The Unintended Consequences of the Presumptive Legislation for PTSD
The introduction of new provincial legislation that establishes Post-Traumatic Stress Disorder (PTSD) as a “presumptive” occupational illness for first responders seems to make a lot of sense. On face value, it recognizes and accepts that there are risks to mental health for those in difficult jobs, and it begins to treat mental and physical health on an equal basis. This is long overdue.It is very likely, however, that this policy approach this could be the case of a pendulum swinging too far and too fast from one extreme to the other. Unfortunately, this legislation has the potential to make matters worse by creating some unintended consequences. I have seen this before.
With close to 30 years in the Canadian military, I spent the last 12 of which developing policy and programs to support service members who were/are impacted by mental health challenges resulting from difficult assignments.
Early on, I observed the power of PTSD as a social phenomenon. I recognized a disturbing and erroneous trend, that when soldiers did not feel well spiritually or psychologically, they repeatedly believed that they had PTSD. In response to this trend, I coined a new term: Operational Stress Injury (OSI) in order to steer the military culture away from the limiting approach of presupposing a PTSD diagnosis, which can then unduly predetermine treatment and care.
In reality, soldiers and first responders alike, akin to any population group, risk developing a multitude of mental health conditions including (but not at all limited to) depression and anxiety. Equally debilitating behaviors (e.g. high-risk drinking and drug abuse), that may not be connected to a formal diagnosis, may also develop. Of course these behaviors can often directly result from a formal mental illness (such as PTSD), but just as often it is not the case.
This is not a challenge to the legitimacy of PTSD, but a suggestion that limiting legislation to one specific diagnosis is dangerously narrow minded. This approach may be a result of society’s collective will to support our uniformed services or it may be the soundbite obsession that has reduced PTSD to being the default mental health disability for military members and first responders.
Either way, this conclusion is far from the truth. Rather than PTSD, it is Depression that the vast majority of those who are exposed to hardships in these helping professions are more likely to suffer from.
When legislation was introduced in Manitoba last summer, William Gardner, chair of the Manitoba Employers Council, was concerned. He argued that presumption would lead to more PTSD misdiagnoses because it would become a “catch-all” for other mental health conditions. He was completely right when he stated, “It’s one thing to presume a diagnosis of PTSD is work-related. It’s another thing to presume that a mental health disorder is PTSD.”
The Ontario strategy that accompanies the legislation includes a broadcast media campaign aimed at increasing awareness about PTSD and includes a free online toolkit. This now further confuses the understanding, well beyond the workplace. Again, all of this is well-intentioned, but too narrow in focus.
For many years, affected first responders had to fight for compensation. Introducing this legislation signals a real change in how we collectively approach issues around mental health. But the devil here is in the details. The risk for the provinces that adopt this new way of dealing with stress injuries, is that they may be creating cultures where people are assumed to have, or will develop, PTSD after an incident. This could lead to not only inappropriate labelling, but inadequate and improper treatment.
Now retired from the military, my associates and I work with first responders. We have already seen this familiar trend reoccur with a rush to assume incidents are automatically linked to developing PTSD. In some reported cases, well-intentioned co-workers “pounce” and encourage fellow workers to get diagnosed with PTSD and to immediately seek clinical care after an incident. This is a disservice to our men and women, who for the majority, will be resilient and bounce back. To suggest they may be ill is unwise.
Legislators are making a mistake. They need to address the issue from a broader perspective, to view this through the lens of the wider focused OSI approach as opposed to a predetermined and single, diagnostic finding of PTSD.
According to research, the most predominant risk factor for those under threat of developing OSIs is the lack of social support. If this is the case, then why not introduce something to counter this?
What needs to happen is the development of robust support systems that are available to first responders well before they need to seek clinical care. Introducing a workplace Peer Support program addresses this risk factor directly, and is now fast becoming a best practice as a compliment to clinical care. This preventative measure is relatively simple to implement and sustain. Once in place it provides a tangible and readily accessible intervention for employees who start to feel unwell by addressing problems before the employee feels that his or her life is falling apart.
I believe it is essential to review the concept of presumptive PTSD and I suggest taking a broader and more realistic approach, one that incorporates the broader concept of Operational Stress Injuries. In addition, organizations should be encouraged to assume a preventive posture to workplace mental health through the adoption of specific measures such as the National Standard on Psychological Health and Safety in the Workplace and Peer Support, as outlined by the Canadian Standards Association (CSA) and the Bureau de Normalisation du Quebec (BNQ).
Originally published on Linked In March 26, 2016