Understanding PTSD and how to address this in your workplace is integral to PTSD Prevention. To get started on prevention practices you need to:

  • Know PTSD Signs and Symptoms
  • Understand the legal requirements
  • Have basic policies and procedures in place
  • Have defined roles and responsibilities
  • Have incident reporting procedures for staff to follow
  • Procedures to Support Your PTSD Prevention Program Policies
  • Mechanisms for PTSD Risk Management
  • How to Develop and Implement an Anti-Stigma Campaign
  • The Importance of Resiliency Training
  • Implementing your PTSD Prevention Program
PTSD Causes, Risk Factors, Signs & Symptoms

PTSD can develop when someone experiences, sees or learns about an event involving actual or threatened death, serious injury or sexual violence.

Causes

It is believed that PTSD is caused by a complex mix of:

  • Life experiences, including the amount and severity of trauma you have experienced since early childhood.
  • The way your brain regulates the chemicals and hormones your body releases in response to stress.
  • Inherited mental health risks such as an increased risk of anxiety or depression and inherited aspects of your personality or temperament.

Risk Factors

  • Having a job that increases your risk of being exposed to traumatic events, such as first responders, corrections and military personnel.
  • Experiencing intense or long-lasting trauma.
  • Feeling horror, helplessness or extreme fear.
  • Seeing people get killed or hurt.
  • Having experienced other trauma earlier in life, including childhood abuse and or neglect.
  • Having other metal health problems such as anxiety or depression.
  • Lacking a good support system of family and friends.
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.
  • Having biological (blood) relatives with mental health problems including PTSD or depression.

PTSD can increase the risk of other mental health problems such as:

  • Depression and anxiety,
  • Issues with alcohol and drug use,
  • Suicidal thoughts and behaviours.

Posttraumatic Stress Disorder 101 eLearning – CAMH

CAMH PTSD

This tutorial provides basic information about posttraumatic stress disorder (PTSD), including:

  • Signs that someone may have PTSD
  • How PTSD differs from common reactions to trauma
  • How PTSD affects the people who have it and those around them
  • How to respond to someone who has been through a traumatic event.
View eLearning

Signs and Symptoms

Symptoms often start within 1 month of an event or repeated events. In some cases, symptoms may not appear until months or years later. The symptoms can make it hard for the person to live their everyday life and can be accompanied by depression, substance abuse, or other anxiety disorders. Below are 3 types of symptoms associated with PTSD1:

Intrusive Memories

Also called re-experiencing symptoms, these memories can start from the persons own thoughts, or can be triggered by words, object or situations that are reminders of the traumatic event. Intrusive memories include:

  • Recurring, unwanted distressing memories of the traumatic event
  • reliving the event as if it were happening again,
  • Upsetting dreams about the event, and
  • Severe emotional distress or physical reactions (heart racing, hands sweating) to something that reminds you of the event.

Avoidance

Avoidance symptoms may cause a person to change their routine, including avoiding things that remind them of the event as well as negative changes in thinking and moods. This includes:

  • Trying to avoid thinking about the event,
  • Avoiding places, objects, activities or people that remind you of the event,
  • Increased negative feelings about self or others,
  • Feeling emotionally numb or inability to experience positive or negative emotions,
  • Feeling hopeless about the future,
  • Losing interest in activities that were enjoyable in the past,
  • Feeling strong guilt, depression or worry,
  • Memory problems including not remembering important aspects of the traumatic event,
  • Difficulty maintaining close relationships.

Hyper-arousal Symptoms

These symptoms are changes in emotional reactions usually constant and can make a person feel stressed, angry, overwhelmed and “on guard.” The symptoms include:

  • Irritability, feeling tense or “on guard,”
  • Difficulty sleeping,
  • Angry outbursts or aggressive behaviours,
  • Being on constant guard for danger,
  • Feelings of overwhelming guilt or shame,
  • Self-destructive behaviours,
  • Trouble concentrating or sleeping, and
  • Being easily startled or frightened.

