I call to order the eighth meeting in this session of Parliament of the Standing Committee on Public Safety and National Security.
Before we begin, I want to welcome our visitors at the back of the room, who are high school students from Montreal, Toronto, Ottawa, Winnipeg, and perhaps other places. They are here with CJPAC. We promise to be on our best behaviour as you are watching us. Thank you for being here.
We are continuing our study of the issue of operational stress injuries and post-traumatic stress disorder, particularly as they affect public safety officers and first responders. We're continuing with our study, gathering information, and really trying to lay a foundational understanding of PTSD/OSI as it affects public safety officers.
We've invited witnesses to come and share their understanding, from a theoretical or research point of view but also from their clinical experience. On our first panel, we have with us Nicholas Carleton, associate professor in the Department of Psychology at the University of Regina, and Mike Dadson, clinical director at the Veterans Transition Network, from Langley, B.C.
We'll begin with you, Dr. Carleton. If you could take about 10 minutes to give a presentation, we'll go immediately after that to Mr. Dadson. Then we'll open the committee to questions.
Thank you very much for inviting me to speak with you today. I'm a registered doctoral clinical psychologist and professor at the University of Regina. I have expertise in anxiety, trauma, and pain, having worked with traumatic responses for the past 15 years.
My research is supported by the Canadian Institutes of Health Research and the Saskatchewan Health Research Foundation, among others. I maintain a small private practice, primarily treating RCMP officers and other public safety personnel who have PTSD and other operational stress injuries.
Canadians have recognized the need for ongoing dedicated efforts to support our military; our public safety personnel, which include a wide array of personnel, such as police, firefighters, and paramedics; and also corrections officers, 911 dispatch operators, veterans, and their families. As you heard from my colleague, Dr. Sareen, we've come a particularly long way in supporting military mental health, but we have a similarly long way to go in supporting the mental health of our public safety communities.
Our public safety personnel have unique workplace environments, where trauma exposure is the rule rather than the exception. That exposure is different for public safety personnel than for military personnel, not better, not worse, but different. Our public safety personnel are deployed at home in an environment of ongoing uncertainty, often for decades. They have complex roles, such as providing protection, law enforcement, and community development. Accordingly, they require dedicated and specialized resources to ensure their mental health.
I have seen, recently and consistently, exceptional mental health leadership from our first responder communities. Indeed, we are seeing increasing demands from all public safety personnel to provide ready access to evidence-based solutions, interventions, and preventive strategies for improving mental health. The rationale is clear: they are reaching a tipping point. The dramatic increase in reported operational stress injuries is starting to overwhelm the stigma that has silenced so many of these citizens for so long. However, these same citizens have also underscored the need for evidence-based solutions informed by expert research.
Our government has set a mandate to develop a coordinated national action plan on PTSD and other operational stress injuries for our public safety personnel. That mandate was followed by the January 29 national round table on PTSD hosted by our at the University of Regina.
The round table brought together leading researchers with leaders from government and public safety, all of whom supported the urgent development of a coordinated national action plan with a heavy focus on research.
Canadians have an established national mechanism for supporting, coordinating, and communicating health research. The Canadian Institute for Military and Veteran Health Research, CIMVHR, represents a 40-university network and facilitates the development of new research, capacity, and effective knowledge translation.
For the past 18 months, the University of Regina, a founding member of CIMVHR, has been working closely with research leaders from other member universities, international academic leaders, and our public safety leaders to develop a dedicated Canadian institute for public safety research and treatment, to support evidence-based policies, practices, and programming for public safety mental health.
The rapidly developing institute includes a host of academically diverse leaders from universities across Canada. The institute's leadership also includes key representatives from the Mental Health Commission of Canada, CIMVHR, the RCMP, the RCMP Veterans' Association, the Canadian Association of Chiefs of Police, the Canadian Police Association, the Paramedic Chiefs of Canada, the Paramedic Association of Canada, the Canadian Association of Fire Chiefs, and the International Association of Firefighters, to name only a few.
