An important part of developing intervention strategies for PTSD is anticipating possible traumatic exposures and then planning how these things might be addressed in your organization. Here are a few things that you may need to consider:

How to Respond to Signs and Symptoms of PTSD in a Worker

It is important for Managers and Supervisors to understand how to appropriately respond to signs and symptoms of PTSD. As part of the workplace Prevention Plan you need to specifically outline the expectations of managers and supervisors when these signs and symptoms present themselves in the workplace. Some tips on how Managers and Supervisors can respond to a worker in distress include:

  • Keep the communication lines open with the worker and ask how you or other team members can provide support, if the worker is not ready to talk wait for them to open up. If they do start to share, do not interrupt, it is often difficult for people with PTSD to ask for help, particular if they feel that they will be stigmatized.
  • Deal with signs and symptoms directly and as soon as possible. If you recognize signs and symptoms it is best to open the dialogue and provide support so that the worker knows they can come and talk to you. It may be difficult for them to open up.

Learn how to recognize signs and symptoms.

  • Provide information about the options the worker has to address PTSD. Help the worker access support and help resources, if they request or need assistance.
  • Encourage the worker to talk to someone they trust about what has happened, this could be team members identified in the workplace to provide peer support, family members, friends, or a Manager/Supervisor.
  • Share with the worker that what they are experiencing is a normal reaction. Provide information about signs and symptoms and when they should speak to a professional or seek additional help.

Early Intervention and Screening Protocols

While some people may recover from an exposure to a traumatic event, others may develop chronic problems over many years. Your workplace may want to implement regular screening protocols based on the type of work or exposures your workers may be experiencing. First Responders, as part of their job, are exposed to traumatic events. Many individuals in these environments may suffer both short and long term effects as a result of their exposure to the traumatic event.

Screening protocols can help identify workers who are potentially at risk of developing PTSD. For individuals who are exposed to a traumatic event, some evidence suggests that screening should be given at 1 month following the event. Early intervention is important for effective treatment and the severity of the initial traumatic event should be considered when determining the need for early intervention.

Below is a sample screening protocol1 that you may want to consider for your organization:

sample screening protocol

Self Assessments and Screening Tools


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The Canadian Institute for Public Safety Research and Treatment (CIPSRT) has additional screening tools available including Anxiety, Depression, Stress, Panic Disorder, Risky Alcohol Use and Social Anxiety Disorder. These tools are anonymous and help to identify symptoms. They are intended to help increase awareness and educate and are not designed to provide a clinical diagnosis. The results let you compare your responses to previously published responses from the general population or other public safety personnel. Your responses are not recorded and there is no person monitoring the screening tools to provide support. If you need assistance you can anonymously email your results to yourself and take that information to an appropriate healthcare provider such as a psychologist or Physician. To access these screening tools:

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Family and Friends Engagement

Sample Family and Friends Program

Establishing a Screening Protocol

Sample Screening Protocol Program

Screening

Health screening is a well-established strategy to promote early detection of illness in at risk groups. Screening for common psychiatric disorders, such as PTSD, can significantly improve rates of diagnosis and reduce time to appropriate treatment, thus overall improving outcomes. Considering the risk for repeated traumatic exposures with First Responders, screening for signs of psychological injury is strongly supported. Those at risk for suicide and other serious mental disorders would also benefit from early and sometimes urgent intervention.

Mental health screening should be offered to all staff in all sectors who may be suffering from a mental health illness including PTSD. Screening should be available for all staff, who have been exposed to traumatic incidents and may be suffering from work-related PTSD.

The following protocol is recommended for employers and occupational health departments:

  • Identify employees that have been exposed to serious incidents, a repeated number of events or who are distressed as a result of any traumatic incident.
  • Once identified, occupational health or other trained staff can deliver by phone or in-person, a screening instrument or protocol.
  • This would serve to identify symptomatic individuals early in the course of and those who develop progressive symptoms of PTSD.
  • Those individuals who screen positive based on a fixed cut-off score would be referred for further assessment and treatment if indicated.
  • Screening should be conducted within 1 month and at 3 and 6 months after serious or repeated exposures.

A positive response to a screen does not necessarily indicate that an employee has Posttraumatic Stress Disorder. However, a positive response does indicate that an employee may have PTSD or trauma-related problems and further investigation of trauma symptoms by a mental-health professional may be warranted.

Specifically for PTSD, several screening methods have been developed. In general, a good screening instrument for PTSD would be brief, sensitive and reliable, consistently identifying those with potential symptoms. Screening tools are not intended to provide a diagnosis, but will help identify those who may require further assessment.

Screening models such as online mental health screening, in-depth mental health screening or routine mental health “check-ups”, or Primary Care (PC-PTSD) screening may be used. The screens do not include a list of potentially traumatic events, which should be tracked, conducted, and maintained by your organization’s Occupational Health and Safety Department.

