In 2021 the Workers Compensation Board of Alberta (WCB) accepted a total of 565 claims for psychological injuries from first responders, which includes paramedical services, police (except those who are commissioned), and firefighters. Out of a total of 792 claims, 227 were denied. Local first responders who spoke to Discover Airdrie who have gone through the process of submitting a psychological injury claim shared their experiences.
(For privacy and confidentiality reasons, names and specific occupations of those interviewed are not being disclosed)
"They're not proactive with PTSD. It's waiting until you break."
H. began her work as a first responder in Northern Alberta. There she dealt with a multitude of traumatic calls. She noted that she started filing WCB stress claims going all the way back to 2011, estimating she filed eight claims, though she underlined this didn't necessarily mean that she was taking time off work. Though her doctors believe she had post-traumatic stress disorder (PTSD) dating back to 2016, she wouldn't leave work until June 2020, when the PTSD she was dealing with manifested with horrific nightmares, flashbacks, and suicidal thoughts.
"There's no proactive approach to PTSD. Before I broke, I missed work a lot. My concentration wasn't there, I was scared to come to work, and I was leaving work all the time. You look on paper, and you can see me fall apart," she said. "If you have [stress] claims, maybe every couple years, somebody might look into it, or maybe touch base, and ask how am I doing?"
H. said that one of the biggest hurdles she faced when dealing with WCB is with regards to preferred treatment. According to numerous studies, the use of ketamine on those who suffer from PTSD and severe depression has been shown to dramatically reduce symptoms of PTSD. However, WCB does not cover this type of treatment.
"I was assessed to enter the psychedelic therapy program and I was approved and WCB has fought me on it since day one, even though this is what my doctors say, is the best for me. They refused to help me with the ketamine program, so I ended up doing it and paying out of my own pocket, and it was successful. I haven't had nightmares or flashbacks since February of 2022."
Ben Dille, Workers Compensation Board of Alberta spokesperson, said that while the WCB is closely monitoring the evidence around ketamine as a treatment option for psychological injury, it is still a fairly new therapy.
"There's still significant variability in terms of both its efficacy, but more importantly, the safety of the patients. In certain case-by-case circumstances where we have approved ketamine treatment, it also involves medical consultants; reaching out to the treating physician to talk through why they feel it's the best course," Dille said. "If it is and we have tried other more traditional treatment methods and those haven't been successful, we can certainly authorize it on a case-by-case basis."
Though H. is still in the midst of transitioning back to work and has been doing so for the past two years, she said that initially there were discussions of her reintegrating back into the workforce two months after a suicide attempt that left her hospitalized.
"That's all they care about is getting you back to work. When I was at my most sick, they were very hostile," she said. "We've got so many people off with PTSD and having to reintegrate in and you're just kind of a number, they don't really care. They're following the algorithm."
Dille, the WCB's spokesperson addressed H.'s sentiment, which other first responders also echoed. He said that while the WCB does focus on a return to work as a critical component, he underlined that he believes many of WCB's clients view their own return to work as a milestone in their recovery.
"Most people don't want to be injured. They want to get better; they want to return to some normalcy and redeem some of their independence. So, returning to work is definitely a component of what we do. But it certainly doesn't supersede the health and well-being of clients; that comes first and foremost," he said.
Though H. has sacrificed many things in her life for the profession she loves and has lost many things as a result of her PTSD, she said given what she knows now, she would still choose the career path she did several years ago.
"I love this job. If somebody had told 16-year-old H. that her brain was going to break, and she was going to lose everything, I would still have done this. l still would have been out there and I'm fighting every day to come back."
When asked if H. would have sought help from the WCB after what she encountered, she vehemently said no. However, another first responder, O.'s experiences with the WCB prompted him to speak up and encourage others to seek help.
"I had an overwhelmingly positive experience with WCB."
When O. started having intense anxiety at work, which continued through in his personal life, coupled with depression, he wasn't fully aware of what was happening to him. He entered the first response world when he was 18 working in different branches and like many first responders, the cumulative impact of traumatic calls developed into PTSD. O. has been off of work for over a year and said that all the case managers that dealt with his files at WCB have been nothing but supportive.
"The first [case worker] I worked with was so overwhelmingly helpful and positive and willing. She checked in with me every couple of weeks, asking how things were going and asking if I was happy. They offered resources and even said they can provide weighted blankets," he said. "It was almost as if they were expecting me to have a bad experience and I was just blown away by how helpful they were."
As part of his therapy and treatment, he was meant to have sessions through WCB with both a psychologist and an occupational therapist. However, because COVID-19 was still dictating how meetings were being held, O.'s 12-week-program would be virtual. He did not find success in the initial stages and when he spoke to a colleague who was in a different program, he immediately made his concerns known to his case worker at the WCB.
"'I said I thought I was being underserved here and I'm not doing well, in this program. I told them that they didn’t understand what was happening and they were trying to push me back to work and I was not ready for that at all. They were super supportive of me, and they said you can stop this program. So, they were willing for me to backtrack in order to move forward."