Institute members are already assessing the impact of implementing the road to mental readiness program with Regina Police Service and others, researching formally integrated mental health into policies, education, practices, and support, concluding the first of several program evaluation reports after assessing the evidence base for and the deployment of crisis intervention and peer support programs for Canadian first responders.
Right now the institute is poised to, first, conduct a coordinated national mental health prevalence survey to refine the widely varying estimates associated with public safety personnel.
Second is to conduct a Statistics Canada feasibility study supporting a gold standard epidemiology survey for public safety mental health.
Third is to conduct a pilot study exploring high-fidelity simulated traumas and training scenarios, so that we can empirically and experimentally better understand risk and resiliency variables for operational stress injuries, therein informing traumatic stress procedures.
Fourth is to implement a comprehensive and ongoing biopsychosocial assessment of RCMP cadets and officers using state-of-the-art technologies to evaluate the impact of integrating evidence-based interventions throughout their initial training, during their service, and as part of lifelong learning. The research will be globally and historically unprecedented, providing crucial information about risk and resiliency variables to inform mental health physicians for the RCMP, other public safety personnel, all of their families, and eventually all Canadians.
The institute can also build solutions to help address new challenges in meeting demands for mental health services, such as those recently underscored by the military ombudsman. The solution requires that we do three things: first, ensure patients can and do access appropriate specialists who are correctly using evidence-based treatments; second, support the training and accreditation of more specialists; and third, support research that improves evidence-based care and innovates models for care delivery.
To that end, the institute is also poised to extend work done at the University of Regina on Internet-delivered cognitive behavioural therapy, ICBT, which can increase our access to highly effective, private, popular, and broadly deployable evidence-based treatment as part of a national stepped care system for all public safety personnel. Pending resources, pilot testing for that system in Saskatchewan and Quebec can begin as early as 2017 with pan-Canadian access for our public safety personnel as early as 2018.
The institute can also help to emphasize evidence-based practice. Indeed many public safety personnel appear to be receiving care that is not empirically supported and that is not good enough. Accordingly, members of the institute have worked with the Alberta Paramedic Association to develop new standards for mental health provision for their members. We have also seen efforts to improve mental health care quality and access through the Canadian Association of Cognitive and Behavioural Therapies, which is working to certify practitioners and ensure access to evidence-based care. These are only a couple of examples of people working hard to ensure that our evidence-based practices are made available to those who need them most.
Solutions for public safety personnel inform solutions for all of us. Moreover, they are our community leaders and role models who can facilitate transformations in attitudes and actions towards mental health at a grassroots level in communities across Canada. We have leaders, including all of you, who want to build on the initiatives I've highlighted today.
I suggest that a full and proper response to the 's mandate requires that we do the following: First, invest in the Canadian institute for public safety research and treatment; second, ensure the institute remains at arm's length while engaging federal and provincial governments, academics, policy-makers, and key stakeholders; and third, support ICBT treatments and stepped care clinics that are funded through partnerships between federal and provincial agencies with workers' compensation boards.
The institute can then do four things: first, use evidence to guide a national action plan for research and treatment dedicated to public safety personnel that incorporates leadership from our public safety personnel; second, facilitate cross-sectional and longitudinal interdisciplinary research projects so we can speak with authority about variables associated with risk, resiliency, and recovery; third, develop nationally recognized online evidence-based resources for operational stress injuries to support our clients, their families, and their providers; and fourth, work collaboratively to facilitate pan-Canadian access for public safety personnel to minimum standards of evidence-based prevention, early interventions, and programs for treatment.
We can do better and we must do better. These solutions are no longer aspirational; they are achievable. Working with our public safety personnel as role models in all of our communities, we can develop and proliferate better assessments and better interventions, and engage in preventative strategies that reduce risks, increase resiliency, and improve mental health, first for these critical members of our communities and then for all Canadians.
We look forward to your support. Thank you.
I'm Dr. Dadson. I'm the adjunct professor at the University of British Columbia on the advisory committee for the centre of group therapy and trauma. I'm also the clinical director and the national director of the veterans transition program. As well, I'm a board member of the International Society for the Study of Trauma and Dissociation. I'm an ordained chaplain and I operate a trauma treatment centre and training centre here in Langley, British Columbia, that services about 200 folks a week.
