Editor’s note: Key details have been purposely left vague in this story to protect the identity of the subject.
When Brad describes what it feels like to have post-traumatic stress disorder, his eyes deaden but his words are haunting.
Brad (not his real name) has been dealing with the fallout of a PTSD diagnosis for the past two years, since he first went on leave in 2017 from his job as a County of Simcoe paramedic at the advice of his doctor.
A recent report released by the Ontario Chief Coroner’s office on the suicides of nine Ontario Provincial Police officers, struck a chord close to home for the first responder.
Due to a fear of reprisal, Brad asked for anonymity in this story.
“I have seen a lot of stuff. I had nightmares for a long time, replaying calls I’d been on. There was vivid imagery of people’s faces and places. Sometimes those faces would be swapped out with the faces of my kids. It really hits you hard,” he says.
“It’s like, you have a bucket and you keep stuffing things in there, and it’s getting full. My bucket is so full, it’s exploding. Now, I’m dealing with everything I’ve tried to hide under there,” Brad added.
Given the number of calls he's been on, there are a lot of memories to come back.
“I’ll drive down any road, and I’ll pass places where I’ll remember I picked up someone who died,” he says. “It’ll be like, I picked up a person there who died... or I pass a forest and I’ll remember I picked up a frozen kid. I’ll pass a tree and remember a man killed himself there, and then I’ll smell his burning flesh. I’ll pass houses and remember being in them.
"A lot of people I’ve worked with don’t like those roadside memorials for that reason.”
Brad says he went through a time in his life when he tried anything just to forget what he had seen, including alcohol and marijuana.
When that was unsuccessful, he says he considered suicide.
“I put a gun to my head. I honestly thought when you booked off, there would be help for you. There was nothing.”
Brad’s story is not uncommon among first-responders.
“We have a lot of first-responders coming in on a weekly basis,” says Dr. Jonathan Douglas, a psychologist with Central Ontario Psychology in Barrie. “I think it’s a bit of a myth that PTSD is the only injury (first-responders deal with). It can really be any kind of psychological distress or disorder that’s traced to the nature of the work.”
Douglas says he prefers the phrase “occupational stress injury.”
“It describes the whole range of things that can arise from this, that can include depression, substance abuse, even psychotic or panic disorders in some cases,” he says.
First-responders deal with mental-health strain more than those in the general population, says Douglas.
“These are people who are being exposed to traumatic situations on a very regular basis, or they’re exposed to extreme traumatic situations or both,” Douglas says. “There’s a tremendous level of traumatic exposure in these people.”
Stigma attached to trauma
Brad says he was drawn to the medical field when he was young, as his father was also a paramedic. He recalls some of his colleagues going off on mental-health or medical leave over his years of service, but he doesn’t remember why or know what happened to them.
“I never thought I would be one of those people. I think there was stigma attached (to talking about it) and there still is,” he says. “I remember one of my old bosses talking about it. He would say, ‘If you can’t take it, get out, because it’s part of the job. It’s just something you handle.'"
There was no single precipitating event that led to Brad showing PTSD symptoms, he says the effect was more cumulative.
“I had like four sudden deaths in a row I had to deal with,” he says. “I was born and raised here, and my parents were born and raised here, so I know everybody. The last call... I used to play squash with the husband and I knew the wife. She had hung herself.”
Brad says the symptoms didn’t show up all at once. He says he found himself starting to cry at work, and started abusing substances to numb his emotions. He says some of it was also having to deal with other people’s grief on the job when he had to tell them their loved one had died.
“My mother had cancer and she died around the same time, too. I have a hard time with grief,” he says.
At first, Brad says he didn’t think he could have PTSD.
“I was like a lot of other people who may say, it’s the flavour of the day, people are just saying they have PTSD to get off work. I used to think like that,” he says.
Lack of treatment options
Brad says he made more than 300 phone calls trying to find help locally.
While the Simcoe County Paramedic Services has a peer support program in place, which is overseen by a psychologist, Brad says his experience with the program didn’t get him the support he needed.
“Also, sometimes the people who volunteer aren’t the people you want to talk to,” he says.
Brad says he spent a few thousand dollars on psychologists himself trying to get a diagnosis, with little luck on that front. At that point, he determined he needed to prioritize getting help for substance abuse. He managed to get a spot in an addictions and mental-health treatment centre outside the county.
“I had mixed results there, too, but I’ve been sober for nearly two years now,” he says. “Personally, I’m an atheist, and 12-step programs have a religious element, but the good part about it was they had a lot of other police, paramedics, fire and nurses there, and they told me they thought I might have PTSD.”
Sometimes, Brad says he still has difficulty coming to grips with his own diagnosis.
“I have doctors and experts telling me I have PTSD, and sometimes I still don’t believe it,” he says. “I always thought it had to be soldiers who are seeing people being killed and they’re killing people. It’s hard for me to wrap my head around it.”
However, once he finally received a diagnosis, Brad says he started to see light at the end of the tunnel. He joined a peer support group made up of other first-responders who had gone through the same things he had, and they were able to help guide him to get the help he needed locally to heal.
“If I hadn’t gone to a Wings of Change support group meeting, I wouldn’t have known anything,” he says.
While the shortfalls of mental-health supports within the first-responder world are well-known, Douglas says there does seem to be improvement.
