Mental health experts question police PTSD compromise [CT Mirror]

May 26, 2015

CT Mirror

A controversial proposal to allow police officers to qualify for workers’ compensation for post-traumatic stress passed the state Senate last week after being narrowed with a key distinction: It would apply to police officers whose mental or emotional problems stem from responding to a death caused by a person, but not those rooted in handling a fatal car accident or any other part of the job.

The distinction might be politically expedient, allowing the bill to move forward after years of unsuccessful efforts. But mental health professionals say it makes little sense and doesn’t reflect the reality of post-traumatic stress disorder, which is defined by how a person responds to trauma, rather than the type of traumatic event underlying it.

“Clinically it does not make sense to narrow the scope of eligibility for workers’ comp on the basis of the nature of the exposure,” said Dr. Harold “Hank” Schwartz, psychiatrist-in-chief at the Institute of Living in Hartford. “One can be as traumatized by witnessing the results of a horrible auto accident as by witnessing the results of a murder.”

Distinguishing between post-traumatic stress stemming from deaths caused by a person and a fatal car accident “doesn’t make good medical sense,” said Dr. J. Craig Allen, medical director of the mental health treatment provider Rushford.

That’s not to say that the underlying event is irrelevant. Exposure to death caused by intentional violence tends to make a person more likely to develop post-traumatic stress disorder than seeing a life-threatening event or accident, said Julian Ford, a clinical psychologist and professor of psychiatry at the UConn Health Center.

And Jason Lang, a clinical psychologist with expertise in trauma at the Child Health and Development Institute of Connecticut, said the type and nature of a traumatic event is one factor – along with severity of violence, exposure to death or severe injury, previous exposure to trauma, among other things – that can affect the severity of a person’s symptoms and impairment.

But Ford said he had concerns about the distinction in the bill. “I see the distinction, but I think it actually has a potential adverse limiting effect on legitimate claims,” Ford said.

Sen. Cathy Osten, a key backer of the bill, didn’t argue with the criticism of the compromise, which she said was the result of whittling down earlier versions to accommodate concerns raised by insurance companies and groups representing cities and towns.

“My goal is broader, but sometimes you have to take small steps,” said Osten, D-Sprague, a Vietnam-era veteran and retired corrections officer and supervisor who has been pushing for three years for workers’ compensation to cover post-traumatic stress in first responders. She said several of her former colleagues did not get the help they needed and took their own lives.

The decision to exclude diagnosed mental health problems stemming from fatal motor vehicle accidents was based on a request by some who thought it would allow too many claims, Osten said.

A previous version of the bill would have included officers exposed to situations in which a person was maimed, but Osten said there were too many questions about how to define it.

“It just created too much additional angst, and I wanted to be able to get some coverage for workers that were experiencing trauma,” she said.

The bill is now pending in the House, where it’s likely to face intense lobbying from municipal groups, which view it as a potentially costly unfunded mandate on cities and towns. The bill also includes a controversial provision that would make it easier for firefighters to claim workers’ compensation if they develop certain cancers. The Connecticut Conference of Municipalities said municipal leaders were shut out of talks that led to the final bill and raised concerns about the process behind it.

When the Senate debated the bill last week, many opponents focused on the potential costs of the new coverage and concerns about the state’s requiring local governments to absorb new costs without chipping in. But Senate Minority Leader Len Fasano, R-North Haven, also took issue with the criteria, questioning why it would cover police who witness the aftermath of a homicide but not those who handle gruesome fatal car accidents.

“Why are we saying that this is important for psychological reasons based on gruesome scenes, and in the same breath, isolating gruesome scenes that we’ve decided are not going to have a psychological effect?” he said. “Either it does or it doesn’t.”

Then Fasano answered his own question.

“We did that because we know if we put them all in, the chances of this bill passing go considerably down,” said Fasano, one of 11 senators who voted against the bill, which passed with 25 yes votes.

Mental health professionals who were critical of the distinction said they considered the bill better than current law or a good first step, even if they see it as too limited.

To be diagnosed with PTSD, a person must have been exposed to a traumatic experience such as a death, threatened death or serious injury, or sexual violence. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders – known as the DSM-5 – which clinicians use to diagnose mental health conditions, includes in that list experiences first responders might face, such as collecting body parts or being repeatedly exposed to details of child abuse.

Symptoms include re-experiencing the event through nightmares, intrusive memories or flashbacks; avoiding reminders of the trauma; negative changes in mood or thoughts, such as feeling alienated from others or losing interest in activities; hyper-vigilance; difficulty sleeping or concentrating; and aggression.

While most people will be exposed to at least one traumatic event in their lives, Allen noted, fewer than 10 percent develop post-traumatic stress disorder.

Whether someone develops post-traumatic stress is the result of multiple factors, experts said. Not all are known, but factors include genetics, resilience and whether a person has been exposed to previous traumas, which can make him or her more vulnerable to the effects of future trauma.

A police officer who experienced three previous traumatic experiences without major problems might go through a fourth that leads to PTSD, Schwartz said, while his partner might go through the same thing but, without the same history, not develop post-traumatic stress.

Schwartz said a more appropriate approach than the distinction in the bill would be to allow eligibility based on the DSM-5 criteria but with a rigorous process for examining claims, such as by requiring two clinicians to agree on a diagnosis and creating a panel of experts to review appeals.

Allen said studies have found that intervening soon after a traumatic experience can greatly decrease the development of post-traumatic stress disorder, and suggested that police departments focus more on earlier interventions. Often, he said, people who are experiencing the effects of trauma don’t recognize their problems as symptoms of a disorder that can be treated, or don’t realize that addressing them early could help to avoid future complications.

“It’s important to understand that there are treatments that are quite effective for post-traumatic stress disorder,” he said.