I'm here to speak to the committee primarily as a clinician and through my experience in the veterans transition program. The veterans transition program is a group-based experiential program that's been operating for 18 years. It was researched and developed through the University of British Columbia. In our experience, we have seen the struggles for veterans and first responders in accessing mental health treatment. We see that there are several barriers that prevent them from accessing treatment. We actually would take the view that there are a lot of effective, empirically based, research supported treatments available but that many first responders are unable to access these treatments because the job that they do requires them to operate at such a high level of competency and high pressure that if they begin to crack, show weakness, or ask for help, they're perceived as failing or being weak and unable to continue in their work. Seeking help may pose a risk to their careers. We've seen this regularly with veterans where, even though they are suffering clear occupational stress injuries or even post-traumatic stress, they'll continue to work in their field and they will resist seeking treatments early because they believe that it could threaten their career, where early treatment may actually prolong their career.
They deal with situations that are far outside the norm. They are not only experiencing a single incident or event but they are exposed to multiple traumatic or high-impact stress situations. They often express that, even in speaking to therapists, they fear that they will damage their counsellors because of the horrors that they've seen. The way that these traumatic experiences, or these occupational stress injuries, intersect with the masculine gender role or the masculine expectations of their position, because they're very highly.... The expectations are that they are to behave in accordance with masculine norms, which is that they are strong, hard-chargers, capable, independent, and don't seek help. They're not the lambs, they're the ones who go and actually provide the help. When they need help it's very difficult for them to actually seek help because that contradicts the very culture in which they are working.
The way that the veterans transition program has addressed this is, first, it was developed in accordance with first responders. We met with first responders, we worked with first responders, and we asked them what would help them to be able to address these concerns. We offer a multidisciplinary program that focuses on a strength-based and peer-helping approach. We work in groups and we don't just help or provide therapy for individuals, we show them some very basic techniques and very basic communication skills that can help them support each other. This, in itself, normalizes the experience, which is really important for those first responders because it helps them to recognize that they can still be the warriors that they see themselves to be but they can incorporate the possibility that they also may need help.
They also find it easy to communicate to one another the experiences, the horrors that they've seen, because they know that they've each seen them. They're not saying anything new when they speak in a group to one another. That normalizes their experiences and it makes them available to receive help. We buffer them from the experiences by providing a very caring and supportive environment, which actually reduces the anxiety and the avoidance so they are able to go deeply into their experiences with one another in a shared way. This actually helps them normalize the experience and then do the work that they need to do.
In effect, they challenge one another to do the work because they see that as part of their new battle, or their new career or their new job.
We use de-stigmatizing language. Instead of using language such as “seeking therapy”, we use language such as “trying to drop the baggage” or “just trying to move through a situation”. Instead of talking about emotional experiences, we'll talk about sensory experiences. We'll begin with the body and their physical reactions, and normalize those reactions.
We believe that one of the reasons our program is so successful is that 50% of the folks who are recommended to our program are actually recommended by other veterans or first responders. That means they come in already expecting that they're going to receive some help that's a bit different from what they've seen in the past. In other words, they won't experience the barriers they've experienced.
Here's an example of a barrier for a veteran. For veterans to apply to be treated for PTSD, they need to demonstrate that they have PTSD, which means they need to retell the story several times, again and again, to a variety of folks who have a pretty clinical mindset. They're not there to actually do therapy; they're there to assess whether the people actually qualify, whether they meet the standard for PTSD. Telling the story in this context again and again actually is unhelpful. It creates avoidance, and they actually avoid even applying for help.
We see many veterans who aren't even a part of VAC services, because they can't go through the process. Their injury is a barrier to their going through the process. That means they don't get treatment.
So 50% of our participants have not accessed services from Veterans Affairs Canada. We have a 90% retention rate, which means that, of the people who have gone through our program, very few have dropped out. When they do, it's usually because of family or because of medical concerns. I'm aware of only one person who's dropped out of the program because they decided not to continue on; it wasn't right for them.