Though O. is slated to start his reintegration to work within weeks, he said that he feels the case workers understand what he needs and what the recovery will look like.
"I was scared that I'm not going to go back to work, and I was scared that the prognosis will mean that I have to find another. Her basic sentiment was, take as much time as it's going to take for you to get well," O. said. "And if it's unsuccessful at the end of it, then there are options for you at that time."
When WCB was posed with the question as to why there seems to be a deep schism between first responders' experiences with filing WCB claims, Dille said that the varying experiences of first responders may be attributed to the complex nature of psychological injury claims.
While O. will be starting his reintegration back into first response, for another first responder A., it is unlikely he will ever go back to work.
"You feel like nobody believes you because nobody can actually see the injury."
When A.'s employer submitted his claim for psychological injury, it would take another year or so of different mental health tests that he would have to go through before his claim was approved.
"You're just figuring out what's happening to you and what has happened to you in the past and then to be put through this period of testing; every question reminds you of what you're going through and every question makes you feel like this is going to be a battle from day one," he said. "You feel like nobody believes you because nobody can actually see the injury. When you break your back, everybody knows you have a broken back; you break your brain and people think you're lying. That's the first thing that goes through one's head, in my experience."
WCB's spokesperson said that whether a claim is physical or psychological, there are two factors that go into the assessment, the first being a confirmed diagnosis, while the second is determining whether the injury or illness arose out of the course of employment.
"For first responders, often their psychological injuries are covered under what's called presumptive coverage and that essentially removes the second part of that equation. So essentially, to get a claim accepted for something like PTSD for a first responder, all we need is a confirmed diagnosis and that process itself is actually quite straightforward," Dille said.
Like H., A. also felt that the question of returning to work wasn't so much a question, as a presumed outcome.
"The support starts quickly but it's not necessarily to get you better, it's to get you back to work quickly."
A. said that in his view, if all case workers were former first responders themselves who have experienced psychological injuries themselves, he believes this would make other first responders not only feel more comfortable but more trusting in the organization.
"Unless you've been through it, you shouldn't be allowed to make any decisions, any judgments or any recommendations, and yes a lot of what they decide is based on what a psychologist says. But there's a lack of trust there because they haven't been through what you've been through."
The WCB explained that the first point of contact with the WCB would be someone from a special care service team. These individuals are often the most experienced case managers. However, Dille said that the idea of having case workers with real-world experience would greatly benefit all those involved.
"We certainly do have case managers that come with experience with psychological injuries and they have prior experience and education in managing psychological injuries. With the special care teams, this is a rapidly evolving field, so part of the education and training they get in is very much ongoing."
Dille added that quite recently their special care service team went through a training program about trauma-informed care, which allowed them to learn from medical professionals who have expertise in the field.
A. said that although it is highly unlikely, he will go back to work as a first responder, he said that the work that he has put into not only understanding his traumas but also learning how to cope with them has been some of the hardest work he has ever done in his life. While A.'s initial start of treatment came in rapid succession, for first responder Y., it has taken him two years of back-and-forth with the WCB to get his treatment covered.
"I couldn't function. I could barely talk; I could barely move."
Several years ago, Y. started experiencing the inability to sleep, haunting nightmares and flashbacks. In July 2020, he responded to a call that was particularly devastating and realized that it was the straw that broke the camel's back. His doctor diagnosed him with PTSD, though he wasn't able to get the treatment he felt was appropriate for him until April 2022. While his initial case worker was anxious to proceed with his case, the second worker, in Y.'s view was not convinced that he had PTSD.
It would take five assessments, with four out of five medical professionals all diagnosing PTSD, that Y. was officially diagnosed.
"I was also told that I had to pick a specific call or a specific date which triggered my PTSD and so when I was trying to find dates to pick; I don't even remember when most of these calls happened. I just know I have nightmares and I can't sleep," he said. "I know I'm depressed, and I'm constantly angry. It got to the point where I hit such a low, that I actually thought the world would be better off without me."
However, as a father to a young daughter, Y. said he continued to fight for the sake of his child, although he claims like H., that if he could go back in time, he would not seek help from the WCB. Like many other paramedics, Y. said that because the traumas first responders suffer are traumatic psychological injuries, injuries that are not visible like a broken arm or leg, there seems to be an undercurrent of doubt and disbelief in those who do report their mental health injuries.
WCB spokesperson Ben Dille said that while the ultimate goal for a claimant is to return to work, progress when it comes to their mental health is hard to measure.
"I don't think there's a simple answer. I think, ultimately, that comes down to the individual themselves and the unique circumstances that they have. I think we find with these types of injuries; it really does take a village to help support someone and make those small but meaningful steps in their progress. There's no black and white answer to that question, but that's the sort of approach that we take."
Data provided by the WCB shows that since 2012, the number of psychological injury claims in first response categories has increased dramatically, with paramedical services having the largest number of accepted claims. According to various statistics from the Centre for Suicide Prevention, while two per cent of Canadians will experience PTSD in their lifetime, it is estimated that first responders experience PTSD 2 times the rate of the average population and that 22 per cent of all paramedics will develop PTSD at some point in their lives.
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