What PTSD Might Look Like at Work

PTSD At Work

Each individual will have their own responses and coping skills in reaction to traumatic events, but there are some identified examples of how PTSD may manifest at work, including:

  • Trouble remembering or concentrating on tasks,
  • Difficulty managing time or completing tasks,
  • Feelings of fear and anxiety with usual duties,
  • Unreasonable reactions to normal situations,
  • Anger outbursts and interpersonal conflict,
  • Excessive fatigue and abnormal sleep patterns,
  • Inability to cope with stressful events,
  • Avoiding certain job duties previously performed,
  • Social withdrawal,
  • Increased alcohol use after work,
  • Performance deterioration,
  • Lateness or absenteeism.

When to see a Psychologist or Physician

A person should see a Psychologist or Physician if the symptoms last for more than one month and include experiencing at least:2

  • one intrusive memory symptom
  • three avoidance symptoms and
  • two hyper-arousal symptoms

 

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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Self-Assessment:
Do I have PTSD?


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Understanding the Legal Requirements

Under the Occupational Health and Safety Act employers and supervisors are required to take every reasonable precaution to protect workers from harm. They are also required to inform all workers about psychological hazards on the job and train employees how to prevent these hazards and protect themselves. Workers are required to follow policies and procedures set out by the employer.

Developing Policies & Procedures

Policies and procedures related to address PTSD should align with any existing mental health and wellness program and the organizational values. When you are Just Getting Started the policies and procedures you want to consider developing include:

Organizational PTSD Policy

Sample Organizational Policy

Anti-stigma Policy and Procedure

Sample Anti-Stigma Policy

Developing a Policy Statement

A policy statement outlines the organizations commitment to addressing Post Traumatic Stress Disorder in the workplace and support of the Workers. Ideally it should be signed and dated by the Organizational Leaders.

It should include a statements that outline:

  • Policies, procedures and programs will be established to address PTSD in the workplace.
  • The organization will commit to providing psychological support in line with emerging best practices, or that are known to be effective, to its workers and, in particular, senior leadership support is demonstrated.
  • The organization will commit required resources to establish, implement and maintain the Prevention Plan & Program.
  • Worker participation is important and required in the development, implementation and improvement of the PTSD Prevention Plan & Program.
  • Focus on organizational needs, understand how PTSD fits into the overall workplace psychological health.
  • How the policy will contribute to a mentally healthy and psychological safe workplace.
Roles & Responsibilities

Establishing roles and responsibilities is an important step in Just Getting Started. As you move through Taking Proactive Steps and Implementing Best Practices you may find that you are adjusting and refining your roles and responsibilities documentation.

Senior Leadership Roles

Senior Leadership should:

  • Understand the impact that PTSD, and other occupational stress injuries have on the organization
  • Identify what health and safety programs already exist and how a PTSD Prevention Prevention Plan & Program can be integrated into existing systems. This should consider:
    • Management Training,
    • Employee Engagement,
    • Anti-stigma Awareness,
    • Communication Strategies,
    • Civility and Respect,
    • Critical Incident Response and Management, and/or Peer Support, and
    • Employee Assistance Programs (EAP) or other benefits that support a mental health and wellness program. Provision of enhanced benefits for use of professional psychologist, or psychiatrist services with training in addressing Post Traumatic Stress Disorder
  • Train individuals in strategies for resiliency and health behaviour
  • Identify gaps that need to be addressed using an assessment.
  • Determine how the organization should monitor trauma exposures.
  • Establish policies, procedures, initiatives and services to support the plan and  program and monitor implementation.
  • Set the tone and lead by example, reducing stigma and encouraging conversations and take every reasonable precaution to protect workers.
  • Enforce the policies, procedures and program.
  • Maintain the program, evaluate it and look for opportunities to improve it.
  • Reduce stigma by participating in positive conversations.