We screen participants, so we don't take everyone. If someone is highly suicidal or psychotic, then we're not going to see them in our program. They need to first get some of those things in check. But our program has a high success rate. Not one participant, of over 600 participants who have gone through our program, has committed suicide.
Our concern primarily is that, at this moment, for us, in our program, we have waiting lists across Canada that can mean some veterans can wait a year and two years, depending on their region, to go through our program. Yet if they go through our program, we're confident that the possibility of suicide will be significantly reduced, to the extent that now we.... Our research demonstrates depression has dropped and their suicidality is minimized.
My concern is that, as these folks wait to get through our program, if any commit suicide while waiting to get into our program.... It troubles me to know we could have helped them significantly, and they're waiting to access our services.
We're kind of boots on the ground. We're here to communicate to the committee some of the challenges we see veterans facing as we're working with them therapeutically.
I think that's where I'll conclude.
Sure. I should make sure that I'm very clear about that. I don't think they are experiencing traumas that are beyond what's happening in the military; I think that they're experiencing things very differently.
When we deploy our military to Afghanistan, for example, we're taking them from a safe zone and we are deploying them to an unsafe zone, and then we are bringing them back to a safe zone. There's an important distinction between that framing and what we do with our public safety personnel or our first responders; we deploy them, effectively, to an unsafe zone for 25 or 30 years. They're in a constant state of uncertainty. On day one they might be out for a coffee with someone, and on day two they might be responsible for arresting that person, resuscitating that person, or rehabilitating that person. We're really deploying them to their own communities, which makes for a very different form of exposure.
We're also asking them, as Dr. Dadson said, to experience trauma on a very regular basis. Paramedics, for example, are called out to manage a current and urgent traumatic event, and they're asked to do that day in, day out, sometimes several times in a day. When we consider how that's impacting our first responders and our other public safety personnel, we need to understand that there's a dose-response that's going on there that's much higher than something we would see in most other cases.
With our military, you might see a very extreme, very intense dose-response, for example, during a specific period; but they're brought back to a safe zone that they can believe is safe and is kept safe by our public safety personnel; whereas for our public safety personnel, they're the ones keeping it safe.
I have had some experience with corrections. In our programs, we invite first responders to join, so there may be one or two first responders, and sometimes a corrections officer joins us.
A corrections officer is just like responders in the police or ambulance or fire. Their context is different, so the way the trauma affects them depends on the context they're in.
As my colleague stated for veterans, they're like a blunt instrument. They'll go into a situation and experience something that's horrific and traumatic. They'll do it with buddies, and they'll leave with buddies. That often is a buffer to their experience, because they're a part of a strong community or a pack, where they have strength.
Police officers, though, are a bit different, because they're walking the streets every day and using social engagement as a means of crowd control. They're constantly scanning their environment and looking for a perceived threat, and when they see it, they're actually withholding a blunt instrument response. They're going for something more nuanced. They're using their social skills to try to play down an incident or to keep an incident from erupting into something violent. When it goes violent, it goes violent very quickly, and they then need to jump into a fight-or-flight or an active role of aggression to be able to match the aggression and to be able to restrain or to control the situation.
For firefighters, the context is different. In the same way, for the folks who work in our prison systems, their context is different, whereby that becomes, really, the place where they're living. They can experience things such as inmates who are self-mutilating, slowly trying to take their lives, and trying to torment the guards as they do it. They have to experience that daily and try to provide a measure of care for those individuals as they deliberately try to psychologically injure them.
Dr. Nicholas Carleton: I agree.
I can speak to some of that and to one of the biggest challenges we have right now.
First of all, yes, I think we could be doing more. Second, I think there are some organizations that are working towards those preventative measures.
One of our biggest challenges has been and continues to be that if I can only afford to do a handful of things, and you ask me which things I can do to buy us the best possible prevention, to build the most resiliency, and to reduce the risk, we don't have those empirically supported answers in as robust a fashion as we need for any of us to make those statements.
