Responding to PTSD by supporting our first responders
A submission to the Standing Committee on Social Policy from the Ontario Public Service Employees Union regarding Bill 163, the Supporting Ontario’s First Responders Act
The Ontario Public Service Employees Union (OPSEU) is pleased to offer this submission to the Standing Committee on Social Policy in response to Bill 163, Supporting Ontario’s First Responders Act. The proposed bill amends the Workplace Safety and Insurance Act (WSIA) and the Ministry of Labour Act to provide presumptive coverage of posttraumatic stress disorder (PTSD) for first responders.
OPSEU represents more than 130,000 members throughout the province in the Ontario Public Service, the broader public service, at the Liquor Control Board of Ontario, and in the Colleges of Applied Arts and Technology.
Our union commends Ontario for tabling this important legislation, which will help ensure that compensation is provided to workers who develop PTSD from trauma experienced at work. It is important that workers receive timely recognition of and treatment for PTSD. Our union appreciates the opportunity to offer input to the Committee’s consideration of this bill.
OPSEU Recommends: include other front-line workers
Post-Traumatic Stress Disorder (PTSD) is a mental illness that can happen when someone experiences one or more traumatic events. A person with PTSD often re-experiences the traumatic event(s) that triggered it. Symptoms of PTSD include:
- Nightmares and flashbacks to the traumatic event(s)
- Constant nervousness or edginess; feeling easily startled
- Feeling that something terrible is about to happen
- Feeling detached or numb
- Having a hard time concentrating
- Avoidance of things that remind the person with PTSD of the event(s)
OPSEU represents many types of first responders covered in the bill, such as paramedics, dispatchers, correctional officers and youth service workers in secure detention facilities. It is well established that first responders such as police, firefighters, and paramedics experience traumatic events due to the nature of their jobs and are at risk of developing PTSD. Correctional workers and youth service workers are exposed to traumatic incidents such as assaults, riots, hostage takings, self-harming behaviours, and suicides as part of their job.
However, OPSEU represents many other workers not named in the bill who face trauma in their work. These workers include health care workers, social service workers, probation and parole officers, bailiffs, other enforcement officers, and workers in child protection. OPSEU believes that front-line workers who interact with the public and who are exposed to disturbing situations, material, or workplace violence are at risk of developing trauma-related disorders such as PTSD. Exposure to violent events is associated with an increased risk of developing PTSD (O’Brien, 1998).
OPSEU can cite recent examples of weapons being brought into probation and parole offices, exposing these members to the threat of violence. One case occurred the same day that a Ministry of Labour inspector attended the workplace to discuss what measures were in place to address workplace violence. OPSEU also recalls horrific incidents, such as the time when a probation officer was attacked and knocked unconscious in his own office. In addition to facing the risk of violence, these workers deal with vicarious trauma every day on the job because their role demands that they engage closely with clients’ lives and life stories and act as their clients’ primary supports.
On Friday, March 28, 2014 at 11:00 a.m., gunshots broke out at the A. Grenville and William Davis Courthouse in Brampton. A man entering the court building shot and critically injured a police officer and then was himself killed by police.
The incident distressed OPSEU’s 5,300 members who work in the province’s 167 courthouses. In a survey OPSEU conducted after the shooting, almost half of respondents reported that they have felt frightened at least once in the last five years because of verbal or written threats, experiencing or witnessing assault on themselves or someone else, or witnessing property damage. A few respondents of the courthouse survey revealed that some of the trauma they witnessed was from threats and attempted assaults directed at child protection workers in courtrooms.
It is difficult to imagine even one child apprehension where a child protection worker is not at risk of violence. In a 2014 study done in collaboration with the Ontario Association for Children’s Aid Societies, nearly three-quarters (74.7 per cent) of Ontario CAS employees reported that they had experienced violence during their careers (averaging 11 years); 26.8 per cent reported experiencing assaults or attempted assaults; 45.2 per cent experienced threats or stalking; and 67.9 per cent experienced verbal or written abuse. Some employees who faced assaults or other violence had to deal with multiple assailants (multiple assailants were reported by CAS employees for 4 per cent of assaults and 8 per cent of threats/abuse); weapons (reported for 9 per cent of assaults and threats); threats to family members; and other stresses.
Approximately one-third (32 per cent) of child protection workers reported that they had experienced violence (assault/attempted assault, threats, stalking, and verbal or written abuse) while working alone. Physical assaults were common; however, psychological impacts (post-traumatic stress) were also very common. Child protection workers are privy to disturbing material, and traumatic child abuse stories. They work closely with families in deeply traumatizing situations and processes.
OPSEU can also provide examples of social service workers being attacked or killed at work. OPSEU member Krista Sepp was stabbed to death in 1989 by a 15-year-old while working alone during the night shift at a Midland group home. Group home workers are not covered under this bill.
