Empowering Ukrainian Armed Forces

The Project Trauma Support Initiative: Empowering Ukrainian Armed Forces’ Psychiatrists and Psychologists in Kyiv – A Look Back

Project Trauma Support recently hosted a transformative two-day lecture series at the Humanitarian Institute of the National Defense University of Ukraine named after Ivan Chernyakhovsky. This pivotal event was tailored for psychiatrists and psychologists within the Ukrainian Ministry of Defense and the Armed Forces, facilitated by our esteemed founder and medical director, Dr. Manuela Joannou, a distinguished Canadian emergency medicine expert with a profound commitment to addressing Post-Traumatic Stress Disorder (PTSD).

Dr. Manuela Joannou shared her insights, reflecting on her extensive three-decade medical journey, with over seven years dedicated to the specialized treatment and rehabilitation of individuals grappling with PTSD. Her focused efforts have predominantly supported Canadian servicemen involved in peacekeeping missions, including those in Afghanistan, as well as police officers and firefighters, benefiting over 800 individuals through our program.

The lecture series began with a poignant moment of silence, honoring the lives lost to the Russian Federation’s armed aggression against Ukraine. Dr. Joannou expressed her deep honor in having addressed the valiant individuals defending their homeland, stating,

“My heart was with you, understanding the adversity you faced. All of Canada stood with you, wishing you safety and health.”

Professor Colonel Vasyl Osodlo, the institute’s head, warmly welcomed Dr. Joannou, acknowledging the exceptional relevance of the course’s subject matter, especially in light of the brutal nature of the unprovoked war initiated by the Russian Federation.

This educational endeavor aimed to foster a comprehensive understanding and effective management of combat mental traumas, stress disorders, and their severest form—post-traumatic symptomatology. It targeted institute students responsible for the Armed Forces of Ukraine’s moral-psychological support and military medicine representatives. This initiative offered an unparalleled opportunity to merge new insights with existing experience, harmonize practices, and enhance mutual empowerment through diverse interaction methodologies. Dr. Joannou’s course was designed to significantly benefit all participants, facilitating the practical application of acquired knowledge.

Emphasizing an interactive educational approach, Dr. Joannou encouraged active engagement from the students, fostering a dynamic learning environment where discussions, inquiries, and shared experiences enriched the educational process.

“Endorsed by the Canadian Medical Association, the curriculum I presented was devised to bolster the participants’ confidence and competence in treating servicemen afflicted with PTSD or moral injuries,” explained Dr. Joannou to the attendees.

The curriculum, introduced by Dr. Joannou, comprised six meticulously crafted modules addressing PTSD, moral and institutional injuries, their interconnections, and strategies for managing depression, anxiety, dissociation, suicidal tendencies, and early intervention techniques. The final modules focused on enhancing resilience to PTSD and moral injuries and tackling compassion fatigue and burnout among healthcare providers and psychologists.

This initiative was organized in collaboration with the All-Ukrainian Interconfessional Religious Christian-Military Brotherhood, underscoring our commitment to addressing the psychological impacts of combat and trauma. Serhiy Lysenko, the Brotherhood’s president, highlighted the ongoing efforts since 2014 to support military and law enforcement personnel through specialized psychological and psychiatric training, drawing on international expertise.

Upon successful completion of the course, participants were accredited with a certificate from Project Trauma Support, marking their enhanced capability to support those affected by traumatic stress. In alignment with our ongoing mission, a similar training program was extended to the healthcare system of the Ministry of Internal Affairs, further broadening the impact of our initiatives.

This collaboration embodied our dedication to advancing the mental health and well-being of those on the front lines, reinforcing our global commitment to trauma recovery and support, and reflecting on this event, we remain committed to our mission of providing continued support and education in the field of trauma care.