We can make some general statements for you, but one of the challenges we've seen is that it has been very difficult to engage in prospective longitudinal research, so that we can measure people before they're injured, identify what things are associated with each individual in large groups, and then track them over years and years. Then we could say to you, “This variable was associated with resilience and this one was associated with risk.” This requires a tremendous commitment on behalf of researchers, clinicians, government, and public safety agencies. It's a team effort. It's one of the things that we're excited about being able to begin shortly with our RCMP, because those are critical answers.
That doesn't mean we can't give you generalities. But specifics, so that we can then provide really good information, require investment in long-term research, and that requires big collaborations. That's what we're trying to do and trying to start, beginning this year, so that we can give you a smarter answer, hopefully very soon.
If I could add to that, as my colleague said, it's difficult to achieve and to get the research. One of the reasons that I see for this is that for the organizations—the military, the RCMP, firefighting—their mandate is to serve and protect. For the military, it's “mission, team, self”, with the self coming last. That's embedded in the culture. That's a part of that hypermasculine culture that is necessary in order for them to do their jobs. That is part of the buffer, but unfortunately it also prevents us from being able to go in and gather the research, because it can produce a culture where the focus is not on prevention and recovery. The focus is on getting the mission done or protecting the public.
When veterans, RCMP, or firefighters are unable to achieve or to live up to the same standard, they start to be on the outside of that culture, and that really begins their descent. They've already become injured before they've been identified, but when they can no longer hide the injury, they start to move out of that culture. They start to become alienated from the group that once helped buffer their symptoms. As they move out, you then start to see the effects of the occupational stress injury or the PTSD.
It's difficult for an organization such as DND to research and to protect people from getting occupational stress injuries when their focus and their mandate is on the mission, not on the protection. Obviously, there's life protection, but it's not keeping people from getting occupational stress injuries, because they're constantly under stress: their mandate is to achieve the mission.
What we see for veterans, particularly when they start to move out and often can no longer operate at the same high level of functioning, is that they're given roles or jobs that are far less than what they're accustomed to, and they already see themselves as “out”. Now they're the injured ones, and they're perceived—and seen in the culture—as the injured ones, which actually exacerbates their symptoms. They really need to begin to be treated right at that point, before they can actually leave the military and even apply for VAC assistance. I don't yet see these organizations and agencies being highly invested in helping their people identify their injuries and treating them before they've actually become problematic.
Dr. Nicholas Carleton: If I can, I'll build off what Dr. Dadson said for a moment—
I'm sorry. Go ahead.
Members of the House of Commons Standing Committee on Public Safety and National Security, thank you for the opportunity to appear before you today to share my perspective on this important topic.
My name is Donna Ferguson. I am a clinical psychologist and practice lead at the Centre for Addiction and Mental Health in Toronto. CAMH is one of Canada’s largest mental health and addictions academic health science centres. We combine clinical care, research, and education to transform the lives of people affected by mental illness or addiction.
Post-traumatic stress disorder or PTSD is an important area that we focus on at CAMH. PTSD occurs when an individual directly experiences or witnesses a traumatic event or has first-hand repeated or extreme exposure to aversive details of a traumatic event. PTSD causes a disturbance in social and occupational functioning and in other areas of life. Symptoms include avoidance of traumatic events; intrusive thoughts, flashbacks and nightmares; and increased arousal, including heightened irritability, sleep disturbances, and hypervigilance.
One in 10 Canadians develops PTSD, but the numbers are twice as high in first responders due to the risk of routine exposure to traumatic stressors. Suicide rates amongst first responders are also high. Between April 29 and December 31, 2014, 27 first responders died by suicide. As of March 2015, 40 first responders have died by suicide in Canada. This is a growing and urgent problem that we must address.
How do we make sure that first responders with PTSD get the help they need to become healthy and return to work? We do not have all of the answers, but today I will share with you three recommendations that I believe will help first responders with PTSD on their road to recovery.
