Correctional officers calling for presumptive PTSD coverage across Canada

Late in the evening of Dec. 25, 2011, families across the country were cosying up by the fire and getting children ready for bed after a Christmas Day filled with eating cookies, playing with toys from Santa and enjoying the company of close friends and family. But Joanne Rutley was holding a severely bleeding man in her arms at Millhaven Institution. Another inmate had slashed him in the throat with a piece of a broken TV screen.

“Whatever his crime was, at the end of the day, he is a human being and my hand is on his neck and I am not going to have someone die in my hand, literally,” says Rutley, a correctional officer who has worked at the maximum-security institution in Bath, Ont. for 16 years.

The man’s jugular vein let go while he was in emergency, but he managed to survive.

Earlier that year, on March 20, 2011, there was a violent altercation among inmates at Millhaven. Jordan Trudeau was in the midst of brutally stabbing another inmate when he was shot and killed by a correctional officer. Rutley was by her colleague’s side when he pulled the trigger, and she took the rifle away from him. Rutley herself was on guard, ready to shoot, for nearly five hours, she says.

In July 2012, Rutley’s roommate and colleague left for work, but never showed up. Police searched for him for 12 hours and they found him dead in his vehicle.

“He had shot himself in his truck in his uniform. I was the last one to see him alive. I was like, ‘Have a good shift. See you tonight when you get home,’ but I never saw him again. That was rough,” Rutley says.

Shortly after losing her roommate, Rutley went off work and was diagnosed with post-traumatic stress disorder (PTSD).

Rutley is not alone when it comes to regular exposure to traumatic events at institutions and community correctional centres across the country. More than one-half (54.6 per cent) of correctional workers in security and non-security roles report symptoms consistent with at least one mental disorder including: PTSD, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder and alcohol abuse, according to the “Mental Disorder Symptoms Among Public Safety Personnel in Canada” study published in the Canadian Journal of Psychiatry in August. The survey was completed by more than 600 correctional workers across the country, which included a variety of job titles, including correctional officers, parole officers, program officers and administrative support.

But if the survey were to look just at correctional officers, the numbers would be much higher, says Rose Ricciardelli, associate director for community and institutional corrections at the Canadian Institute for Public Safety Research and Treatment and one of the researchers for the study.

“The correctional officer occupation is hands-on all day, every day. Where I think there is still trauma, etcetera, experienced and still stress and caseness experienced among administrative and other sectors and it’s significant and high, I do think that within the institutions it will be higher,” she says. “The stuff that’s dealt with on the day-to-day is much more challenging and the lack of resources in the institution, the strain that is placed on the officers, the expectations… is going to have an effect.”

Of particular concern to the Union of Canadian Correctional Officers is that the rates of PTSD are going up. A 1992 study published in Forum on Corrections Research found 17 per cent of the 122 Ontario correctional officers surveyed “experienced effects severe enough to be clinically diagnosed as suffering from PTSD.” A 2003 survey of 271 corrections employees in Saskatchewan found 25.8 per cent reported “symptom levels of PTSD suggesting a probable clinical diagnosis of the disorder.” In May 2016, Lori MacDonald, assistant deputy minister for the federal Department of Public Safety, said about 36 per cent of male correctional officers have identified as having PTSD.

“I’m not surprised that these rates have increased because of the lack of treatment programs and, to a certain degree, it’s a bit of a new phenomenon… There’s more awareness about this,” says Jason Godin, the union’s national president. “When I started in corrections you used to see violent incidents and you know, ‘Suck it up and go home.’ That’s how the game was played in those days.”

 One reason why the numbers are so high is because correctional officers work in a confined environment, says Ricciardelli, who is based in St. John’s, N.L. They are in the same place, dealing with the same issues and the same people day after day.

