Post Traumatic Stress: a new way forward for first responders

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Australia21 NSW Police photo of paramedic and police officer at scene of car crash

NSW Police Traffic and Highway Patrol Command

“It shouldn’t be a career limiting move to put your hand up and ask for help.” That’s one of the strongest messages to come out of a ground-breaking Australian roundtable discussion about Post Traumatic Stress among first responders.

Just as Post Traumatic Stress (PTS) exacts a costly toll on the military, it takes a less-recognised toll on Australia’s police, paramedics, firefighters and emergency service personnel — the people who are usually first on the scene at accidents, crimes, natural disasters and other tragedies.

Convened by Australia21 and FearLess Outreach, the PTS Roundtable at the Australian Federal Police headquarters in Canberra brought together many leading first responders, along with mental health workers, medical practitioners, psychologists, industrial associations and a range of support agencies.

The Roundtable started a national dialogue aimed at developing more effective preventive, treatment and recovery strategies for Post Traumatic Stress (also known as Post Traumatic Stress Disorder) caused by prolonged and repeated exposure to violence, trauma and shock in the line of duty.

Most importantly, participants acknowledged it was important to listen to the voices of lived experience.

“The layering of suicides, car crashes, sudden deaths that you attend as a first responder takes its toll and leaves you with dents in the soul,” one first responder told the forum.

 

Getting the organisational settings right

Australia21 Fearless - PTSD Roundtable, Canberra May 2017There was consensus at the Roundtable that normalising Post Traumatic Stress within the first responder culture would go a long way towards alleviating losses in personnel and efficiency, according to Australia21 Chair Paul Barratt.

“We need to change the culture to acknowledge that it’s normal for what we see and do to affect us, it’s normal to seek support if you feel you need it, and it’s normal to get better as a result of treatment,” he said.

Paul presented some of the early findings from the Roundtable at a seminar at the University of New England in Armidale, where he’s an Adjunct Professor (you can watch the webinar here).

He told the UNE audience that first responders need a work environment which allows them to lead normal, healthy lives without being ‘damaged’ by their inevitable exposure to traumatic situations and events.

He said a range of early intervention measures and ongoing education and counselling are needed to deal with PTS issues, combined with effective management of staff who are already on stress leave. But above all, a change of culture is required to ensure that people who need help to manage PTS are encouraged to do so.

“The people who are the cultural drivers in any organisation are middle management. If you have good guys at that level it helps take all the stigma from mental illness.”

 

Staying on the job

Australia21 - Grant Edwards pulling a truck ABC Australian StorySupport to overcome the stigma of PTS was life-saving for AFP Commander Grant Edwards.

Grant was once Australia’s strongest man, able to pull massive locomotives, aeroplanes and semi-trailers with only the power of his body. But no amount of physical strength could protect him from psychological injury.

Grant was at the coalface of the AFP’s most difficult work, variously heading up a team investigating child exploitation, training police in Afghanistan and supervising Queensland airport security for the G20, arguably one of the biggest policing operations in Australia’s history.

When he began to unravel in 2014, his GP was the first to suggest that he may have had post traumatic stress disorder.

“I heard those four letters, PTSD, and I’m thinking, ‘That’s my life’s gone, my job’s gone, I’m going to be cast as a crazy person’,” he told the ABC recently.

Initially, Grant refused the offer of treatment, fearing being put onto medication would mean losing his weapon and security clearances. It took a breakdown for him to understand he was injured in ways not seen by the naked eye and he needed help.

After the suicide of a colleague in February 2017, there was a flood of complaints about the AFP from disgruntled former and serving members. Grant decided to go public with his own struggles, becoming a lightning rod for change inside the organisation.

Grant was surprised that he was supported by his superiors instead of being shunned.

Many others had not been so fortunate.

“When someone does put their hand up and says, ‘I’m unwell’, until very recently they have been made non-operational or moved to a different area,” Angela Smith of the AFP Association told the ABC.

AFP Commissioner Andrew Colvin admitted that mental health had not been handled well in the orgnisation.

“We look back through how police and the AFP have dealt with mental illness or PTSD in the past and we’ve tended to stigmatise it. You didn’t talk about your weaknesses, you didn’t talk about your vulnerabilities, because that was a sign you weren’t doing your job, you weren’t strong enough or cut out to be a police officer,” Commissioner Colvin said.

 

 
Grant is now the AFP’s Commander of the Americas, and he’s on a mission to remove the PTS stigma from policing — and society in general. So his support of the Australia21/FearLess initiative has been very welcome.

The Roundtable was featured in ‘The Strong Man’ on the ABC’s Australian Story, which told Grant’s story of battling PTS and helping others to speak up about it. If you haven’t seen it already, make sure you watch: it’s very moving and incredibly powerful.
 

The end of a career

But PTS continues to be a career-ender for many police and other first responders — not just those who have experienced violence or the threat of it first hand, but also those who have been exposed to the trauma suffered by others.