Attacks happen daily. Consider the developmental services worker who was assaulted in the basement of a group home while transferring clothes from the washer to the dryer who had to use her own cell phone to call 911. In another instance, this time in northern Ontario, a personal support worker was grabbed around the neck and strangled near a fridge in the kitchen. The assailant stopped squeezing the worker’s neck only when two other workers pulled his pants down to his ankles. These workers remain exposed to these daily dangers and are vulnerable to PTSD.
Ontario’s Ministry of Labour is well aware of the workplace violence in healthcare – the Ministry set up a Leadership Table to devise ways to reduce workplace violence. Indeed, in 2014, of the ten occupations reporting the highest incidents of workplace violence, four are healthcare-related: Registered Nurses, nurses’ aides, community and social service workers, and Registered Practical Nurses. General hospitals, psychiatric hospitals and addiction hospitals have the highest number of lost time injuries (LTI) from workplace violence. Here are some examples:
- More than 500 workplace violence incidents occurred at the Centre for Addiction and Mental Health from 2013-14;
- 274 incidents of workplace violence occurred at Ontario Shores Centre for Mental Health Sciences from January to August of 2015;
- At least 13 physical assaults on staff resulting in injury have occurred since May 2014 at Waypoint Centre for Mental Health Care; and
- 23 physical assaults were reported at the Royal Ottawa’s Brockville Mental Health Centre from 2014-15.
OPSEU members in healthcare – especially those working in mental health facilities – are often afraid to even enter their own workplaces and they describe frequently working in fear. OPSEU believes that all these workers who face risks of violence need to be covered under the PTSD legislation of Bill 163.
It’s not just what our union observes firsthand; the U.S. Department of Justice, Bureau of Justice Statistics completed a National Crime Victimization Survey which reported on violence in various jobs throughout the U.S. (Duhart, 2001). This report concluded that between 1993 and 1999 (within 29 identified workplaces), college or university teachers reported the lowest violent workplace victimization rate (1.6 incidents per 1,000) and police officers reported the highest incidence (261.8 incidents per 1,000). Other rates per 1,000 were: 21.9 for nurses, 68.2 for mental health professionals, 54.2 for junior high teachers and 53.9 for convenience store workers.
Not only are these types of workers exposed to workplace violence, but they engage with people’s trauma every day at work. They see horrible things and hear horrible stories that appear in their dreams or keep them up at night.
OPSEU urges the government to follow Manitoba’s lead and include all front-line workers in the bill. Manitoba changed the definition of occupational disease to include posttraumatic stress disorder and added a presumption clause 4 (5.8) that states:
If a worker
- is exposed to a traumatic event or events of a type specified in the Diagnostic and Statistical Manual of Mental Disorders as a trigger for post-traumatic stress disorder; and
- is diagnosed with post-traumatic stress disorder by a physician or psychologist;
the post-traumatic stress disorder must be presumed to be an occupational disease the dominant cause of which is the employment, unless the contrary is proven.
Manitoba also added definitions for the DSM-5, posttraumatic stress, and psychologist. Manitoba based its legislation on the most recent research. Manitoba found that 89 per cent of the 2000-2014 disallowed claims were from other occupations, including child protection, social workers, nurses, corrections, probation and parole, and mental health. Manitoba’s PTSD legislation is part of Manitoba’s Five-Year Plan for Workplace Injury and Illness Prevention launched in 2013 and includes mental health as one of its 10 action areas. The plan commits Manitoba to improving supports, resources and coverage for workers who routinely face traumatic events as part of their work in an effort to reduce work-related PTSD.
OPSEU Recommends: diagnosing PTSD by physicians
We note that Bill 163 requires that PTSD be diagnosed by a psychologist or a psychiatrist. This will be difficult given Ontario’s shortage of these types of clinicians, especially in rural areas. We also know that because of the stigma surrounding mental illnesses, many workers may be reluctant to see a psychiatrist or psychologist, but may be more willing to speak about their symptoms and feelings to their family doctor. We recommend that the bill be changed to allow PTSD to be diagnosed by physicians as well. Manitoba’s legislation allows PTSD to be diagnosed by a physician or a psychologist (See Section 4 (5.8) above).
OPSEU Recommends: strengthen prevention obligations
Bill 163 would give the Minister of Labour the power to direct the employers of included workers to provide information to the Minister about their plans to prevent PTSD in the workplace. It also gives the Minister the power to collect the information to assess the PTSD prevention progress and prepare reports. There is no corresponding amendment in the Occupational Health and Safety Act (OHSA) to require employers to prepare a plan to prevent work-related PTSD. No requirements in the current bill attract enforcement by health and safety inspectors. The penalty under the Ministry of Labour Act for not providing this information is low at a maximum of $25,000.
Why is strengthening prevention important? Because for every worker with diagnosed PTSD, there are more than twice as many with symptoms (LeBlanc et al. 2011). Therefore, without strong prevention, there will be a constant stream of workers developing diagnosed PTSD.