First, all provinces need legislation that gives first responders faster access to workplace insurance benefits. Many first responders have had to prove that their work-related traumatic events directly contributed to their PTSD symptoms and diagnosis, which has made it difficult for them to access timely, appropriate care. In February 2016, Ontario introduced legislation that would create the presumption that PTSD diagnosed in first responders is work-related. Removing the need to prove a causal link between PTSD and the work-related event will expedite claims through insurance companies and lead to faster access to treatment and resources. If passed, this legislation would also require employers to implement PTSD prevention plans within the workplace. We need to ensure that all Canadian first responders are covered by similar legislation.
Second, first responders must be able to work in psychologically safe, stigma-free environments. Many first responders have undiagnosed PTSD. Some may be living with the symptoms on a daily basis and experiencing the distress of PTSD, but they are afraid to come forward to their friends, families, colleagues, or superiors for fear of reprisal. They worry that their colleagues will ostracize them and that their superiors will unfairly demote them.
Mental illness is a very difficult topic for people to discuss, particularly for first responders whose occupation requires them to be constantly stoic. First responders are part of a culture that frowns upon weakness. There is a belief that the job comes first and their lives, feelings, and families come second. The expectation comes with a great deal of pressure on individuals who see demise, destruction, death, and carnage on a regular basis. It is difficult enough to work this way every day, but even more so for those with PTSD who are dealing with symptoms of intrusive memories, traumatic events related to work, distressing dreams or nightmares, sleep disturbances, and hypervigilance. It is especially difficult when your colleagues or superiors think you should “suck it up” and get over it.
It is important to create a positive work environment for first responders that prioritizes mental health, addresses stigma, and provides psycho-education on PTSD. Such measures will prevent PTSD from becoming worse, possibly prevent suicides, promote a healthy recovery, and support a successful return to work or maintenance at work. Creating a positive work environment can include having each service work with, for example, the Mental Health Commission standards for a psychologically safe workplace, or even developing an employee mental health strategy that includes providing training in psycho-education with a focus on PTSD symptoms and the challenges related to PTSD.
The following is a case example. A 48-year-old woman was employed as a police officer for approximately 21 years. She was suffering from undiagnosed PTSD symptoms for the first five years of her career. She continued to work with these symptoms, constantly experiencing one traumatic event after another until the final straw. She was faced with a traumatic event after which she felt she could no longer cope and went off work. She saw her family physician who prescribed her medication for her PTSD symptoms and was formally diagnosed with PTSD.
Within a few months her claim was accepted by WSIB, the insurance company, and she was referred to a psychologist in her community for treatment. After one year she returned to modified work on a full-time basis. She was assigned to desk duty and was not allowed to work on the road in her front-line capacity for at least two years. She had a difficult time returning to modified work as she was teased by her colleagues who would constantly play pranks on her. She was also mocked by her superiors and was constantly accused of shirking her duties. They inundated her with most of the paperwork and said it was now her job to do the extra paperwork. This was a very difficult time for her as she lacked the support she needed to get well and maintain work successfully. She was receiving treatment from a psychologist and had been recovering prior to return to work, but now experienced a setback. She was demoralized and her symptoms deteriorated due to lack of support at work.
My third recommendation is that all first responders have access to evidence-based treatment for PTSD. It is important that first responders with PTSD be able to access not only support and treatment but that they be able to access the right treatment to enable them to recover.
Evidence-based treatment for PTSD includes cognitive behavioural therapy, CBT. This treatment is also called prolonged exposure, which involves imaginal exposure, having the client process the traumatic event to assist with reducing the intensity and frequency of intrusive thoughts, flashbacks, and distressing dreams.
The other CBT and intervention is in vivo exposure or what we call real-life exposure. This involves having the therapist help the client to develop a step-by-step ladder or hierarchy of the distressing traumatic situations that the client is actually avoiding while rating the distress levels for each situation and working to reduce the distress level over time.
When a first responder diagnosed with PTSD is able to access these treatments, their chances for successful return to work and productive life are good.
A U.S. study that looked at CBT and long-term outcomes for PTSD indicated that patients who received CBT reported less intense PTSD symptoms and particularly less frequent avoidance symptoms than did those who received supportive counselling.