Occupational Health professionals should be aware of and have access to validated screening tools for PTSD and other mental disorders. They should be trained in how to identify those at increased risk for PTSD, suicide and other mental disorders and refer to appropriate mental health professionals in a timely manner.

The Screening Program should also be re-evaluated annually by Occupational Health professionals and your JHSC to ensure screening is being consistently performed and those screening positive are seeking assessment and treatment.

Important Messaging for Workers about What to Expect

Traumatic events can be very difficult to understand. You can use the following tips to help communicate with all workers, supervisors and managers how to manage their own feelings before, during or after a traumatic event. These tips come from SAMHSA’s (Substance Abuse and Mental Health Services Administration) National Mental Health Information Centre, and are designed to help civilians who volunteer during disaster relief, however the tips are relevant to all traumatic events.2

  • No one who sees a traumatic event is untouched by it.
  • It is normal to feel sadness, grief and anger about what happened and what you saw.
  • It is natural to feel anxious about your safety or the safety of those who are important to you.
  • Acknowledge your feelings, it will help you move forward more quickly.
  • Everyone have different needs and different ways of coping. This is normal.
  • It is healthy to reach out for, and accept help if you need it.

After the Event, Minimizing Stress for the Worker

An important part of managing the crisis is helping your workers minimize their stress when they return to work. You may want to consider the following actions when you are developing your Prevention Plan.

  • Allowing time off for workers who have been involved in the traumatic event.
  • Transitioning workers back into the workplace by initially assigning them to less-demanding jobs.
  • Developing protocols to provide workers with stigma free counselling so that workers can address the emotional aspects of what they have experienced.
  • Instituting debriefing sessions that focus on helping workers put their experiences in perspective and validate what they have seen, done, thought and felt.
  • Providing ongoing education or workshops that provide information on PTSD, stress management and actions workers can take to take care of themselves.
  • Offering group peer support activities.

Learn what are the Return to Work considerations for a Prevention Plan.

How to Respond to A Crisis Situation

Peer Support: Just Getting Started

Having a peer support program in place is a recognized evidence based practice that is utilized in organizations. It is important to remember that while peer support is an important part of dealing with PTSD, it is not a substitute for professional support. This section talks about some of the basics of peer support and how to get a program started in your workplace, recognizing that when you are starting out with your Prevention Plan and Program you may not have the resources to establish a full peer support team.

Peer support is an intervention that leverages shared experience to foster trust, reduce stigma and create open channels of communication for seeking help, sharing information and support resources. The focus of a peer support program is to establish positive coping strategies, using common language which fosters trust and credibility between team members. Following are some of the benefits of using peer support to address PTSD in the workplace:

  • Peer support is focused on the person. It provides the worker emotional and social support from others who share a common lived experience, the experience may not be specific to the traumatic event, but in relation to the job, emotional pain or mental health challenge that is experienced. It is important for those suffering from PTSD to maintain social relationships.
  • Peer support can help workers cope with memories of the trauma through the process of sharing stories and learning how to deal with emotions such as anger, shame, guilt or fear.
  • Peer support provides a focus on hope and recovery.
  • Peer support can help the worker learn how to talk about what is happening to them and support them in seeking help.
  • Peer support team members bring credibility of lived experience they can speak the same language, they understand the organization and how it operates and they know what services are available to the worker within their organization.
  • Peer support builds trust with other people, which is important when addressing PTSD.

The Mental Health Commission of Canada has established Guidelines for Practice and Training of Peer Support which may be helpful for your organization. If you are Just Getting Started, here are some approaches you may want to consider:

  1. Utilizing the Service Chaplain as a source of Peer Support.
  2. Utilizing a volunteer Peer Support Mentor from the Joint Health and Safety Committee. This person should be provided training to help them fulfill their duties which includes:
    • basic skills to be a peer support mentor,
    • listening skills,
    • psychological first aid, and
    • referral options for workers within the organization.

The benefit of utilizing this approach is that this person is already familiar with your health and safety program and they are a member of team. When selecting this person they should be viewed as being a credible resource, are respected by peers and undergo a selection process.

It is important that the peer supporters are monitored so that they feel supported in their role and can get help they need to deal with trauma related experiences. This could include the provision of access to a behavioural health expert, opportunities to improve peer supporting skills, monitoring of their own health and wellbeing.

Suicide Prevention

Suicidal thinking is usually associated with problems that can be treated and resolve with time. The Canadian Association for Suicide Prevention has resources and information to support you, your coworkers or staff such as links to regional distress centres, coping with suicide loss, understanding what suicide is and news and resources.

To access help in your region: https://suicideprevention.ca/need-help/

To learn more about coping with suicide loss: https://suicideprevention.ca/coping-with-suicide-loss/

1. National Institute for Health and Care Excellence, 2005.
2. Occupational Health and Safety Administration, 2016