Late one night in the summer of 2014, Bill Rusk, a police sergeant in Owen Sound, Ont., was crouched on the roof of a downtown store, watching the window of a second-floor apartment in the building next door. His squad had come to bust up a drug deal, and had been told that a violent man was hiding inside with a sawed-off shotgun.
After taking a second look, Sgt. Rusk reached through the open window and yanked the suspect out; other officers on the scene rushed forward and arrested him. It was only after police entered the apartment that Sgt. Rusk learned that the silver object was a small speaker that the gunman was using to prop the window open.
It was the sergeant’s third confrontation with armed suspects in two weeks and, although the raid ended peacefully, he soon found himself plummeting to the depths of a psychological crisis the likes of which he hadn’t experienced in years.
Most commonly associated with soldiers returning from combat, post-traumatic stress disorder (PTSD) is a condition that afflicts individuals who have sustained a profoundly shocking or traumatic experience, and then continue to endure a range of symptoms – including flashbacks, extreme anxiety, depression, outbursts of rage, and hypervigilance – often, long after the fact. A recent Globe and Mail investigation found that 54 Canadian soldiers and vets who served in Afghanistan took their lives after returning from battle (and, according to updates from the military and further reporting by The Globe, that toll has now reached at least 62).
Far less understood is that PTSD afflicts all sorts of civilian workers – particularly firefighters, paramedics and police officers. While Canadian data is scarce, surveys conducted by researchers in the United States, Britain, Australia and Brazil show that the rate of PTSD among first responders ranges from 5 to 22 per cent, with paramedics reporting the highest levels, according to a 2012 article in the Journal of Workplace Health and Safety by B.C. nurse Cheryl Drewitz-Chesny. A 2009 study, conducted by the U.S. National Institutes of Health, found that as many as one in three police officers in the United States report at least partial PTSD symptoms.
Across Canada, thousands of first responders are struggling, frequently in silence, with the consequences of jobs that expose them to a daily diet of horrors: monstrous violence, suicides in progress, mangled bodies, inconsolable relatives. Last fall, to cite one example, eight of the 15 paramedics who responded to a devastating collision north of Toronto, which claimed the lives of a grandfather and three young children, had to take leave to deal with PTSD symptoms.
And the disorder is not restricted to first responders alone.
Also among the victims are 9-1-1 dispatchers, search-and-rescue workers, and transit operators at the controls when their vehicles strike someone, especially individuals attempting suicide. Often, responders return to work – having coped to varying degrees with their experiences – only to endure traumatic echoes years or decades later.
Back in 1990, as a muscular, 6-foot-4 rookie on patrol in a rough Toronto suburb, Sgt. Rusk was shot five times by a drug dealer he was chasing. One bullet shredded his right hand and the other passed through his face and neck and then out his shoulder. Although his injuries were debilitating, he found himself, just weeks into his recovery, being prodded by divisional commander Julian Fantino (who later led several police services before entering federal politics) to take reporters on a walk around that same neighbourhood – to show the public that the police hadn’t lost control.
He balked at Fantino’s request, and eventually quit the Toronto force, relocating almost 200 kilometres north. The psychic scars left by the shooting lingered for years, in the form of anger, nightmares, involuntary flashbacks and chronic sleeplessness. Although he was formally diagnosed with PTSD in 1993, the Ontario Workers Compensation Board, nowadays known as the Workplace Safety and Insurance Board, didn’t extend benefits to him.
After that summer night in 2014, the nightmares and other symptoms returned, with a vengeance.
According to organizations representing frustrated responders, the problem of untreated workplace PTSD has become increasingly dire.
Not that the disorder itself isn’t on at least some politicians’ radar. During last fall’s federal election campaign, Justin Trudeau pledged to develop a suicide-prevention strategy for Canadian Forces personnel and veterans. And after being elected Prime Minister, he gave Public Safety Minister Ralph Goodale marching orders, in a mandate letter, to create “a co-ordinated national action plan on post-traumatic stress disorder, which disproportionately affects public-safety officers.” As well, the Liberals say they’ll spend $20-million to build two PTSD research centres – although as Scott Bardsley, a spokesperson for Mr. Goodale, acknowleges, specific details have yet to be worked out.
But for the most part, as a health-care and workplace-safety issue, the treatment of first-responder PTSD falls to the provinces, which regulate labour conditions. And only two – Alberta and Manitoba – treat work-related PTSD as an occupational injury automatically eligible for worker’s compensation benefits. Such “presumptive benefits” laws require compensation boards to automatically provide sick-leave benefits to first responders with PTSD (just as firefighters diagnosed with certain types of cancer are now presumed to have been exposed to carcinogens during fires).
Alberta introduced such measures specifically for first responders in 2012. On Jan. 1, Manitoba launched an even broader workplace PTSD policy, which applies to any worker in any profession. Erna Braun, Manitoba’s labour minister, says that the province changed its laws in response to feedback from a wide range of employee groups as part of a comprehensive rethink of its workplace safety rules.
Angry at the pace of change, and worried for their members, first-responder groups are calling on other provincial governments to follow suit.