Source: armyinform.com.ua
Source: https://armyinform.com.ua/2023/06/12/kanadskyj-proyekt-pidtrymka-travmy-u-kyyevi-navchayut-psyhiatriv-ta-psyhologiv-zsu/
Photos: Volodymyr Polishchuk, ArmyInform correspondent

Resilient Leadership

Resilient Leadership: What We Wish Leaders would Know

Manuela Joannou M.D. CCFP(EM)FCFP
Medical Director, Project Trauma Support

I was having a discussion with a dear, seasoned, and enlightened friend of mine and I was lamenting the state of the world today. There seems to be such division, anger and attack, outrage without investigation, scholarship, or the seeking of facts. Narratives and ideologies that seem to be ironically destroying the very things they purport to promote are taking over the institutions, organizations, and services we rely on for social stability and progress. Few people are willing to stand up and voice their dissent, or to use independent critical thinking to point out what is sometimes the obvious.

“Ah” but my friend replied. “You have to remember that it was at times like these in history that true leaders emerged”. He went on to refer to Winston Churchill and JFK. So that got me thinking…. Where are the leaders? Please come forth now.

For the past 9 years, I have been immersed in studying what has been referred to as “Post Traumatic Stress Disorder” (PTSD) in military members, veterans and first responders, and more recently, front line medical personnel as well. My greatest teachers have been those who were seeking help themselves, those who allowed us into the inner workings of their hearts, minds, and souls to see the impacts of what they had to see and do, and under what types of physical, physiological, and psychological conditions. Truth be told, this work has taken over my life, and I would not have it any other way.

This work has led me to believe that we are not accurately assessing the true scope of what is being lumped together as “Operational Stress Injuries”. Post Traumatic Stress Disorder (PTSD) is only a small part of the story. The symptoms of PTSD are simply the adaptive brain trying to protect against further threat or injury/death. Face it, our nature and evolution has programmed us to survive, at least long enough to ensure the existence of the next generation (hence the rationale for the meme of “Darwin Awards” to those whose unfortunate choices serve to take them out of the gene pool). A diagnosis of PTSD, the disorder, can only be made after a person has been exhibiting sufficiently distressing symptoms to affect their everyday lives for a period of at least 30 days. This is because anyone can suffer from post-traumatic stress. Most are able to process the stressful event, make peace with it, and more or less come back to their baseline level of functioning. Why do we let people fester in that first month without appropriate assistance in finding the right perspectives so that healing can happen quickly, and possibly even provide the opportunity to find new inner resources and perspectives that can lead to more resilience? In my humble opinion, we have gotten it all wrong. Waiting until a person qualifies for a diagnosis of PTSD may serve the insurance industry and dictate whether someone has a viable claim of injury but??? I hope you get my point. Much can be done immediately after a stressful event to help guide a person to healthy processing. A skilled clinician or leader/colleague can identify when someone is slipping into maladaptive thinking patterns that can lead to increased distress and help them to find better approaches.

Another dear friend and mentor of mine, a very wise, experienced, and scholarly psychiatrist has declared her belief that in ten years, PTSD will not even qualify as a psychiatric diagnosis.

We have become only too aware of the fact that it is often Moral Injury and not PTSD that causes the burden of suffering. Our pioneering work exploring moral injury and our novel option of treatment has contributed to a paucity of research in this area.

Much of the distress we have seen in the military members, first responders and veterans that reach out to us, comes from a specific form of moral injury, we now know as “sanctuary trauma”. The form of sanctuary trauma we see most often is when a conscientious, well meaning officer or soldier (could be physician, paramedic firefighter or any front line professional) has been involved in one or more serious incidents which caused great distress, and instead of receiving the support and understanding and even praise they deserve from their place of employment, they are instead met with hostility, reprimand, made an example of, or otherwise in effect “thrown under the bus”. This elicits strong feelings of injustice, betrayal, and anger, and can seriously erode the morale in the mind of the individual, as well as others within the organization.