Managers and Supervisors

Managers & Supervisors should:

  • Be involved in the workplace assessment and participate in identifying controls.
  • Participate in training to be aware and ready to address the day to day aspects of PTSD prevention and management.
  • Receive training on how to recognize signs and symptoms of PTSD and understand the causes and risk factors and understand how to support workers suffering from PTSD.
  • Participate and contribute to establishing policies, procedures, initiatives and services to support the program.
  • Provide advice on how to monitor/screen trauma exposures.
  • Identify individuals at risk of PTSD.
  • Be prepared through training, coaching or other means to engage workers in discussions about psychological health and safety.
  • Encourage active discussion with workers about mental health and psychological safety.
  • Implement processes to report concerns and provide support to workers in need.
  • Help identify control methods that support PTSD prevention such as workplace rotations for highly exposed individuals.
  • Enforce the policies, procedures and program.
  • Reduce stigma by participating in positive conversations.
Meeting

Health and Safety Committee

The organizations health and safety committee should be engaged in the development of a PTSD Prevention Program.3

To actively participate the committee should:

  • Understand the factors of the job that impact psychological health and safety, in particular PTSD. They should develop awareness about what it is, as well as the symptoms causes and risk factors.
  • Be involved in the workplace assessment.
  • Assist the organization in developing a process for identifying workplace mental health and wellbeing issues, and in particular PTSD.
  • Help identify controls that can be put in place to address psychological health and safety, in particular PTSD.
  • Help reduce stigma related to mental illness by participating in identify needs for education, training, and resources to address PTSD, and participating in delivering these to the organization.
  • Participate in training to enable support of the workforce as required.
  • Engage in the development of a communication plan and strategies.
  • Reduce stigma by participating in positive conversations.

Workers

Workers should:

  • Comply with policies, procedures and program.
  • Participate in training and education about PTSD, and resiliency.
  • Report concerns, incidents to that they can be investigated and addressed.
  • Listen to coworkers and encourage engagement in the program if needed.
  • Reduce stigma by participating in positive conversations.

Unions and Associations

Unions and Associations should:

  • Be consulted about policies and procedures.
Procedures to Support Your PTSD Prevention Program Policies

Establishing Organizational Commitment

Your organization should establish policies and protocols that illustrate commitment to prevention of PTSD and to fostering a culture of support and anti-stigma in the workplace. To demonstrate their commitment, senior leadership should be actively involved in the mental health, wellbeing and psychological safety policies, programs and services. Senior management should also express that the PTSD prevention plan is a vital component of the organization’s Occupational Health and Safety Program across all operations, processes, and procedures. Part of creating a supportive culture also includes allowing for open dialogue between all employees, peers and management. Information should be shared from both the top down and across the organization.

A zero-tolerance policy for harassment and discriminatory practices should be enforced at all levels to demonstrate commitment and support to PTSD Prevention and anti-stigma. Enhanced benefits and wellness may also be considered as they relate to incidents of traumatic mental stress and post-traumatic stress disorder. Additionally, the Joint Health and Safety Committee should be engaged in continuous improvement and evaluate the policies and programs at planned intervals.

Engagement of the Joint Health & Safety Committee

The Joint Health and Safety Committee or Health (JHSC) and Safety Representative (HSR) can play an important part your PTSD Prevention Program. These engagement procedures should be aligned to the role that the committee members or representative play in your existing health and safety program which include:

  • How the JSHC/HSR will be involved in review of the PTSD Prevention Program and make recommendations for improvements to the program
  • Review of training programs for staff
  • Identification and/or tracking of trauma exposures, injury/illness reports
  • Training for JHSC members to ensure understanding of PTSD risk factors and symptoms, including organizational and job factors that impact on PTSD
  • Consulting the JHSC when assessing or modifying the existing program(s)
  • Sharing the results of any organizational assessments with the JHSC
  • Consulting and including the JHSC when new programs or resources are created, as they relate to PTSD Prevention
  • Involve JHSC in the communication strategy of programs and resources to employees across the organization
  • In a commitment to continuous improvement, the JHSC and management should review the programs and policies relating to PTSD Prevention annually

It is important your committee or representative be familiar with what internal and external resources are available as well, as they may be asked by peers or help promote resources. In some instances, the JHSC committee or Health and Safety Representative may also be used as a resource for any concerns or complaints regarding the PTSD prevention program from fellow staff or peers. The Committee may be helpful or required in investigations as well.