In Ontario, Kathleen Wynne’s Liberals have been promising to introduce reforms for months, but have yet to deliver anything concrete. Labour Minister Kevin Flynn has insisted the government is “taking a very serious look” at presumptive benefits, and continues to promise to deliver a plan this year – but has yet to reveal details of what it might look like.
In the meantime, the only faint glimmer of hope for those affected by on-the-job PTSD in Canada’s largest province is a private member’s bill, tabled by NDP MPP Cheri DiNovo, and based on Alberta’s law, that is to be debated in the Legislature next month. In Nova Scotia, the opposition New Democratic Party tabled a private member’s bill last fall; the government says it’s studying the idea.
But while politicians drag their feet, the Ontario Human Rights Commission has upped the ante, filing a discrimination allegation in November against the Toronto Police Service for failing to include on its memorial wall the names of officers who took their own lives because of a mental-health disability. Indeed, the Human Rights Tribunal of Ontario in 2014 began to clamp down on employers like police services that fail to adequately accommodate the needs of officers with PTSD, including those who don’t realize they’re suffering from the condition but have been reprimanded or fired for erratic stress-induced behaviour, such as excessive use of force.
As politicians dither, the consequences of untreated PTSD continue to prove devastating for those on the front lines of emergency response. U.S. researchers have found links to heart disease and metabolic disorders related to chronically elevated levels of cortisol, a hormone secreted by the adrenal glands in times of severe stress, that can, in excess quantities, increase stress-related symptoms. Unrecognized and untreated, PTSD also often wreaks havoc on the families of those affected – most notably in the form of higher divorce rates, and a tendency among sufferers to silence their demons with drugs and alcohol.
PTSD sufferers also are alarmingly prone to taking their own lives. In Canada, according to the Tema Conter Memorial Trust, which provides support, family assistance and training for public-safety and military personnel affected by operational stress and PTSD, 39 first responders took their own lives in 2015. Police officers, in fact, are more likely to die by suicide than in the line of duty.
For many years, mental-health professionals and workers’ compensation officials believed that PTSD was triggered by a single harrowing event. But researchers have now begun to discern the cumulative effects of sustained exposure to intense workplace pressures. According to the 2009 study at the National Institutes of Health, among police officers such pressures “may play an important role in the development and maintenance of psychological distress.” And the latest Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013, stated that PTSD can occur after sustained exposure to disturbing incidents over many years.
Complicating matters is the fact that an individual occurence of the disorder is “very, very difficult to predict,” says Tom Gabriel, a retired police officer who provides peer counselling for the Toronto Police Association. Two people may react to the same event differently – and there is no way to prepare adequately for some of the experiences that first responders encounter on a near-daily basis.
Deanna Lennox, a member of the RCMP in rural Alberta and B.C. from 1997 to 2013, says she entered the service with little appreciation for the scope and severity of the kinds of things she would see and do – which ultimately included, among dozens of other upsetting incidents, breaking in on a woman violently beating her daughter while the girl’s father looked on placidly, and having to empathize with a child molester to extract a confession.
After years working as a paramedic in Ontario’s Huron County, Liz Black-Petrie found herself taking PTSD leave after a devastating incident in her private life. At a family gathering last spring, she ended up riding in an ambulance with her severely injured mother. (Due to an ongoing legal action, she couldn’t disclose details of the precipitating incident.) And, once at the hospital, and despite Ms. Black-Petrie's own wounds, she instinctively began delivering emergency first aid to her mom – until an ER physician found her weeping inconsolably.
Her psychologist has warned her that when she returns to work, she may experience triggers when attending to “mother-like” accident victims.
Indeed, although first responders are grappling with a workplace injury as genuine as any other, they face daunting cultural hurdles, including institutional denial, bullying or ridicule, pushback from workers’ compensation officials – and, all too often, indifference from the general public they serve. As a result, men and women who do difficult front-line jobs day after day often openly reveal as little of their turmoil as possible.
Bruce Kruger knows the toll exacted by long-term trauma. When The Globe and Mail asked to meet with him to discuss his battles with PTSD – which had prompted a hard-hitting 2012 review of the disorder’s impact on the Ontario Provincial Police – the ex-detective said it would have to be somewhere with no curtains or blind spots, and where he could sit with his back to the wall. Long retired, he continues to suffer from severe anxiety and a related condition that makes him easily startled.
His story, like that of Sgt. Rusk, begins long ago. In 1977, as a young member of the OPP, he found himself in a shootout near Bracebridge. A fellow officer died during the exchange of bullets, but Det. Kruger killed the gunman – and afterward was treated like a hero.
Det. Kruger carried his pain around for seven years, becoming ever-more withdrawn with family, friends and colleagues. Finally, he sought help from an OPP peer-support group.
In policing, the stakes expand beyond individual officers and their families, and may have implications for entire communities.
In the wake of shootings in places such as Ferguson, Mo., and in New York, Baltimore, Chicago and Toronto, police violence has become a hot-button issue across North America. And while such incidents have rightly placed a focus on how citizens can become the victims of those charged with protecting them, they also raise tough questions about whether there’s a connection between extreme untreated occupational stress and violent conduct by police officers.