In truth, sanctuary trauma can come from any person or place that one would normally go to in seeking comfort, solace, and the assurance of their well-being. Families of origin often commit the first sanctuary trauma. Then so can schools, clubs, committees, teams, insurance companies, medical and mental health professionals, bosses, leaders, and command staff. As our society seems to be moving toward increased generalized division and animosity, we look to our leaders, especially our politicians, who in a democratic society are given the responsibility of the final say, to provide our “sanctuary”.

In the case of military and law enforcement, it is not too difficult to find examples of how their respect and authority has been eroded in today’s society. It is getting to where the oath to “serve and protect” means to put oneself in harm’s way for an increasingly hostile, unappreciative, uninformed public. This is being reflected in worrisome difficulties in recruitment and retention in both the military and policing organizations, and who can blame someone for not wanting to sign up for this? I was speaking with another friend who has my utmost respect, who himself is a seasoned law enforcement officer who went on in his career to become a sought after professional mental health expert. His view is that our entire system is heading for collapse, and this might be necessary, as some things are just too broken to be fixed.

So where are the leaders we so desperately need to help lead us out of the current social quagmire? It will take some very unique individuals who are truly resilient, wise and have very thick skin. I do know of some people like this, but most of them are not sure they have the stomach for this any longer. Those with true leadership potential who have their hearts in the right place need all the support and backing we can give them.

In our work, we have defined the characteristics of resilient people. I now propose we discuss these characteristics as they apply to effective leaders who can implement much needed change. Here is my advice to leaders, and a list of “Things I Wish Leaders Would know.”

Remember that when difficult situations arise, your members are looking to you for direction, reassurance, and resolution. What you say and do in these times will define you as a leader. When your team knows they can count on you, they will follow you anywhere.
Resilient people don’t have to know everything all the time. They surround themselves with good people and they engage their team in discussions and ask for input. Resilient people are willing to sit in silence for as long as it takes, to ponder the various solutions and to respond, versus reacting.

Make decisions after carefully considering the facts, and then be strong in your position and your convictions. Don’t just say you are going to do something. Do it!! You will lose credibility and respect as a leader if you don’t follow through. Don’t make promises you can’t keep. One of the greatest compliments any first responder can give to a colleague or leader is that he or she is “solid”. This means showing up and being there for others when needed, not changing your mind, your mood, attitude, or availability.

Having said this, do not be afraid to change your mind or take a new direction if you get new information. Do not become one of those who in effect says “my mind is made up- don’t confuse me with the facts”.

Know that you are always a salesperson. You are selling the idea that people should follow you, respect you, and listen to what you have to say. You will especially need to be a skilled salesperson when you are trying to sell an idea that is not popular or goes against the mandated narratives. If you have done your scholarly homework, come armed with solid facts, and are prepared to address needs and overcome objections, you are a skilled salesperson who will be successful in moving your organization and your team forward.
Resilient people cultivate self-awareness. Be brutally honest as to why you are making the decisions you are making and what is truly influencing you. Are you being driven by unconscious bias? Are you choosing options that benefit you personally at the expense of your team, a member, or the greater good? Are you being affected by your own hurts, vulnerabilities or are you “chasing your own injury”? Are you trying to crowd someone else out because you don’t like them or are competing with them? Are you truly here to help people, or are you really just trying to glorify yourself and ensure your own financial success, status and comfort? There is nothing wrong with being ambitious, but to commit to true leadership means having the honesty to put others before oneself. “Mission, men, me” is the order of priorities in virtuous military spheres.

Also, make a point of educating yourself as much as possible about human nature, mental health, behavioural patterns, personality traits and personality disorders, and how to skillfully deal with all personality types in all types of situations. There is much less mystique to this than you think. Do not undervalue your own “street smarts” that you have accumulated from being on the job. Do not be intimidated by big words, diagnoses, and theories used by mental health professionals. You can learn the important parts of these quite easily. You may know more intuitively than many so-called experts. In my view, emotional and psychological intuition and emotional intelligence should be a must for any promotional considerations.