Exposure Reporting and Tracking

The organization should establish procedures to collect objective information on exposures to traumatic events so that staff can be appropriately supported, should they begin to develop symptoms acutely or in the months post exposure. In many cases, symptoms may arise as a result of multiple or cumulative exposure emphasizing the need for proper tracking.

Orientation and Training

As part of your PTSD Prevention Program, you should incorporate PTSD Awareness and Anti-Stigma Training for all employees. This training should include general mental health information for employees about signs and symptoms of mental health injury including PTSD, distress, and reduced coping, what to do if they recognize these signs and symptoms in themselves or a coworker, and how to seek help, both internally and externally. Post-exposure education is significant as it may include techniques to manage PTSD, organization specific return to work policies and procedures, roles and responsibilities, and other peer support or counselling options that are available. Additionally, PTSD Awareness training should include anti-stigma training, such as how to support open dialogue, dispel myths about PTSD, frame help seeking as adaptive, and increase awareness in order to decrease the amount of negativity and prejudice as it relates to PTSD.

You may also want to consider additional training for all managers and supervisors so that they are able to support their staff and answer any questions when implementing the Prevention Plan. Other aspects to consider when creating PTSD Awareness training include the frequency of training, type of delivery, and timelines for completion.

Risk Management

There is limited research on the sensitivity and specificity of using any potential marketing for identifying individuals at risk for PTSD and there is no guide for the employer to reliably identify an employee as high risk. According to research the most appropriate way to identify risk is to focus on those individuals who have risk factors (prior history, repeated exposures to trauma, observed changes in performance or an increase in difficult interpersonal reactions) (Alexander & Richard, 2007). Procedures should be established for monitoring and offering the opportunity for mental health assistance.

Screening

Based on the type of work that first responders do and the potential for high exposure to traumatic events, establishing “routine” screening protocols, rather than just voluntary, is extremely important. It is recommended that more formal screening take place immediately for those in high distress or not functioning, at one month for those exposed and at risk, as well as 6 months following exposure to identify those with slower onset of difficulties.   Those symptomatic should be referred to appropriate mental health resources.

Recovery and Return to Work Procedures

The organization should identify roles and responsibilities related to recovery and return to work within the organization. This could include mechanisms for referral to psychological support, Employee Assistance Programs or Community supports.

Resiliency

Resilience is the ability of a person or organization to successfully adapt and recover after stress, adversity, or trauma. Resiliency is important for both an individual and an organization as it helps to maintain balance during a stressful time or event, and in some cases, can help protect from the development of mental health issues such as post-traumatic stress disorder.

Additionally, resiliency in both an individual and an organization may have other desired outcomes such as improved performance, lower rates of absenteeism and presenteeism, a reduction in substance abuse, increased involvement in work, community, or familial activities, and increased physical and mental health.

Achieving resiliency requires commitment from senior leadership of your organization and should build upon the organization’s existing values and culture. Moreover, a commitment to continuous improvement is essential in achieving and maintaining organizational resiliency. This may be done through the inclusion of, and program evaluation by, the Health and Safety Committee or Representative.

Resiliency Training

As part of your organization’s commitment to PTSD Prevention and Recovery, you should incorporate resiliency training for all levels of the organization. Resiliency training should include an overview of what resiliency is and why it matters, information for reducing arousal symptoms, techniques for managing distressing emotions, and preparing for a crisis. Additionally, understanding the risk factors, such as severity of exposure, should be included in training so that first responders are able to understand how resiliency is related to prevention of PTSD.

