Horror in Florida School Reignites Debate on PTSD and Workers’ Compensation

Should workers’ compensation provide mental health benefits to first responders who witness traumatic events such as the parkland, FL school massacre? It’s a question being discussed throughout the country following the deaths of 17 people in Marjory Stoneman Douglas High School at the hands of a 19-year-old former student on Valentine’s Day.

• Where do you stand on the issue of WC coverage of PTSD for first responders?
• Have you had workers who have faced traumatic events?
• What are the typical recoveries you see for workers with PTSD?

Florida’s Legislature is debating bills to include mental health treatment for first responders with post-traumatic stress disorder in its workers’ compensation system. Opponents are concerned about what they say could be exorbitant costs to cover a multitude of stress-related conditions which may or may not be caused by the workplace.

In our extensive work with first responders who suffer the psychological effects of such tragedies, we have seen that short-term interventions such as cognitive behavioral therapy (CBT) can be highly effective in helping them deal with these incidents and return to function and productivity. What is most important — and what can keep costs lower — is ensuring these and other workers affected by trauma get help as soon as possible and get the right treatment.

PTSD
Like most states, Florida does not currently provide such coverage unless there is a physical injury associated with the mental condition. Among the issues being debated is the standard that would be used to judge benefits eligibility.

PTSD is defined as a reaction to a traumatic event, a stressor, the victim has experienced, witnessed or been confronted with that involves actual or threatened death or serious injury, or threat to the physical integrity of oneself or others. Additionally, the person’s response involves intense fear, helplessness or horror.

PTSD claims arise when a worker is exposed to a life-threatening event in the workplace, and has persisting symptoms that meet diagnostic criteria. It causes the person to engage in avoidance behavior of any stimuli related to the event, along with a general numbing of reactions. The person may constantly relive the event and have significant deterioration in his ability to function. PTSD at its worst can trigger anxiety, depression, drug abuse, and even suicide.

That said, not everyone exposed to a horrific tragedy develops PTSD, and of those who do, some may have some though not all symptoms. A major determinant is when and what type of treatment the person get. The causality of PTSD is of particular importance in workers compensation claims, since the onset of PTSD-like symptoms is multi-factorial.

Some of the risks for developing PTSD after witnessing a trauma are the same psychosocial factors present in injured workers with delayed recoveries; substance abuse, depression, anxiety, and past trauma.

A study of police officers in Quebec examined risk factors for PTSD. It found that the specific circumstances at the time of and immediately after the trauma play a role in whether a person develops PTSD. For example, those who have strong negative emotional reactions — fear, guilt, shame, anger, disgust or sadness — or physical reactions such as palpitations, trembling, dizziness, sweating, hot flushes or shivering during or right after the event are more vulnerable to developing PTSD.

A key component in traumatic distress associated with PTSD development is the notion of loss of control, whether it is one’s emotions or bodily functions. Also, dissociation, or a detachment and lack of emotional reactivity, is a risk for PTSD.

The severity of the event and the perception of negative social interactions are also major risk factors for the development of PTSD symptoms following a traumatic event. Getting appropriate social support during or immediately after the incident can help prevent PTSD development. Talking to colleagues, seeking psychological help and having time off are key.

Preventing/Treating PTSD
Getting treatment immediately after a traumatic event can mitigate and even prevent PTSD from developing. Victims should be given ‘psychological first aid’ in the days after. In addition to an assessment of the worker’s psychological and physical state, a trained person should also help make the person feel secure by informing them of the possible psychological consequences and giving them tangible, emotional support.

CBT is recommended within the first few weeks following a traumatic event. When provided to the worker in a timely manner, this does not need to be long-term or expensive. In fact, several CBT sessions within two weeks of the event can help people who have acute stress disorder symptoms.

We see the results of this time and again. Proper diagnosis and CBT delivered very soon after a traumatic incident gets the vast majority of workers back to productivity relatively soon. Some need further follow up but will still recover within a few months. Workers who have delayed recoveries following a traumatic event may have comorbid issues that need additional attention.

Conclusion
First responders are much more likely to witness life-threatening events to themselves or others. Research, such as that done on Canadian police can help us develop preventive measures to help them better prepare to face traumatic events. When they do, short term CBT interventions can get them back to functionality quickly.

We’d like to hear from you:

• Where do you stand on the issue of WC coverage of PTSD for first responders?
• Have you had workers who have faced traumatic events?
• What are the typical recoveries you see for workers with PTSD?

Please share your thoughts.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at https://theimcsgroup.com, or http://www.cope-with-pain.com. Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640