Some people are not mentally well, and it is important to recognize this and deal with them appropriately. These people can be a danger to your organization. Make sure you give them the attention and the airtime they deserve. Learn to truly listen to them and give them some understanding. Give them the benefit of the doubt and do a thorough search into the validity of their complaints. Allowing someone to feel heard at a crucial time can prevent lengthy, expensive complaints and grievances down the road. Learn some skills to deal with difficult people but develop your own style so that your scripts are genuinely and authentically yours. Whatever you do, do not give an angry, unwell person a microphone and a platform to allow them to spread a message far and wide because it lines up with a narrative you wish to promote. This is where brutal self-reflection means that you have to be honest about your own intentions. Giving a wide audience to an angry person who is not well to further your own agenda is one of the worst forms of exploitation, and it is sadly a practice that has caused much harm in society.

Some people were just not cut out to do certain jobs. We honour people when we believe they can handle the truth. By taking a person off assignment, you may be saving them and others from untold grief. You are responsible for how you give information and feedback, not for what information you have to give or how it is received.

Develop your own critical appraisal skills. Do not allow yourself to be swayed by group think. True leaders have independent thought and creative ideas to solve problems. Very often innovators are targeted for their work, but do not let this dissuade you when you know you have viable solutions to offer. To quote Ethel Kennedy “No one can diminish you without your permission.”

Be aware of times when you are being pushed by the “higher ups” to do and say things that go against common sense and decency. There are usually one of the two following reasons for this. Firstly, it has been pointed out to me by a number of military members and others working in emergency services that those who are in a position to make changes that would benefit everyone may have no motivation to make changes because the system worked well for them and allowed them to advance to their enviable positions.

Another reason is that the organization is jumping to appease “the court of public opinion”. We know that those who squawk loudest get the attention. Our media has come to live by the creed “if it Enrages it Engages” which is a sad state of affairs. So often, strongly negative opinions are voiced and “reported” without much investigation. It appears that there is much outrage and so little attention to facts. Those who understand group mentality know that the masses who are disenfranchised, disgruntled and often without clear direction will go along, because now they have a focus and an outlet for their dissatisfaction, and they have found a “tribe”.  The resulting division and attack is the exact opposite of what we need to heal society today: compassion, connection and generosity of spirit. Much is printed in the media under the guise that “the public has a right to know”. I strongly oppose this view when an unfortunate individual is publicly shamed for doing their very difficult job or has made an unfortunate decision as a result of psychological injury from doing said difficult job that few can or will do. We have strict laws of medical confidentiality and I believe that society has an infinite debt to those who suffer a moral or psychological injury because they are taking hits on the front line so we don’t have to. Yes, taxpayers ultimately pay the price for front line services. But they also pay the price when a front line professional goes off work for a long time, or even forever. And we owe it to the taxpayer to make sure that we have a healthy, sustainable system that can respond to emergencies. If our systems collapses, there will be a state of compromise of personal and national security.

As Dumbledore says to Harry Potter in Harry Potter and the Goblet of Fire:

“Dark times lie ahead of us, and there will be a time when we must choose between what is easy and what is right”. Be brave enough to voice your independent thoughts, even though they may be in opposition to the current popular narrative. Chances are your members are mostly thinking the same things, and they will respect you even more for standing up for them. It may be that going against the grain might lessen your career advancement options or identify you as a target in your organizational hierarchy, but you will like who you see in the mirror.

Stop worrying about how everything looks on the outside. Give up the need to virtue signal and create window dressing. Avoid getting sucked into smoke screen issues that serve to divert attention from the important things. Don’t get pressured into the “Emperor who is sporting the new clothes” scenarios either. There are real issues that need decisive actions. You may not be popular if you aren’t bowing to the court of public opinion, but you will be an effective leader who gets the job done.

You are going to offend some people, but some people are just pre-offended. Resilient people know that what others think of them is none of their business. They don’t care about running in a popularity contest. Their locus of self-esteem is within. Their mission is greater than the agendas of those who want to discredit them.