This is another case example. A 40-year-old male police officer employed for approximately eight years was suffering from undiagnosed PTSD from a traumatic event in which he and his family were threatened by a suspect he had arrested. The threat and alleged stalking by the suspect went on for many months before he began to experience many of the PTSD symptoms mentioned. Finally, after a year, he visited his family doctor and was formally diagnosed with PTSD and prescribed medication for his symptoms. After a few months, his WSIB claim was approved; he was signed off work; and he was referred to me for psychological assessment and treatment. I have been seeing him in treatment, using CBT interventions, in addition to some anger management and social skills training techniques to decrease his heightened irritability, which was one of the main problems for him. After almost a year of treatment, he was ready to begin the return-to-work process, a step-by-step gradual return to modified work initially, followed by a return to his pre-incident role as a full-time police officer.
Since his return to full-time employment, his quality of life has improved. He now has a better relationship with his family. He is socializing again with his friends. His anger is under control, and he's fully functional at work again, even handling some of the issues related to stigma in the work environment. He has been receiving praise from his superiors for his work performance, and he has also told me that the CBT I provided him has saved his life. He is very grateful to me for helping him to resume his life with his family and friends, and to return to an occupation he's very proud of and successful at.
Committee members, thank you again for the opportunity to speak with you today. We are grateful that you are developing a national framework or action plan for first responders suffering from PTSD. I hope that the information and recommendations I have provided will assist you as you move forward with your work.
I would be happy to take any questions.
Thank you for inviting me here today.
I'm here to speak about evidence-based interventions to prevent OSI and PTSD among first responders. My background includes more than a decade of working with first responders, combat veterans, and police, both as a research scientist in two U.S. veterans hospitals and most recently as an academic at the University of Toronto. My research is focused on the health and performance costs of severe and chronic stress experienced by trauma-exposed first responders. I will cover a number of key points and then provide recommendations.
First, operational stress injury and post-traumatic stress disorder are associated with significant health costs, physical disease, and early mortality. My colleagues and I have demonstrated that officers are two and three times more likely to develop chronic health conditions, such as cardiovascular disease, diabetes, and even cancer, when compared to the general population. The U.S. Department of Veterans Affairs data says that the cost of health care for treating a first responder with PTSD is almost five times higher than it is for treating a first responder without PTSD, due to the costs of comorbid physical and mental health treatment.
Second, research clearly indicates that first responders are most likely to develop OSI and PTSD following highly stressful critical incidents in which they are exposed to traumatic material, such as a severely abused child, or when they are forced to use lethal use-of-force options. Yet, during use-of-force training, first responders do not receive adequate training in managing the severe psychological and biological stress responses that do put them at risk for OSI and PTSD.
My colleagues and I have witnessed this first-hand. We've collected thousands of hours of biological and psychological data with first responders, both during their training and in active duty emergency calls. We've collected data on things such as heart rate, breathing, body movements, sensory distortion, fear responses, and stress hormones. Our research indicates that these extreme stress responses actually negatively affect their performance, raising the risk that during a lethal use-of-force encounter they may not use the de-escalation techniques that are available to them and may make a lethal use-of-force mistake. These are directly the types of incidents that are related to getting OSI and PTSD.
Third, scientifically validated resilience interventions for addressing the stress associated with critical incidents in use of force are essential in preventing OSI and PTSD. Science-based methods are the only way we can test that an intervention is working and achieving the intended outcome and worth the financial investment.
Canada is at a critical juncture in deciding the best course of action to address OSI and PTSD among first responders. This committee will be considering the available and proposed interventions with limited training dollars, so it's critical to clarify what we mean by an evidence-based resilience intervention. Large-scale resilience-building programs, originally developed for military personnel, such as the road to mental readiness, have been rolled out in some police organizations. However, there are no randomized, control trial, evidence-based studies showing the efficacy of this for preventing OSI and PTSD among first responders.