Among them is Former Victoria Police detective Narelle Fraser, who recently told her story to ABC Radio Life Matters.

Over a 22 year police career, Narelle spent much of her time in the Homicide, Rape, Child Exploitation and Sex Crimes units.

It was when she was viewing 1,700 videos of child pornography that she started to unravel, even though the task was not new to her. In fact, she had volunteered to do the worst jobs because she didn’t have children and she didn’t want officers who were parents to have to see the abuse.

“I would put my hand up and do all the tough jobs because Number One I thought I could handle it, but Number Two I was trying to save my colleagues the trauma, and in the end I couldn’t even save myself.”

Australia21 - Narelle FraserSoon afterwards, she was an informant at a rape committal and as the victim was being hammered by the Defence her own mind closed down. She blanked out for 20 minutes, only realising it when staff came looking for her because she had left the courtroom.

Uncontrolled anger, nightmares and flashbacks finally sent her to a doctor, who diagnosed PTSD.

“I said ‘Oh, no you’ve got the wrong person. I love my job, I’m good at it, I’m respected’, and I just couldn’t get my head around that I had this serious mental health issue.”

That was in 2012. In 2014 Narelle left her career behind to heal, albeit begrudgingly.

“Even though I loved the job it was making me physically sick.”

Professor Sandy McFarlane, who’s one of Australia’s leading academics on Post Traumatic Stress, told Life Matters that Narelle Fraser’s story is all too common.

“It’s often those people in organisations like the police — because they are constantly putting themselves in the front line — who are particularly vulnerable to suffering,” he said.

“They are very committed to their jobs, they want to stay there, and that often drives them to stay there longer than they should.”

Over recent years the Australian Senate has held inquiries into the mental health of serving Australian Defence Force personnel and into suicide by veterans and former defence service personnel.

But Professor McFarlane said the impact of stress and trauma on Australia’s domestic first responders had not received the same scrutiny.

“State governments I think do a far worse job in caring for employees, whether they be firemen and women, police officers, ambulance officers, health professionals, child protection workers. I think there’s a very significant deficiency at state levels in provision of these services.”

 

Throwing off the stigma

Australia21 - Peter James shows his medals to the ABC

ABC News: Laura Beavis

Unfortunately, the stigma of PTS is still pervasive in many workplaces.

In Tasmania, the Health & Community Services Union has just made a submission to the state government calling for PTS to be defined as a presumptive illness for ambulance paramedics. That would mean if an emergency service worker was seeking compensation, the employer or insurer would have to prove their post-traumatic stress was NOT a result of their employment, instead of the legal burden being the other way around.

The union is highlighting the case of Launceston paramedic Peter James, who was among those first on the scene at both the 1996 Port Arthur massacre and the 2006 Beaconsfield mine collapse.

Mr James was recognised for his bravery as a paramedic with medals and awards, but said receiving recognition that the work caused post-traumatic stress took a long and complex legal fight.

“Basically, you’re a liar until proven otherwise, and then you’re probably a liar that got away with it,” he told the ABC.

Peter James and Dean Yates, the Reuters Health and Wellbeing Advocate, met with Tasmanian Premier Will Hodgman in August 2017 to put the case for making PTSD a presumptive work-related injury for first responders.

“I reckon there is a good chance Tasmania will be the first state in Australia to introduce such legislation,” Dean said after that meeting.

 

Efficiency v effectiveness

Australia21 Fearless PTSD Roundtable Canberra May 2017Paul Barratt believes there’s too much emphasis on efficiency in first responder organisations and not enough on sustaining effectiveness.

“Efficiency has to do with performing a given operation at least cost, and about making resources go as far as they can. Effectiveness has to do with successful completion of missions.

“So for example, too much emphasis on efficiency, such as not having trained personnel perform back office functions, can compromise the opportunity to rotate personnel through lighter duties,” he said.

Paul would also like to see a range of measures aimed at addressing PTS in the workplace, including:

  • more robust recruit screening and training;
  • improved return to work strategies;
  • better support and training for managers in dealing with PTS sufferers; and
  • increased staffing levels to reduce exposure to trauma.

“No-one ever complained when the fire brigade came and put out a house fire, that they had three too many fire fighters,” Paul said.

“There’s a certain number of people required to achieve a task, but organisations that don’t acknowledge that really put their staff under pressure. And the cost of having individuals succumb to PTS injury is enormous, both in the management of those affected, and the fact that they have been taken out of the workforce,” he said.

“Having people in a good mental state goes to how effective an organisation is.”

Australia21’s volunteer Board and small staff are now collating the Roundtable transcripts, submissions and recommendations and will release a report to the public before the end of 2017.
 
 
Australia21 - Hunched over manFearLess Outreach Australia is a charity that works with people living with the consequences of PTSD, especially the families of those who experience it. 

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