You don’t have to overcomplicate things by adding extra layers of rules and bureaucracy every time something unusual happens. Nothing is perfect. Recognize one-off incidents as being rare and out of the ordinary, not likely to be often repeated. Allow your members some leeway and independent, case by case thinking. Afterward, you can have an operational debrief, and discuss what went well, what didn’t, and have some collective team learning as a result. Resist feeling that there is a need to add new, complicated rules/policy because of “one offs”. There are more than enough of these already.

Value independent thinking and common sense and support your team in the decisions they make or made. At times in the first responder world, there is no time for hesitation or reflection as rapidly evolving critical scenarios require swift decisions. In these instances, it is important to know that training and intuition becomes the authority. These are to be valued and respected, not only for your own leadership decisions, but also used to validate and support the actions of your team.

Recognize that your team members are often called to make life and death decisions in split seconds with incomplete information. They are doing a job that very few have the courage and resilience to do. Do not scapegoat someone and “make an example of them” in the “spirit of transparency to the public”. This is extremely damaging and demoralizing for the individuals on the team and to the organization in general. It will only mean there are less members willing to take any risks to do their jobs well. This approach of “being transparent to the public” just might result in a public that falsely feels they are “informed” and therefore given the right to criticize from a position of safety. This is a naïve public that may soon become sorely undefended with no one to call when their own crisis arises.

Resilient people practice acceptance and commitment.  If you are in a situation where doing the right thing will cause you to have unjust punishment or be stigmatized, you may realize you are working in a broken system that cannot be fixed. As James Clear writes in his book Atomic Habits, “you don’t rise to the level of your goals, you fall to the level of your systems”. He also writes: “if you’re having trouble changing your habits, the trouble isn’t you, the trouble is your system”.

If you are truly finding yourself in a compromising situation and have done all you can to sell ideas, advocate, and promote healthy change for the greater good, maybe it’s time to make a move and vote with your feet. Beware  feeling trapped in a toxic situation because of seniority, pension, benefits, or status. It is not worth selling your soul, your relationships, your mental health and your wellbeing and compromising your values for the sake of what you have perceived will be a tidy, easy future. There are no guarantees in life. Have faith that there is truth to the sayings “this or something greater still” and “the truth will be known in the end”.

I do believe in Karma. It’s just that sometimes it takes too long.

You might not want to leave a sinking organization because you worry about what will happen to your team. This is admirable, but resilient people know the limits of their influence. Maybe the organization will fill the hole you leave with someone better. Or maybe it will get worse. You have no control over this, and it is not your problem. How long will you allow a broken system to continue to limp along, only because of the risks, sacrifice, dedication, and loyalty of good people like you and your team? Maybe your decision to leave will make your members respect you even more and will give them the courage to do the same and save themselves. Maybe true justice will be served, and effective change will occur when those at the top who make the final decisions are forced to do the work in the trenches because there is no one left.

Maybe then, there will be a scramble to find and call back the true leaders who left.

I in no way want to sound pessimistic. In fact, most people who know me will accuse me of being an eternal optimist. Optimism truly is a superpower. I remain optimistic that cool, sensible heads will prevail, and that there will be some leaders who truly have the solid constitution to stand up for their convictions without being swayed by political pressures.

Be kind, compassionate, reasonable always.

It sounds so simple, but if people attack your reasonable and kind position, by definition they are being unreasonable, unkind, and likely have some ulterior motives that it should not be too difficult to uncover.

Resilient people keep good company. There is strength in numbers. The leaders of the leaders will dare to speak their well-researched truths and will likely find that many others have the same feelings and beliefs but are too afraid to say them out loud. A concerted effort by teams who are on the same page can be powerful. Margaret Mead stated “never underestimate the power of a small group of committed people to change the world. In fact, it the only thing that ever has”.

