Post-Traumatic Stress Injury: Hearing, Helping, Healing

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Jim Regimbal chaired the Yukon Employees’ Union’s recent Human Rights panel discussions of Post-Traumatic Stress Injury.  As Dawson City’s Fire Chief, President of the Association of Yukon Fire Chiefs, and Yukon’s Director on the Canadian Association of Fire Chiefs, he has advocated for improved services to first responders suffering from PTSI and has been instrumental in bringing the issue into focus in Yukon.  He provided powerful empathy and insight earned from his many years on the job. 

The first step is acknowledging and accepting that, whatever name it’s given, Post-Traumatic Stress Injury is real and that trauma significant enough to cause injury can’t easily be quantified. The science supports this, with mountains of evidence explaining the changes to brain structure caused by exposure to trauma. We can’t choose not to “believe in PTSI” any more than we can choose not to believe in climate change. The evidence is clear and the science is irrefutable.

PTSI can be the result of a sudden, dramatic incident but it is just as likely to develop invisibly over many years.  Its onset can come without warning, sometimes after a seemingly benign event.  Whitehorse Psychologist Nicole Bringsli used a water glass analogy; a glass can hold only so much liquid.  All it takes is one too many ordinary, inconsequential drops of water and the glass spills over.  We can witness and contain only so much pain and trauma before we reach our capacity to cope and, like the water glass, we risk spilling over.

What constitutes trauma?  There’s no easy answer. Trauma that affects one individual very profoundly can sometimes be borne by another, or can be overcome with access to the right kind of support at the right time.  Bringsli reminded us that each individual brings their own history and sensibilities to their work, and each person responds differently to similar circumstances.

What occupations or events are likely to lead to psychological injury?  Combat veterans, first responders like firefighters, police officers, EMS providers, dispatchers and corrections officers witness things they can’t ever forget, scenes and calls that will affect them forever.  A career of running into burning buildings, delivering terrible news or fighting to save lives takes an enormous toll on the heart and psyche.  There are many lines of work that put people at risk, and it’s important to recognize the danger so we can provide appropriate resources to all those who need them.

Many caring professions are occupied predominantly by women, and many struggle silently with the emotional impacts of that difficult work. Though rarely labelled PTSI, the ongoing emotional trauma has the same impact on quality of life and mental health. It’s time to consider how broadly affected both men and women are by their work, and how many professions are high risk for psychological injury.

Social workers face heartbreaking situations in the line of duty. Removing children from dangerous homes, denying parental access and leaving vulnerable children in foster situations takes a terrible toll. Sheena Larose, a former Child Protective Services worker from Ontario recently wrote “Unless you are in the trenches, people don’t understand that child protection work can be among the most intensive, heart-wrenching and volatile work one could ever encounter.”

Social workers counsel child abuse victims and must bear witness for their frightened and confused young clients. When we talk about social workers’ emotional health, we often say they have “burned out”… we don’t consider PTSI as a likely outcome.  Vicarious trauma and compassion fatigue – whatever we call it, the results can be life altering and career limiting.

Front line workers in shelters for domestic violence victims face recurring trauma – imagine the daily challenge of maintaining a healthy outlook when you’re immersed in the pain of others.  How hard must it be to turn a woman away when your facility has no space, knowing she and her children have no choice but to return to a dangerous home?  These workers must also remain anonymous to protect the security of those they help, and so they often have no choice but to struggle in silence, without recognition or support.

Prevention is more valuable than cure; our panel members spoke again and again of the urgent need for effective critical incident de-briefing practices, currently almost non-existent in Yukon. They talked of the need for trained peer support, for non-judgemental listening and for access to counselling services. Other jurisdictions have comprehensive supports we haven’t even begun to consider here in the Territory. 

When our panel was asked for a wish list to help combat Post-Traumatic Stress Injury, there was consensus on the need for critical incident debriefing, for pro-active discussion and peer support. More funding is needed to ensure local mental health service providers are resourced to provide care when it’s needed. Employers must prioritize worker safety and be as diligent in protecting the minds and spirit of their employees as they are about their physical well-being.    