“The OPP, for example, has recently adjusted the benefits for officers to give them much greater access to mental-health services, and this makes a lot of sense, because if we can catch it before it’s too late, and the earlier we can address it in the career of a first-responder, the less likely it is it will lead to long-term disability,” says Douglas.
Douglas believes the solution lies in early intervention.
“I think if we were able to get these people so much earlier in their career and give them the skills they need to really deal with traumatic situations, they might need short periods of disability throughout their career, but shorter, so a couple of days or a few weeks, but they wouldn’t need to be off for years necessarily, and I think we’d have a greater possibility of people being able to absorb those situations and manage them more effectively,” he says.
Support from management and sanctuary trauma
While County of Simcoe Paramedic Chief Andrew Robert says there isn’t necessarily a referral program in place internally for paramedics who come to management saying they need mental-health support, it may not be that way for long.
“It’s interesting because we’re right at the cusp of change with the program,” Robert says. “This is relatively new (for us).”
Paramedic services are engaging local psychologists and other experts to overhaul their peer support team processes, Robert says, as well as adding another level of training for paramedics to better prepare them for the traumatic scenes they will face.
“We’re really hoping to put more programs and supports in place. There is a gap. There’s isolation that can occur between the point of injury to the point where there’s clear diagnosis and treatment plans put in place,” Robert says. “That isolation that can take place is real, and we want to make sure we do better than we have historically in trying to reduce that gap.”
Sanctuary trauma is an issue of which Douglas is very aware is a barrier to health for someone dealing with a mental-health issue.
“It’s the response of the system to the injured worker,” says Douglas. “It’s anytime you’re counting on someone being there and that’s not what happens. Not only do I see it a lot, there’s also pretty good evidence that sanctuary trauma... can make the period of disability substantially longer. This is also true of physical injury.”
When asked whether there are barriers preventing management from reaching out to paramedics on mental-health leave, Robert says it has been historically difficult to determine the best course of action.
“We’ve certainly had times where we have not been in touch with people, where we would have liked to. And there have been other times where we have stayed in touch with people," he says. "There’s been certain instances where part of the treatment plan of (someone on leave) is to not have any contact from the employer. We see that in writing coming back to us and we think, ‘If I contact this person we might do them more harm than good.'
“It’s kind of evolved from that point where sometimes I’m afraid to cause a problem by calling," Robert added.
Robert acknowledges that this tactic needs to be re-evaluated to have the default practice be a call, unless the service is informed differently.
“I certainly wouldn’t want to be part of the problem. (In the past), we erred on the side of caution, but wrongly, in retrospect,” he says. “Now, I think we’re going to do it the other way around, especially because that’s really what we’re reading in the literature coming out now.”
Robert says paramedics on leave drifting away is a big part of the problem that's being addressed.
“I’m not alone in saying we haven’t done so well in the past and we’re trying to do better going forward,” says Robert. “It was always a reality, but in the past, we didn’t recognize it for what it was.
“We’re in the business of trying to help people, and that doesn’t stop when they have our own uniform on,” he added.
Douglas echoes Robert’s thoughts on how difficult it can be for the service to know what the best course of action might be.
“There’s a very simple solution: Try asking. Seek the input of the first-responder, and they will tell you what they need. And I think that’s so much better than being afraid to make that call.”
Brad describes his own internal struggle with sanctuary trauma.
“WSIB is going to look after me now, but you really do feel like you’re abandoned. I gave my heart and soul to the job," he says. "I know my shirt doesn’t define me, but it’s all I ever really did or knew. I kind of thought they’d look after me a little bit better."
While he does have a couple of friends from work who have stuck by him, Brad says most of the people he knew through his job have disappeared.
“I loved being a paramedic,” he continued. “I remember being one of those young kids who wanted to save the world. I still think of myself as a paramedic. I fully intended on going back and finishing my career there.
"I don’t think they’d create a job for me. I don’t think they have a clue what to do with us.”
When it comes to first-responders, Douglas says workplace ties can run more deeply than in other vocations.
“The reality is, any workplace tends to represent a kind of a family where we spend so many hours in that workplace it’s so important to our well being," he says. "I think when we’re looking at first-responders, it’s even deeper than that because being a first-responder isn’t just a job, it’s an identity. The employer needs to recognize that.”
Hope for the future
Brad says he sees lots of areas for improvement between agencies.
“I spent years fighting insurance companies when I should have been focusing on getting better. The first six months were a battle. I don’t even know if people who still work there know that these things are going on,” he says.
Brad says his mental health has improved tremendously since he got the right supports in place, although he clarifies his doctors don’t think he’ll ever return to work as a front-line paramedic.
“There’s no guarantee you’ll go back to work (as a paramedic) and never see anything bad again,” he says.
When he describes his mental-health state now, he says it’s very different than it was before his struggle, and he doesn’t see himself ever fully returning to where he was emotionally.
“It’s a roller-coaster. I cry about anything now, whereas I never cried about anything before. I grew up in a family where boys didn’t cry,” he says. “When I started (as a paramedic) it was mostly men, but even now that there are 50 per cent women, I think they too have that expectation.”
Despite everything Brad has been through, he considers himself to be a survivor and a fighter.
“I had to fight to get better. Although, I think I’m one of the lucky ones. I have kids and a wife who love me,” he says. “When you finally ask for help, you’re in a pit of hell. There’s no deeper you can dig. There are some people who aren’t able to do that. Those are the people who are killing themselves.”