Finally, Resilient people have a menu of self-care habits. You cannot be all things to all people and take on monumental challenges of change without finding ways to recharge your own batteries. Resilient people get out of their heads. Engaging in exercise, music, some meditative practices, a hobby, or pastime that offers you a “flow state” brings its own intrinsic reward and energy. It makes time warp, allows you to be un-self-conscious for a while, and opens your mind to intuitions, insights and creative brilliance that can provide ideas to inform new and lasting change. Resilient people consider the possibilities…

HOW MANY OF THESE CHARACTERISTICS DEFINE
YOU IN YOUR LEADERSHIP STYLE?

  • Resilient people are willing to sit in silence
  • Resilient people cultivate self-awareness
  • Resilient people know that what others think of them is none of their business
  • Resilient people practice acceptance and commitment
  • Resilient people are kind, compassionate, and reasonable always
  • Resilient people keep good company
  • Resilient people have a menu of self-care habits
  • Resilient people get out of their heads
  • Resilient people consider the possibilities

A Novel Approach to Mitigating Operational Stress

Peer Resilience Coaches: A Novel Approach to Mitigating Operational Stress Injuries within the Emergency Services and the Canadian Armed Forces

We would like to introduce a new entity, the “Peer Resilience Coach” that works in the gap between a peer supporter and a psychotherapist. Service Injury Support Centre has developed this training, which is a 3-day intensive course offered to select individuals who may or may not have had personal experience with Operational Stress Injuries.

The Peer Resilience Coach (PRC) is a uniformed professional (first responder or military member) fully operational within their organization who has undergone this specialized training. Their mission is to interact with their organizations and members, to promote healthy working conditions and healthy coping mechanisms, and to recognize common thinking patterns and situations that lead to increased psychological distress. In the overall objective of managing Operational Stress Injuries, they cover the spectrum from building resilience, through early intervention and assistance with treatment. They work in partnership with the organizational structure, with individuals and their families, and with professional resources as needed.

The ideal candidate for this training is someone who has significant lived experience and has the respect of their peers and command staff alike. The PRCs have demonstrated excellent communication skills and are wise, compassionate and psychologically minded. The candidates to be trained as Resilience Coaches are voted in by their peers and approved by the Chain of Command as well. The benefits of having PRCs working within the organizations include the fact that they can resolve conflicts, improve morale and job satisfaction, and they can prevent the development of significant Operational Stress Injuries (OSI’s). The PRCs are knowledgeable about the resources available to members of their organization and can provide referrals and be a liaison with mental health professionals. They model resilience building attitudes and behaviours. They are aware of how OSIs can occur and how they impact a person. This includes being knowledgeable about the development of Post-Traumatic Stress Disorder (PTSD), anxiety states and depression, and especially Moral Injury and Institutional (Sanctuary) Trauma. They have an advantage over psychotherapists in that they have lived experience and members seeking assistance do not need to explain the culture and/or implications of their operations to an outside clinician. “There is no one that knows the job like someone who does the job”.

In cases of critical incidents that could cause PTSD or Moral Injury, the PRCs can provide group or one on one defusing and debriefing immediately after the danger has passed, before anyone goes home. They are trained to recognize signs that a person may be suffering from post- traumatic stress or burnout. They can also identify when a member might be having difficulty processing an event or might be at risk of developing a moral injury and can help the member develop healthy attitudes and behaviours that can prevent the development of longlasting OSIs.

The PRCs are strategically placed within their teams so that they can get to know the members. They can astutely recognize when there may be family obligations, mental health issues or personality traits that might need some special consideration. They may be able to help to clarify the issues or help a member find resources so that they can remain operational. The PRCs can be serving members of any rank within the organization.

The PRCs themselves will be observant to any behavioural indiscretions or code of conduct violations and will have the backing of Command Staff to address them before they lead to complaints and grievances.

The PRCs help to strengthen morale, build teams, and can be the glue that keeps the platoons working and training together for common goals. They can foster an atmosphere of support, compassion and understanding so that all members look out for each other and are willing and committed to helping each other.