“It’s not like you’re a (police) officer and you respond to a call and it’s really stressful. The chances are you can never go back to that same place. (Correctional officers) may cut down a prisoner and prevent their death by suicide and they still have to walk by that cell and check that cell and work in that exact environment. So I expect the degree of trauma to be higher,” she says.

Rutley believes the vast majority of correctional officers will experience a mental health issue at some point in their careers — it’s just a matter of time.

“Eventually, the cumulative events that occur in terms of the violent incidents at work, they eventually erode any healthy psychological well-being that you have. Eventually your bucket gets full,” she says. “There will come a point where they’ve had enough.”

Correctional officers are subject to physical abuse, such as hitting, punching, spitting and having feces thrown on them, as well as verbal abuse, including receiving threats against themselves and their families. They respond to incidents where inmates are mutilated, severely stabbed and bleeding profusely. There have even been cases where correctional officers were stabbed, held hostage, murdered and sexually assaulted by offenders. According to statistics from the Government of Alberta, 33.5 per cent of all assaults in prisons and jails are committed against staff by inmates and in a 20-year career, a correctional officer will be seriously assaulted at least twice.

The recurring exposure to traumatic events such as these can lead to PTSD.

“They are accumulating these traumas and it’s taxing their mental health and it’s not necessarily the big trauma that gets them, so to speak. It might be a bad encounter with a boss; something you and I would look at and say, ‘You’re faking it,’ because clearly this shouldn’t have caused a problem. But it’s because we didn’t understand the framing,” says Nick Carleton, scientific director at the Canadian Institute for Public Safety Research and Treatment, who is based in Regina.

It’s important to keep in mind that there are significant individual differences when it comes to experiencing potentially traumatic events. One worker might develop PTSD, while her co-worker will not.

“It’s really important to not downplay the experience of other individuals,” Ricciardelli says. “What maybe one person can handle, another can’t and we can’t hold a person responsible personally for how they are affected by their experiences. We can’t control it. We can’t turn off our emotions.”

Additionally, the risk can vary based on circumstances for a particular individual. For example, if an individual is going through a difficult time in his life — working long hours, having problems with his spouse or his child is struggling in school — he may be more at risk for a mental health issue than if everything is going smoothly.

“We want to say that it’s suicides or stabbings or fecal fire bombs. We want to say it’s one of these things, but it’s so much more complicated than that,” says Carleton. “And if we isolate it to a specific set of things, we are at grave risk of stripping people of resources who need it or telling people they are sick or potentially sick when they may not be.”

PRESUMPTIVE LEGISLATION

To illustrate the difficult events correctional workers experience that can lead to occupational stress injuries — psychological difficulties resulting from operational duties — the Union of Canadian Correctional Officers produced a compelling 30-minute video as part of its Working on the Edge campaign. The video reenacts real-life scenarios that correctional workers face, including responding to an inmate who had been stabbed, locking themselves in a safe room after a riot, being verbally harassed and cutting down an inmate who hung himself.

As part of the campaign, the union is calling on the federal government to support a national strategy to recognize correctional officers as first responders and give them access to PTSD resources, regardless of where they live in Canada. Workers’ compensation falls under provincial jurisdiction, even for officers who work in federal institutions, like Rutley at Millhaven, which means workers’ compensation coverage for PTSD varies across the country. Some provinces have presumptive coverage, meaning workers do not need to prove their illness was a result of the job; it is just presumed that it is. Others have coverage for first responders only, which may or may not include correctional workers.

Manitoba and Saskatchewan have presumptive PTSD coverage for any worker in any occupation with a diagnosis who has been exposed to a traumatic event at work.

Ontario and Alberta have presumptive PTSD legislation for first responders that specifically includes correctional officers, and Nova Scotia has passed similar legislation that will be in force this fall. Correctional officers in Nova Scotia have submitted more workers’ compensation applications for PTSD support since 2014 than any other profession.

New Brunswick has presumptive coverage for first responders, but this does not include correctional officers.