An issue is that classroom-based material, as research has shown, is not easily transferred when you're trying to learn motor movement skills in such things as use-of-force training and so forth, so it may be misleading to assume that resilience programs delivered in classroom environments would generalize the use of force and behavioural outcomes in the real world. In fact, our biological objective data show that if we want to reduce the maladaptive stress physiology that is associated with OSI and PTSD, we must intervene directly in the training for these high-stress critical incidents, and this entails use-of-force training.
There are few researchers globally working on evidence-based—meaning randomized, control trial evidence—OSI and PTSD prevention programs. I know of one group in the United States. As far as I know, our group is one of the only ones in Canada doing this type of work. I'll present for you the basics of our program.
First, our science-based method, based on all the objective data we've collected, has shown that use-of-force training and de-escalation techniques are best delivered by use-of-force trainers, not in classroom settings by health professionals or so forth. You get the best buy-in from the actual officers in this very tough environment if it's taught by use-of-force trainers. The topics should be helping officers consider their full range of options, including verbal de-escalation and less lethal use-of-force options, so that encounters do not escalate unnecessarily, leading to potential OSI and PTSD.
Second, we use strategies that maximize how humans form brain pathways to learn new information and retain it. This is critical, because in high-stress encounters, responses result from the most automatic, instinctual reactions. Applying some of our techniques for physiological control during critical incidents can override these natural human responses that block an officer's ability to consider all their use-of-force and de-escalation appropriate options.
Third, training should be personalized and individualized, tailored to the individual officer. In our program, devices for officers were taking advantage of new developments in technology, which can analyze an officer's sensory nervous system readings during highly realistic police training scenarios—events like hostage-taking, school shootings, and calls to distressed persons. It's very important that they are exposed, in training, to these highly realistic scenarios.
When they receive their own information about their own body and their stress responses, the expert use-of-force trainers then can create an individualized use-of-force instruction for them so that they can learn what their triggers are and how to overcome those in the use-of-force situations. Currently training for use-of-force situations is in blanket form. Everybody gets the same. Clearly some officers' needs are not being met in this form. We found this even with the most highly trained tactical teams on the federal level. They still benefited from personalized training. They were less likely to shoot the wrong person, such as a person holding a phone and not a gun. Those are directly the events that lead to OSI and PTSD.
We have recommendations based on this data. We need greater support for scientific evidence-based research and intervention. We need more just-in-time funds allocated for researchers. Currently, grant cycles of eight or nine months are too long. We are missing opportunities to work with organizations that are trying to answer the public's outcry for more police training and end up adopting non-evidence-based training programs. We don't have funding in to actually provide them with evidence-based training.
Second, we need to develop minimum standards for assessing performance outcomes of police training programs in terms of the quality of the training program offered and the value returned for the officers and the public they serve. There are programs available, as I mentioned, but they are not evidence-based. Standards regarding program quality need to be established. Things like evidence, scientific studies, and randomized control trials are critical, as are data from pilot studies. We need funding for large-scale longitudinal follow-up to understand how often and how intensely we need to be training these officers before they have OSI and PTSD, in order to avoid it. There are ever-changing threats in society for police officer safety and wellness. We need to take advantage of the most current technological devices and neurobiology of learning in order to meet these changing demands in society.
Three, we really need to establish a centre for excellence in evidence-based police training. Surprisingly, currently there's no global centre for excellence in police training. By establishing a national centre, Canada is poised to take an international lead in developing the highest quality police use-of-force training and critical incident stress management. Canada can create and export new police training programs, further benefiting the field of law enforcement internationally and building Canada's reputation and goodwill.
Finally, we need to require certification for police trainers and facilities based on high quality standards and best practices.
We recommend that police trainers be required to be certified regularly and to maintain a high degree of current knowledge through continuing education programs much like what is required of health professionals and physicians. There is a cost benefit to doing interventions for OSI and PTSD. A U.S. program, though not as comprehensive as our program currently, did find a 14% reduction in annual health care costs among first responders, so as you can imagine, if it's over $1,000 per year per employee, in an organization of 500 officers, that would be a cost savings of over half a million dollars that could be redirected to police training.