WorkSafeBC about his clinic becoming a recommended provider, which would mean those seeking counselling there for approved claims for workplace injuries would have their sessions covered financially.
“We are trying to help people who have had traumatic experiences to develop tools and become more resilient so they become more functional across all layers of their life,” Gjos said, adding that vocational rehabilitation experts work with patients who have taken a leave of absence.
“We are collaborating on their return-to-work path. It is a really important aspect, especially in safety-sensitive jobs.”
Ross, who has been a clinical counsellor for 20 years, believes first responders are more willing to ask for help than they were in the past.
“Now it’s a little easier to do it more openly and have the support of your workplace behind you in a way that wasn’t quite there before,” she said, but added that more work needs to be done.
Johnston believes changing the language from “disorders” to mental health “injuries” will encourage more first responders to come forward for help, just as they naturally would with an injured arm or leg.
He also senses a change from the dire situation a few years ago, when his department lost two members to suicide in just seven weeks, to more encouraging times now.
For those in the early stages of feeling down, Johnston has a few recommendations: Get more sleep, which is often a challenge for those who work shifts; stay connected to friends and family, which can also be difficult when you work nights and weeknights; and have a physical outlet or hobby that can clear your head.
For Johnston, a former Team Canada distance runner, it is going for long jogs.
For those more mired in workplace gloom, he hopes his take-away message for first responders is that “taking a knee” in counselling will make them more confident in other elements of their lives.
“If firefighters can understand that idea that it will help you become stronger in your job and your personal life, not weaker.”