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.
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 PTSD: 1

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

Self-Assessment:
Do I have PTSD?

Download

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.

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.