British Columbia has no presumptive coverage for PTSD yet, but the government has said it intends to present such legislation in spring 2018 (details of the coverage to be determined).

Newfoundland and Labrador does not have a PTSD presumption, but in November, WorkplaceNL initiated a review of its mental stress policy. The goal of the review is to “modernize the approach to work-related mental health issues, including post-traumatic stress disorder.”

Quebec, Prince Edward Island, Northwest Territories, Nunavut and Yukon do not have presumptive PTSD legislation.

Of note, Saskatchewan is the only province to have presumptive coverage for any psychological injury incurred through work, not just PTSD, for any occupation.

When Rutley was diagnosed with PTSD in 2015, prior to Ontario having the presumptive legislation, she could only take six weeks off before she had to go back to work because her claim had not yet been accepted and she had run out of sick leave. But when she went off work again last May, she was accepted right away.

“We are already seeing some good results in Ontario where now that it’s presumptive, if I am diagnosed with PTSD… they are going to get me treatment a hell of a lot faster,” Godin says, adding with presumptive legislation, workers are covered for any relapse they may have.

For jurisdictions that do not have presumptive legislation, correctional officers need to prove their PTSD was caused by their job. Once they get a diagnosis, they submit it to the workers’ compensation board where it can be under review for quite some time. The same process applies to any other mental health disorders that workers have developed over the course of their employment. During the waiting period, the officer is just sitting at home, not getting treatment and “suffering tremendously” — and this is when suicides happen, says Godin.

“The sooner you get the guy into treatment and back to work, the better things are,” says Godin. “The first thing I always hear from them is ‘Geez Jason, I just want to go back to work, but I can’t get there.’”

Godin would like the provinces to get together and agree on what presumptive legislation for PTSD looks like — and for it to specifically refer to correctional officers as first responders. Behind the walls of a prison, correctional officers act as police, firefighters and paramedics.

“We play at least one or two of those roles every single day we walk into work,” says Rutley.

Part of the problem is correctional officers are “out of sight out of mind,” says Godin, which is why the union is working hard to educate politicians on how they are doing all three jobs.

“We’re often the forgotten group,” says Rutley. “(People say) ‘Oh well, Paul Bernardo has been locked away for the last 25 years.’ Nobody stops to think who’s taking care of that guy everyday.”

Nathalie Dufresne-Meek, director general, labour relations and workplace management at Correctional Service Canada (CSC) in Ottawa says the organization is working on getting more coverage for correctional officers from coast to coast.

“We work closely with the Labour Program of Employment and Social Development Canada to engage the workers’ compensation boards to try to make a presumptive clause available to all employees across the country, so that’s certainly something we will keep working on,” she says.

In his mandate letter to Minister of Public Safety Ralph Goodale, Prime Minster Justin Trudeau said he expects the minister to “work with provinces and territories and the minister of health to develop a co-ordinated national action plan on PTSD, which disproportionately affects public safety officers.”

In October 2016, the federal standing committee on public safety and national security issued the Healthy Minds, Safe Communities: Supporting Our Public Safety Officers Through a National Strategy for Operational Stress Injuries report. The report lays out 16 recommendations, including for the federal government to acknowledge the provinces that have already adopted legislative measures that include a presumption of occupational stress injuries for first responders, study those legislative measures and invite the provinces and territories where this is not the case to consider this type of public policy.

R2MR

Originally developed by the Department of National Defence, the Road to Mental Readiness (R2MR) program aims to improve mental health outcomes for employees and reduce stigma. The program has become a training standard in the organization.

CSC worked with the Mental Health Commission of Canada to tailor the training to corrections, so the scenarios are more reflective of what correctional officers encounter.

Employees must complete the half-day program, while supervisors and managers receive a full day of training. The CSC is aiming for all employees and managers to be trained in R2MR by March 2019, says Dufresne-Meek.