There’s a dearth of clinical research – in large part because police supervisors investigating use-of-force incidents do not have access to officers’ medical history. Still, some experts and law-enforcement experts feel that a link exists.
“Sometimes police officers relieve their stress by becoming increasingly violent toward citizens, suspects and even their own families,” former Colorado police officer Paul J. Brown wrote in an oft-cited 2003 paper on PTSD in law enforcement. In a more recent op-ed piece in the Washington-based political newspaper The Hill, Renee Behinfar, an Arizona clinical psychologist who has treated first responders and SWAT team members suffering from work-related stress, contended that untreated PTSD has the potential to lead to excessive use of force.
Observed Mr. Brown, “After many years of seeing things on a daily basis that would make most people cringe, police officers begin to feel numb. Morale goes down and sometimes police officers relieve their stress by becoming increasingly violent toward citizens, suspects and even their own families.” Although there’s clearly no excuse for such violence, ignoring one of its possible causes does neither the police nor the public a service.
Some years later, Mr. Traversy was trapped in yet another burning house. When the trucks arrived, a child was still inside – and because the resulting steam would have been as lethal as the flames, crews couldn’t start extinguishing the blaze. Mr. Traversy, already inside the building, tried to make his way out – but became entangled in wires in the dark, smoke-filled basement, quickly losing his oxygen supply.
He did escape, but couldn’t shake a sense of panic: He began waking up at night, shouting and gasping for breath. Such episodes persisted for more than two years, he says, but he didn’t tell his co-workers, even though he was fighting flashbacks on a daily basis.
For those suffering from PTSD, seeing someone is crucial. Paulette Laidlaw, a Burlington, Ont. psychologist who works with many police officers in her clinic, says that the increased public and media focus on first-responder suicides may give sufferers the impression they’re “doomed.” But, she hastens to add, “That’s false – PTSD is quite treatable."
With that idea in mind, when first responders and their advocacy organizations talk about reform, they focus on changes that will save both lives and money by destigmatizing the condition, through the development of policies that recognize it as an occupational hazard and that help its victims get back to a productive work life more quickly. Chief among those changes: more generous employee-assistance plans to cover psychological services; improved training for new recruits on how to develop coping strategies that help them become more resilient; routine use of “critical incident debriefings” for first responders involved in traumatic situations; and presumptive-benefits laws.
The long-term effectiveness of early treatment is widely recognized, but many emergency-service organizations still offer as little as a few hundred dollars, through their employee-assistance plans, to cover sessions with a psychologist – barely enough money to pay for an initial assessment. “They’re set up to fail,” says Ms. Laidlaw, because adequate therapy can take months, and cost thousands of dollars.
What’s more, those who need time off often find themselves dragged into protracted disputes with workers’ compensation boards. Claimants are required to prove an injury that is invisible; the stress of trying to do so, and of having their injuries dismissed out of hand, can add to their trauma, say both psychologists and victims.
Sufferers such as Mr. Kruger and Sgt. Rusk are themselves intensely frustrated by the reluctance of governments to pass laws that would, in effect, normalize first-responder PTSD by formally acknowledging that such jobs come with a real risk of mental illness – and that seeking treatment shouldn’t involve fighting with skeptical, or simply stymied, workers’ comp officials.
That reluctance may have at least something to do with cost. Ontario police organizations have warned of a “financial tsunami” should PTSD become a presumptive benefit, and have argued, as well, that when first responders go on leave to be treated, their employers may be hard-pressed to find replacements.
Alberta’s experience suggests that financial fears may be overblown. Its Workers’ Compensation Board says that it received 75 such claims in the two years before the legislation came into effect in 2012, compared to 131 in the two years after – and that the money paid out grew by only $600,000, to $1.7-million. “Clearly, more first responders experiencing psychological injuries are coming forward to get the help they need, and we believe that’s a good thing,” says a spokesperson for the board.
In some cases, the disdain seems to flow from the top. Ms. Lennox, the former RCMP officer, had crucial support from one senior officer, but points to a disturbing incident in which RCMP Commissioner Bob Paulson referred during a speech to officers with PTSD claims by twirling a finger near his temple in the familiar gesture. The speech, recorded on a cellphone, was posted online, and he later apologized.
Other agencies claim to have made similar changes, although Mr. Marin says that far too few have adopted reforms on the scale of the OPP. At the Toronto Police Service, Deputy Chief Mike Federico says that the 5,000-officer agency provides wellness and fitness programs, peer-support groups, and generous cash allowances for psychological counselling for first responders and their families. He adds that supervisors are trained to look for signs and symptoms among officers who seem to be having trouble coping. “I’d like to think the TPS is on the leading edge,” he says.
As first responders increasingly talk publicly about their struggles, some have concluded that solutions won’t come only from their employers or their governments, whatever right noises are starting to be made. Instead, they are seeking out one another, through social-media networks, in informal meet-ups and at formal conferences.
John Lorinc is a Toronto freelance writer.