Strengthening prevention requirements is critical to help reduce stigma which minimizes the condition. The Mood Disorders Society of Canada refers to the Canadian Medical Association’s August 2008 Eighth Annual Report Card on Health that states:
- 46 per cent of Canadians believe that a diagnosis of mental illness is merely an “excuse for poor behavior and personal failings”
- One in ten Canadians think that people with mental illness could “just snap out of it if they wanted”
- 42 per cent would no longer socialize with a friend diagnosed with mental illness
- 55 per cent would not marry someone who suffered from mental illness
OPSEU recommends strengthening prevention obligations by adding employer and supervisor obligations in the OHSA that can be enforced by Ministry of Labour inspectors. Incorporating prevention of PTSD in the OHSA also empowers the internal responsibility system to action the issue. Employers and workers on joint health and safety committees and health and safety representatives who have the most workplace expertise can engage in activities, make recommendations, and implement measures to prevent PTSD.
Other considerations: the compensation must be real
OPSEU believes that we also need to at least be aware of current problems at the Workplace Safety and Insurance Board (WSIB) and the reform needed there. Over 20 doctors have recently come forward saying that their professional opinions have been disregarded by the WSIB, even in cases where the doctors have performed surgery on workers. The Ontario Federation of Labour documents four cases in its report, Prescription Overruled, and a subsequent ombudsman complaint filed by injured worker legal clinics documents over a hundred additional case examples.
We also hear of cases where the claim is approved but few or no benefits are approved to support the worker – no wage loss recovery, no or very little medical assistance, etc. What good is a yes if the injured worker receives no material or other support?
OPSEU knows of PTSD cases in child protection where employers appeal PTSD cases and do so more than once in the same case – and on more than one occasion in a single office! This adversarial and painful process sentences the worker to perpetual uncertainty and further trauma when they are already suffering from a debilitating illness. Adding a legislative presumption for all front-line workers needs to be accompanied by steps to ensure that workers can truly access these benefits quickly and seamlessly.
OPSEU has another example of what workers go through to continually convince the system that their PTSD is serious and requires consideration. In this case, a member was assaulted by a client in a hospital a number of years ago and developed PTSD. The assault was widely covered in the media. When she was deemed fit to return to work, the employer fought tooth and nail against a reasonable accommodation for her, thus reigniting her PTSD symptoms. Now after more than a year of being back at full-time work in a suitable position, she is currently being forced by her employer to revisit her doctors all over again and to re-prove how her work provides an ongoing problem. This is traumatic for the worker and shows a lack of understanding on the employer’s part of how PTSD works. How many times will this worker (and others) have to relive their trauma to fight for compensation and recognition of their PTSD?
OPSEU is troubled that many of our members are currently having difficulty obtaining benefits.
We worry that, if left unchecked, those troubles will continue and will prevent workers from receiving the benefits described in Bill 163.
OPSEU is pleased that Bill 163 has been tabled in the legislature. If passed, it will remove barriers and provide timely and more accessible compensation for PTSD to some workers. However, why limit this positive initiative to only some groups of workers? OPSEU believes that all front-line workers who develop PTSD as a result of their work should be included in these changes. Manitoba did it; Ontario should do it too.
And the bill should account for shortages and long waits for appointments with psychologists and psychiatrists, especially in rural areas, and accept diagnoses from physicians, as Manitoba has done.
Lastly, the Bill 163 should be accompanied by a stronger prevention strategy that is linked with Ontario’s enforcement and prevention system. Clarity on prevention will ensure that workplace decision-makers undertake initiatives and adopt measures and procedures that prevent PTSD.
Duhart, D. 2001. National crime victimization survey. Violence in the workplace. U.S. Department of Justice. NCJ 190076.
LeBlanc, Vicki R., Cheryl Regehr, Arija Birze, Kevin King, Aristathemos K. Scott, Russell MacDondald, and Walter Tavares. 2011. “The Association between posttraumatic stress, coping, and acute stress responses in paramedics.” Traumatology 17.4: 10-16.
Mood Disorders of Canada. 2012. Post-Traumatic Stress Disorder: Out of sight, not out of mind. Report to the Government of Canada. http://www.mooddisorderscanada.ca/documents/Advocacy/PTSD_Report_EN.pdf
O’Brien, L. 1998. Traumatic events and mental health. Liverpool, UK: Cambridge University Press.
Ontario Federation of Labour and Ontario Network of Injured Worker’s Groups. 2015. Prescription Overruled. Toronto. http://ofl.ca/index.php/prescription-overruled-report/
SPR Associates. 2014. CAS Workers at Risk: A Current Assessment of Worker Safety, Client Violence and Child Protection in Ontario's Children's Aid Societies – A System Under Pressure. Toronto.