While one objective of the R2MR program is to build resilience, another is to destigmatize mental health injuries. Employees are seeing symptoms in colleagues and reaching out to offer support, as well as taking a closer look at their own mental health.

“We have heard some of our employees say, ‘Gosh, I wish I had this a little while ago’ and it has been very helpful for people because people recognize themselves in the mental health continuum and it has urged some of our staff to actually seek support,” says Dufresne-Meek.

Breaking down the stigma around mental health is not easy in this type of industry, so employers and labour unions have their work cut out for them when it comes to shifting the culture.

“We didn’t talk about that 20, 25 years ago. You went to work and did your thing and at the end of the day, you went and had a beer,” says Godin, who worked as a correctional officer for 14 years. “When we saw a violent incident in Kingston Penitentiary, when I started there, the treatment program was the Portsmouth Tavern. That’s what we had.”

Kelly Fagan, deputy director of operations for correctional services with the Government of Alberta would love to see more corrections workers accessing psychological services.

“Guards, most of them, are alpha male and females, so they are always stoic and brave and they never want to ask for help, so sometimes they suffer in silence until it’s too late,” he says. “If you rolled your ankle, you would go see a doctor. If you’re not doing well, you (should) go see somebody who is going to help you.”

The Union of Canadian Correctional Officers is calling for a national treatment centre for first responders. An all-too familiar scenario is a correctional officer shows up for her treatment program in the community and an offender is sitting right next to her, Godin says.

“So you can imagine how difficult this is,” he says. “For us, it’s a private thing. Nothing against the inmate getting treatment, but this is why we need a place to go. I think sometimes our members are reluctant to go for treatment based on those types of circumstances that may arise.”

The centre could also act as a research hub to determine what mental health interventions are effective for correctional officers. As it stands now, there is a wide range of psychological safety programs running at federal and provincial institutions and community correctional centres across the country, but it’s unclear what’s working.

“I genuinely believe there is a lot of potential… but it’s a matter of figuring out what would be ideal in that context,” says Ricciardelli.

The Canadian Institute for Public Safety Research and Treatment has developed an online tool for public safety personnel to screen themselves for mental health disorders. Individuals can complete a questionnaire for various disorders, including anxiety, depression, PTSD, panic disorder, alcohol abuse and social anxiety disorder, and see how they compare to other corrections workers. This is important because a worker could be higher than average for the general population but normal for corrections, says Ricciardelli. The tool cannot provide a diagnosis but it does allow the worker to print the results and take that to a certified professional.

The anonymous and confidential tool can help corrections workers realize they may need to seek mental health support.

“There’s no light that goes off and says, ‘You’re getting depressed.’ We’re the last one to know. It’s gradual, you don’t notice yourself changing,” says Ricciardelli. “This (tool) could suggest that something might be up; go check it out.”

PEER SUPPORT

Many institutions have formalized peer support programs to help corrections officers deal with difficult situations. In Alberta, more than 100 corrections workers are trained peer supporters. These workers may refer their colleagues to the employee assistance program (EAP) or other local resources in their community, such as distress lines, helpful non-profit organizations, support groups or local mental health professionals with a known track record for treating first responders.

“We’re not Dr. Phil. All we can do is we acknowledge and refer,” says Fagan. “It’s just trying to get back that sense of community where we’re all looking out for each other.”

Peer supporters may also be trained to support employees after a critical incident.

Employers need to be mindful of what workers are chosen as peer supporters. In Rutley’s case, she was not comfortable using the peer support program, so she would opt to discuss her struggles with a friend.

It’s important to get a broad cross-section of people for the peer support program, so that everyone can have someone they would feel comfortable talking to, says Fagan.

“It’s like junior high: Your alpha male is only going to talk to your alpha male; your quiet person’s going to talk to that person; the veterans will talk to other veterans,” he says.

