In Just Getting Started you set the foundation of PTSD Prevention Program, now you are ready to Take Proactive Steps. In this section we will review:

  • 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
Procedures to Support Your PTSD Prevention Program Policies

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

Orientation

Ensure that all staff receive awareness and anti-stigma training so that they understand the signs and symptoms, how to respond to signs and symptoms, organizational policy, roles and responsibilities; identify when someone should see a health professional, how to support open dialogue, hope and recovery, dispelling myths about PTSD, and increase awareness about stigma and mental illness to help identify prejudices.

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.

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.

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.

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.