Bob Baillie barely reacted when he received his dispatch instructions. A paramedic for 13 years, he has responded to nearly every 9-1-1 call imaginable, but he sensed something was different as he approached the lobby of the hotel where a woman had been found without vital signs. “I’m sorry you have to see this,” Baillie recalls a police officer saying to him. Upstairs, his colleague lay dead of helium asphyxiation, a carefully planned method of suicide.
The ride back to base was silent between him and his partner, Baillie recalls, and he felt a profound sense of being disconnected from reality. Baillie had seen firsthand what most paramedics, police officers and fire fighters knew only as rumor: First responders kill themselves in alarming numbers.
A Sense of Urgency
Thirty-nine first responders died by suicide in 2015 according to the Tema Conter Memorial Trust, a Canadian organization that supports first responders with mental health illnesses such as PTSD.
“We’ve already had five first responder suicides this year,” says Director Vince Savoia. According to data tracked by Savoia, PTSD was diagnosed in 60% of those who died by suicide. While all first responders can be affected, two paramedics took their own lives at the end of January, and a sense of urgency has heightened within the paramedic community, where the prevalence of PTSD is highest.
“Some employers are known to terminate paramedics with PTSD, so no one comes forward and asks for help,” says Savoia.
While the stigma around PTSD in the first responder community is improving, Savoia states that treatment options are expensive and recovery is slow. The Trust is advocating for changes to legislation so that mental healthcare is covered by OHIP (the Ontario Health Insurance Plan) and the Workplace Safety and Insurance Board.
Savoia asks: “Why can I go to the ED and get my broken leg fixed, but if I need counseling, I have to pay out of pocket?”
For seven years advocates have been calling for presumptive causation legislation that would make PTSD a workplace injury. “The issue of legislating presumptive causation and funding tools for taking care of paramedics in Ontario is one of our three top priorities,” says Geoff McBride, president of the Ontario Paramedic Association. “It can’t happen soon enough. It is time for people who care for others to be cared for.”
Progress, says McBride, is slow but steady. Through education and popular media, people are realizing that mental illness is like any other illness, like a broken bone. McBride thinks we have reached a tipping point: “It is becoming easier to talk about mental illness among colleagues, but governments need to act.”
Stakeholders Gather for National Roundtable
Politicians seem to be taking notice. Canadian Prime Minister Justin Trudeau has promised to develop a suicide prevention program for the Canadian Forces, and Public Safety Minister Ralph Goodale has a mandate to develop a “coordinated national action plan on post-traumatic stress disorder, that disproportionately affects public safety officers.”
Funding has been promised for PTSD research to the amount of $20 million and in January, stakeholders gathered at a national roundtable in Saskatchewan to discuss solutions.
On February 1, 2016, the Province of Ontario announced a strategy to help reduce the incidence of PTSD and suicide among first responders. Yasir Navqi, minister of community safety and correctional services, oversees first responders in Ontario. “We have all seen the devastating and far-reaching impacts of PTSD on our first responders” he said in a statement, adding that the Liberal government is “sending a strong signal today that we have a comprehensive approach” to ensure first responder well being. That approach has both “preventative and legislative components,” says Minister of Labour Kevin Flynn. While unable to offer specific details until a bill is formally introduced later this month, the Ministry of Labour says it is taking a very “serious look at presumptive benefits.”
Cheri DiNovo, a member of the provincial parliament from the New Democratic Party, says, “Good intentions aren’t what’s needed, what’s needed is action.”
The sponsor of five private member bills over seven years—all of which failed—DiNovo says that PTSD must be recognized as a workplace injury as it is in Manitoba and Alberta. “If the government doesn’t recognize PTSD as a problem, why would employers?” she questions when asked about municipalities terminating paramedics with PTSD.
Less Talk, More Action
Until legislation is passed that facilitates the delivery of mental health services to the paramedics who need it, paramedic Natalie Harris will continue fighting for change. Harris was on the road in 2012 when she was dispatched to a 9-1-1 call for two women who had been brutally murdered. “I was aware that I would see horrible things, but was not prepared for the mental turmoil I felt when I saw firsthand the evil humans are capable of,” she says. Harris became depressed and suicidal, turning to alcohol. The day after she testified at the murder trial, she overdosed and stopped breathing. She spent the next year in and out of hospitals and treatment programs. As part of her therapy, Harris started to blog about her journey. “My blog gave me freedom from the grip mental health stigma had on me,” she recalls. Harris is now a globally renowned advocate for first responders who suffer from PTSD.
McBride is pleased to see politicians holding summits and releasing press releases but remains skeptical.
“We’ve talked this thing to death…what we need now is less talk, more action,” he says.
Harris and Baillie agree. They go to work on the road every day, wondering if the next call will bring trouble for themselves or a colleague.
“We won’t get rid of suicide,” acknowledges Savoia, “but when we peel away the emotion, what people are truly asking for is to be seen, heard and understood. It’s that simple.”
That’s why Savoia offers first responders a crisis line staffed by trained professionals at 888/288-8036. While governments talk about PTSD, DiNovo sits in her Queens Park office, hearing about yet another paramedic who took his own life. “I don’t know what we’re waiting for…how many deaths will it take?” she says.
Disclaimer: Blair Bigham is currently a resident emergency physician at McMaster University and was a paramedic for 10 years prior. No financial or intellectual conflicts of interest.
After a decade working as a helicopter paramedic, Blair Bigham completed medical school in Ontario, Canada, where he is now a resident physician in the emergency department. After completing his Masters of Science at the University of Toronto, Blair worked as an associate scientist at St Michael’s Hospital in the fields of resuscitation science, knowledge translation and patient safety. He has authored over 30 scientific articles, led major national projects to advance prehospital research, and participated in multiple collaboratives, including the Resuscitation Outcomes Consortium. He has taught and mentored clinical and academic paramedics and loves his new role teaching medical students. He serves as a volunteer on the board of directors for the MedicAlert Foundation of Canada and is a task force member for the International Liaison Committee on Resuscitation. Blair has signed his organ donor card; have you? E-mail him at firstname.lastname@example.org; follow on Twitter @BlairBigham.