RETURN TO WORK

Whether a worker is off on workers’ compensation, short-term disability or long-term disability, a robust return-to-work program can help the employee come back to work when it’s safe and comfortable for him to do so, Dufresne-Meek says. CSC has return-to-work advisors in each of its six regions who provide support to employees and managers and work with the insurance provider and the union to determine the best time for the employee to start looking at returning to work, she says.

Employers might want to try easing workers back in, says Carleton.

“Throwing someone in cold water is not usually a good idea. It’s probably better to grade someone back on: ‘Come back and let’s get you back used to the steps.’ And I would do it with the support of a mental health professional providing the tailoring for that individual because everybody’s different.”

A key component of supporting workers with mental illnesses is following up with them. It’s important that managers call the workers who are off so they do not feel isolated. Fagan notes there’s often a lot of calls at the beginning of a worker’s leave, but then the calls become less frequent. The longer someone is off work, the harder it is to come back, Fagan says, so maintaining regular contact can help maintain the worker’s relationship to the workplace.

“I try to beat the drum: ‘Let’s make sure that nobody falls through the cracks’ and I think the managers have been creating a culture where if a person’s been off, they call them just to see how they’re doing. It’s a simple thing,” he says.

Godin acknowledges it can be difficult to find suitable accommodation for correctional officers returning to work.

“We do our best, but there’s not enough options for us. We are limited basically to what’s inside the institution and that’s a bit complicated,” he says. “We’re always looking for other options.”

As of press time, 50 correctional workers are off work at the Regional Psychiatric Centre in Saskatoon due to work-related stress and injuries, says Godin, so accommodating that many workers is a challenge.

In general, if employers can keep people “working and engaged” then they should do exactly that, says Carleton. For example, when workers in the Alberta corrections system are going through a tough time and they are getting burnt out, they are told to speak up and say they need to work in an easier area for a while, says Fagan. 

In May, an inmate at Millhaven had his throat slashed and it hit a major artery. Blood was splattered everywhere — the most blood Rutley had ever seen — but it was not being cleaned up. Rutley was trying to remain calm and just do her job, but she was required to walk around the blood throughout her shift and it proved to be more difficult for her than expected.

“It was like playing hopscotch throughout the night,” she says. “After eight hours of stepping over this, the blood started to smell and coagulate and then the flashbacks started and the smells; everything started to come back from the shooting in 2011.”

A couple days later when she went back to work, she was put in the mental health unit. She protested and said she did not think she could handle it, but the response was, “Well, everybody has to take their turn,” she says.

During her shift, an inmate who was known for significantly harming himself was literally pulling out his guts.

“At 8 o’clock that morning when we got back from the hospital, I unloaded my weapon, I did everything and I said, ‘Book me off for the next two nights because I’m done.’ That was May 26 and I haven’t been back,” says Rutley. “I can’t go back, the thought of it makes me throw up… I don’t want to deal with inmates, I don’t want to deal with self-injurious harm anymore, I don’t want to see anybody get beat up or stabbed anymore. I am done.”

Rutley is currently taking classes online through the University of Guelph in Ontario for horsemanship. Learning how to trim hooves and perform first aid on a horse has been a welcomed change of pace from the institution. Rutley regularly goes to the country to ride her horse and try out her newly learned skills, something she finds to be a great therapy for her PTSD.

While Rutley doesn’t see herself going back to the institution any time soon, she continues to share her story in the hopes of bringing awareness to the mental health struggles of correctional officers. Looking forward, she would like for there to be less red tape for officers who are trying to get help for their psychological injuries, more support and ongoing care.

When it comes to her own future, Rutley would love to start up an equine business, but she just doesn’t feel up to it quite yet.

“I’ve just kind of suspended everything right now,” she says. “I shouldn’t be feeling like this. It should be everyday I wake up, ‘Yippee! I get to go massage a horse’ or ‘Yippee! I get to trim a hoof’ or whatever, but some days are even hard just to get out.”

This article originally appeared in the February/March 2018 issue of COS.