Jeannie Dendys, Yukon’s new Minister responsible for the Yukon Workers’ Compensation Health & Safety Board offered her commitment to supporting PTSI prevention & treatment.  YWCHSB Chair Kurt Dieckmann stressed the role of the employer and the value of prevention.  It’s important to make sure protections are built into work environments likely to experience critical stress and trauma.  Normalizing help-seeking behaviour will go far, he says, to de-stigmatizing PTSI and making work safer.

How we respond to our injured colleagues, neighbours and family members, is an indicator of how likely they are to heal.  Forcing sufferers to convince us of their injury, prove its cause and defend their need for help adds insult to injury and creates barriers sometimes too great to overcome.  During the recent Territorial election campaign, new Premier Sandy Silver promised to amend the Yukon Workers’ Compensation Act to include presumptive provisions for post-traumatic stress disorder (PTSD/PTSI) in first responders. That commitment was echoed by Minister Dendys at our event.  At YEU we believe presumptive provisions must cover first responders, but that other high risk worker groups must also be included if the system is to protect those at greatest risk of harm.

Our community is compassionate; we are quick to help families in need. We support our sick, injured neighbours when there’s a fire, a death or catastrophic illness. That empathy must extend to the helpers, not just to the victims. 

We invite you to watch the full video recording of our two panel discussions.

Watch The Nature of Things for PTSD: Beyond Trauma

 

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Straight Talk: The Independent Medical Examination or IME

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If you have an illness, injury or disability that impacts your work temporarily or long term, you may require an accommodation, need extended leave and/or disability benefits. Accessing any of these requires documentation, including proof of your medical circumstances. If your employer requests an Independent Medical Examination or IME, there are a few things to know.

What is an IME?
An IME is an examination by a medical professional who does not have a therapeutic relationship with the patient. Often, the IME doctor is a specialist chosen by the employer, and there is a contractual obligation to provide a report to the Employer on their findings.

When is an IME requested?
Your employer may request information to determine that your illness or disability is genuine and the impact it will have on your attendance. As a last resort and where the Collective Agreement allows, your employer may require you to attend an Independent Medical Examination (IME) at their expense.

Why can’t I just provide a Doctor’s note?
Doctor’s notes that say “Can’t attend work for medical reasons” or “off work for 30 days” or “patient needs new supervisor” are not well received. The Union often hears of employees denied access to their sick leave benefits because their medical notes are seen as insufficient to prove they are or were unable to perform their duties because of illness or injury. Similarly, notes that reflect numerous restrictions may compromise the employer’s ability to accommodate the employee.

When a medical certificate is requested, it should confirm a bona fide medical condition, provide information about the nature of the condition, explain your prognosis as it relates to the workplace and your return to work, and list any restrictions or limitations on your ability to perform your duties. Ideally, your medical practitioner will provide objective medical evidence about your limitations as they relate to your job so that your employer can respond with a reasonable accommodation or help you access disability benefits.

Do I HAVE to provide an IME if they ask?
You can refuse to attend an IME, but this may result in delays returning to work or denial of sick leave and other benefits.

When an employee is dealing with multiple or chronic medical conditions, a mental health issue, a substance use issue, workplace conflict or when there is a mix of culpable and non-culpable behavior, it can be more difficult to identify the medical restrictions without breaching the employee’s privacy.

If you are asked to provide consent to the employer to speak with your doctor, you should preview the questions the employer wants to ask and limit your written consent to those questions. Do not consent to open questions such as “please explain…”. 

ASK QUESTIONS! Who will get to see my information? How will my information be used?

You are not obliged to consent to release medical information (medical/family history, test results, diagnosis) to your employer. You have the right to alter any consent form to protect your privacy. There are benefits to an IME, but also some important things to keep in mind to protect your rights and privacy:

Pros:
•Access to a specialist more quickly
•Comprehensive medical exam and report for your treatment provider
•Clarity around your medical condition, treatment and restrictions

Things to think about:
•An IME can be invasive and should only be requested as a last resort, where other appropriate medical queries have not resulted in sufficient information to explain ongoing absence or develop an accommodation.
•Many Collective Agreements oblige the employer to follow the recommendations in the report, which may not be consistent with your preferences.
•You are entitled to your privacy. Your employer does not have the right to information about your diagnosis, test results or your medical history.
•The employer does not have the right to share your medical information without your expressed, specific consent.

When medical issues affect you at work please contact us. Let us help you navigate the system and protect your rights.

Sick Leave: Ours to Protect!

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