Mechanisms for PTSD Risk Management

Risk Management is an important component of a PTSD Prevention Program. This involves:

  • Identifying exposures to potentially traumatic events
  • Assessing the impact of the exposure of those events on individual staff
  • Monitoring or screening staff on a routine and continual basis (immediate, 1 month, 6 months, ongoing) for signs and symptoms of PTSD
  • Implementing PTSD intervention strategies which include provision of psychological support in line with emerging best practices that are known to be effective, this could include use of a psychologist or psychiatrist trained in addressing PTSD, peer support programs, substance abuse and suicide risk support, family and community supports, etc.
  • Evaluating the effectiveness of the programs
  • Learning from the organizations experiences and adapt the program for continuous improvement.

PTSD Risk Management

Risk Management and Mitigation Strategies

Research has identified mechanisms which organizations can use to support risk management and mitigation. These mechanisms include:
• Implementing duty rotation so that there is an opportunity for staff to restore a normal pattern of behaviors and reduce psychophysiological arousal
• Training supervisors to detect and anticipate adverse outcomes of exposures to traumatic events. When staff behaviors indicate possible signs of PTSD, the supervisor should recommend a health assessment
• Implementing a routine screening protocol for all those exposed immediately after exposure, at 1 month and again at 6 months. At any time individuals who are exhibiting signs of stress injury they should be immediately referred. Research indicates that screening is more likely to be successful if it leads to the provision of support and treatment. Screening should be supported by preventative health messages and organizational support/peer support and not just a voluntary option.

How to Develop and Implement an Anti-Stigma Campaign

It is important that your workplace promotes awareness of mental health and PTSD and helps to counter the stigma and discrimination that can be associated with these illnesses. A campaign is a series of activities, initiatives and policies developed to support education, awareness and improvement related to a defined topic. Implementing a campaign that reduces stigma and promotes a healthy workplace can have many benefits for a workplace including:

  • Improved productive, moral and employee satisfaction
  • Improved staff retention and co-operation
  • Reduced medical leave and staff turnover
  • Reduced absenteeism and presentism
  • Improved engagement and loyalty to the organization

People who are being stigmatized because of PTSD may be subject to disrespect, exclusion, ridicule and excessive scrutiny, which can negatively impact both work and home life. Attitudes and actions that promote stigmatization include:

  • Promotion of stereotypes of people with mental health/PTSD
  • Trivializing or belittling someone who is suffering from PTSD
  • Using insulting language with someone who is suffering from PTSD (i.e. describing them as crazy, lazy, faker, etc.)
  • Patronizing someone suffering from PTSD by treating them as though they are not as good as other people
  • Excluding them from opportunities for alternative work or promotion

Stigma is real and defined as “the negative and prejudicial ways in which people living with mental illness are labeled. Stigma is an internal attitude and belief held by individuals, often about a minority group.” (Workwell, Canadian Mental Health Association Ontario, & The Dalla Lama School of Public Health)(Mental Health Commission of Canada, 2013) Self-stigma, which is just as common, is defined as being embarrassed about having a mental illness and can often result in someone not seeking help because of feelings of shame, guilt or inferiority and a wish for concealment. Some of the resulting outcomes of being stigmatized include:

  • Delay in getting access to treatment, which can impede recovery
  • Weakened social support which impacts ability to interact with other people
  • Reduction in quality of life/quality of work-life
  • Lower self-esteem

Below are some steps that you can take to develop and implement an Anti-Stigma Campaign within your organization.

  1. Understand how PTSD and mental illness is currently perceived in the workplace, what needs exist, what supports exist, what is the current experience, what are currently held myths within the workplace (I can’t work once I’m diagnosed, PTSD is a sign of weakness, etc.).
  2. Identify key messages for staff, family and friends and the broader community and how you can engage families and friends of your employees and the broader community to help promote awareness and encourage conversations about PTSD and mental illness .
  3. Identify existing staff communication channels and how they might be used to promote ongoing awareness and education about PTSD and mental illnesses.
  4. Evaluate your campaign and identify what steps need to be taken to continue improvement in the organizations culture towards PTSD and mental illness.