Vision for a Comprehensive Mental Health Support

Vision for a Comprehensive Mental Health Support System for First Responders and Military Members

Manuela Joannou M.D. CCFP(EM)FCFP
Medical Director, Service Injury Support Centre
Founder, Project Trauma Support

 

Military Members for a variety of reasons, which is resulting in an increased number of insurance claims for psychological injuries and prolonged absences from work. This is unsustainable, both in financial terms and in terms of the quality of emergency service available to society. But the real cost is to the affected first responders, who may have their lives ravaged as a cost of being in service. This document will summarize opportunities for improved working conditions and points of intervention where psychological injury claims and absences are decreased, and overall service, career satisfaction and longevity is increased. We propose that more can be done to improve emergency service workers’ and military member’s resilience, and that leadership skill and sensitivity in addressing mental health of their members can be enhanced. There needs to be more recognition that Moral Injury very often causes the burden of suffering and needs to be addressed. Peer resilience coaches can be selected and trained to provide skillful, timely and cost -effective support and early intervention. Likewise, special teams of physicians and other allied health professionals with emergency experience can be trained to provide specialized care with improved cost and effectiveness.

IMPROVEMENT OF THE SETTING:

In assessing the challenges of improving mental health within the emergency first responder services, it is apparent that stigma is a significant obstacle. Emergency Services and Defense organizations must incorporate educational programming for their command staff, new recruits and seasoned serving members to help them better understand the psychological impacts of their operations. This would include education on importance of sleep and healthy lifestyle to counter the effects of shift work and overtime hours necessitated by difficult calls. The concept of potentially psychologically and morally injurious incidents should be explored, and members should be supported in developing their own personal resilience philosophies and strengthening their own healthy coping mechanisms.

Command Staff should be given education on how to be more sensitive to the needs of their members who might be dealing with some psychological as well as physical impacts of their work. Leaders should make a point of getting to know their members well, so that they can notice early signs of difficulty. They should be especially tuned in to recognize that some behaviours that could lead to disciplinary measures could be early signs of PTSD, depression, substance abuse or other signs of mental health impairment. In addition, command staff should have a forum where they can be free to seek help and peer support for themselves without suffering any career repercussions.

The overall culture should be one of support, camaraderie and compassion, reflected through attitudes that foster improved morale, dedication and career satisfaction.

IMPROVEMENT OF THE MINDSET

Members and supervisors alike should get regular training in improving their own mental resilience and should be made to feel comfortable coming forth when they are noticing the early signs of stress.

Their first line of resources should ideally come from their own Family Physician, but they should also have access to carefully selected and trained peer Resilience Coaches, who are colleagues that have lived experience on the job but have had extra training in helping others to examine their own attitudes and thought patterns that can lead to increased psychological distress.

Members should feel comfortable speaking with their immediate supervisors, knowing that their requests for help or special considerations will be met with kindness and compassion. Every effort should be made to give members the accommodations that they need in order to get them back to being fully operational as soon as they are able.

Members should be encouraged to check in with their physicians on regular, at least yearly intervals, and have physical as well as psychological assessments done. If it is felt that members need more extensive psychological care than what the family physician or resilience coach can provide, they should be referred to a dedicated mental health professional.

There should be a team of specially trained mental health clinicians available to work with emergency service personnel. These should have either some personal experience working in emergency fields themselves or have taken it upon themselves to learn as much as they can about the culture of the emergency services, the types of critical incidents first responders may have to attend, and the impacts of such exposures.

Family members of first responders should also have access to educational programs that allow them to be alerted to the first subtle signs of operational stress, and what resources are available to help their loved ones. Many social workers and psychologists are trained in family therapy and can offer good supports to spouses and children of first responders who might be impacted vicariously by a first responder’s work stress.