Understanding how Mental Illness and PTSD is Perceived In the Workplace

Before you can run an anti-stigma campaign in the workplace you need to understand the current state. Information about how PTSD and other mental illnesses are perceived in the workplace can help to open conversations and build a strong foundation for a successful program. One tool you can use to assess the workplace mental health culture generally is the OHCOW Mental Injury Toolkit resources (insert link), another is the sample survey below. This survey has been adapted from MHCC Opening Minds Survey for Workplace Attitudes (Mental Health Commission of Canada, 2013) It can be used by your workplace to understand the current workplace attitudes towards PTSD which can then inform an Anti-Stigma campaign.

The survey should be administered anonymously. When it is complete you should review with the JHSC or HSR as well as the Sr. Leadership to determine how the information can be used to inform your organization wide Anti-Stigma campaign.

Prevention Plan Building Block: Sample Survey

Download Sample survey you can use to assess how PTSD is perceived in the workplace.


Download

Identifying Key Messages for Staff

It is important for your workplace to identify some key messages for staff so that they understand what PTSD is and how they can support one another in the workplace. To be successful in your communication efforts you need to make sure that the information is heard and understood. Think about who in your workplace should help develop the key messages, what information is needed to development the messages and where you will go for information.

It is important that these key messages are actionable and resonate with employees. To develop these messages look at the results of your workplace survey and determine how as an organization you would like to shift or change attitudes and beliefs. Questions you can use to develop your key messages include:

  1. Why does addressing PTSD matter to our workplace?
  2. What specific items from the workplace survey would we like to address? Which is the priority? By when?
  3. What does success look like? How will/should each of the items be addressed? How will we know if we have been successful – what are the indicators?
  4. Why would staff care that these items are addressed? What are their motivations, needs, behaviours, challenges, pain points and goals and how does this impact how they receive the message?
  5. What should be addressed next?

Identifying Key Messages for Families and Friends

Plan specific communications for family members and friends of your employees that help them understand PTSD signs and symptoms and the steps that the organization is taking to reduce stigma at work. Explain your organization’s PTSD Prevention Plan and share how they can specifically support the plan and the anti-stigma efforts. It is important that family members have the opportunity to understand the supports available to them and their loved ones from the organization. Promote open dialogue with family and friends as they play a key support in identification and support for employees who experience PTSD.

Sharing the Anti-Stigma Campaign

Once you have your key messages identified, you need to determine how you will share the message. It is important when you are selecting how to share the message that you take into consideration the audience who is receiving the message, where they need the information and when they will need it. You may need to tweak the message to meet the needs of various audiences and have it reviewed by an advisor knowledgeable about PTSD in advance (Peer-support leader/health professional). Some examples of methods of communication you could use include:

  • Briefings
  • Team meetings
  • Newsletters
  • Posters or other communications in the lunch room
  • Letters to employees or family members
  • Websites

Evaluating an Anti-Stigma Campaign

To evaluate your anti-stigma campaign, consider what you defined “success” to look like when you were building your campaign. Identify what the specific indicators are and how you will collect data or information to assess the impact of the key messages. Indicators to consider include:

  • Has there been a shift in attitudes and opinions? (can be captured through re-administering the organizational assessment)
  • What communication channels seemed to be the most effective? Can you count the times the channel was accessed/referenced/used?
  • Were different communication channels more effective for different audiences?
  • Are there specific case study examples, initiatives that came about as a result of the Anti-stigma campaign (integration into team meetings)
  • Is there a sense in the workplace that there is more open dialogue about PTSD, how to access help, etc?

1. Mayo Clinic, 2016. National Institute of Mental Health, 2016.
2. National Institute of Mental Health, 2016.
3. Great West Life Centre for Mental Health in the Workplace, 2005.