 

PREVENTION OF OPERATIONAL STRESS INJURIES

If the above measures are in place, much will be done to address the cumulative stress of front- line service. However, the nature of emergency service work means that there will be many critical incidents that could potentially be psychologically or morally injurious. Early intervention with defusing or debriefing can be skillfully provided by trained resilience coaches who have themselves dealt with similar incidents and are trained to recognize the potentially maladaptive thinking patterns that can lead to increased and prolonged distress. This can be done in a group setting, but in some instances, it may be necessary to offer the debriefing in a one-on-one format.

The importance of restorative sleep after critical incidents must be stressed, and it is important to have physicians available who are capable of prescribing sleep medications if necessary. The physicians may also order time off work as indicated in order to prevent long term absences later. Accommodated positions may be necessary for a short term to allow members to recover from difficult calls. If there are disciplinary measures, professional conduct charges, criminal charges or investigations into operations, more psychological support, time off or accommodation may be needed.

MORE DEFINITIVE MENTAL HEALTH INTERVENTIONS

Although implementing all the cultural changes, building resilient teams and providing effective early intervention strategies will go a long way to preventing lasting psychological injury and prolonged absences from work, there will be times when specialized, more definitive care is indicated.

Addiction to drugs and/or alcohol presents a special situation, where a secure, residential facility should be considered. Ideally, there would be a facility available where only first responders attend. In this way, the addiction and any psychological injuries sustained from service can be addressed simultaneously, and participants can feel free to talk about any work-related traumas.

Post Traumatic Stress Disorder and Moral injury can cause significant disability, and when it becomes apparent that short term absence or accommodation is not beneficial, then a more intense program should be considered. We have found that our six day Project Trauma Support residential experiential program offered at the right time can be effective in either keeping a member operational or helping them return to work. Many times, the hurdle that needs to be overcome falls into the category of Moral Injury or Institutional (“Sanctuary”) Trauma, and our program specifically addresses these, as well as PTSD and other Operational Stress Injuries.

Day programming that offers group psychotherapy can be effective and can be combined with a residential program, either before or after.

Longer term in -patient hospitalizations should be reserved for members who are showing signs of severe psychiatric illness, or when there is a need for diagnostic clarity or optimization of the medication regimen.

In special circumstances, where there are refractory cases of PTSD, depression or suicidal ideation, it might make sense to consider some of the emerging therapies with ketamine or Psychedelic Assisted psychotherapy.

SUCCESSFUL REINTEGRATION

Return to work after absence, accommodation or more definitive treatment should be approached strategically with sensitivity to the potential psychologic impacts. Return to work is in effect exposure therapy itself. There should be the availability of resilience life coaches, kind and compassionate leaders, and support from colleagues and peers. There should be regular, ongoing one-on-one sessions with a trusted clinician who can monitor sleep, anxiety levels, effects of any medication, stress tolerance, adaptability, concentration and overall psychological and physical health. Peer support should be made available, preferably through collaboration between the professional association and the employer. Linking with outside agencies and members from other emergency services can often be beneficial. This provides additional supports and the validation that work in the emergency services extracts a toll on the very humanity of an individual. The training, instruments, weapons and uniforms may be different, but the psychological impacts are the same.

Recharge and Re-Engage

Special Service PTS Cohort # 66

Project Trauma Support is grateful to have received a grant from the J.P. Bicknell Foundation which allows us to offer this special program for First Responders and Military Members who are staying on the job in spite of significant operational stress.

Rainbow over a treeWith increasing challenges faced by those who are the first and last defense of our communities and our country, it is imperative that we develop and implement responsive programming that can assist those who hold the lines in a timely and effective manner. Project Trauma Support has developed a novel residential, experiential curriculum that has shown success in helping first responders process their difficult calls so that they can continue to serve solidly with pride.

Since 2016, we have had over 800 first responders, military members/veterans and front-line medical professionals complete our programs.

FRIDAY DECEMBER 1st to WEDNESDAY
DECEMBER 6TH, PERTH, ONTARIO

“YOU DID NOT GO THROUGH ALL THIS FOR NOTHING
and….
YOUR STORY IS NOT OVER YET”

For more Information, see www.projectraumasupport.com or email us
at [email protected]