Battling Operational Stress Injuries

Ottawa OSI Clinic

Michele Boivin, PhD, CPsych

Jakov Shlik, MD, FRCPC

Operational Stress Injuries

• Psychological injuries caused by combat, law enforcement or other operational and service-related duties.

• Comprised of biological damage to brain systems, psychological damage to beliefs and self-esteem, and social disruption.

• Everyone is affected, some injured, many get better.

The effect of war on the mind

American Civil War -

Soldier’s heart

WWI – Shell shock

WWII – Battle fatigue

Post-Vietnam syndrome

1980 – DSM-III PTSD

“Thousand Yard Stare” 1944

Modern non-medical terms

Combat stress reaction

Combat stress injury

Operational stress injury

Mechanisms of stress injury

Combat/operational stress

Trauma Fatigue Grief

Impact

injury Wear and

tear injury Loss injury

ASD, PTSD Adjustment

disorder

Depression

Anxiety Disorder

Grief reaction

Depression

Nash, PTSD 101

Belief injury

Safety

Control

Moral order

Righteousness

Value of life

Goodness of people

Modern warfare factors

• Peacekeeping stressors

• Advanced technology

• Lethality, atrocities

• Lack of frontline

• Land mines, IED

• Suicide attacks

• Extreme environments

Richard Johnson: sketches from front lines

Suicide

Homecoming

Distress hypervigilance, memories fatigue, insomnia, dreams,

Identity change

Anger and impulsivity

Alcohol and drugs

Adjustment

Family

Loneliness

Work

Health

Society

Leaving the service

Loss of support

Loss of goals

Loss of health

Loss of financial security

Bureaucracy

Civilian life

Operational stress in law enforcement

• Critical incidents

• Cumulative stress

• Exposure to crime and depravity

• Internal and external pressures

Employee well-being within Canada’s Police Departments

• Multiple competing unremitting demands

• Expectations for top performance

• Organizational stressors

• Hindrance to help-seeking

Duxbury L & Higgins C. Caring for and about those who serve: Work-life conflict and employee well being within

Canada`s Police Departments. March 2012

OSI clinical manifestations

• PTSD

• Depression

• Anxiety Disorder

• Pain

• Psychosomatic problems

• Sleep-related conditions

• Alcohol and drug abuse

• Gambling, risk-taking, aggression

• Self-harm and suicide

OSI treatment

• Mental health care

• Social support

• Medical care

• Vocational recovery

• Physical recovery

• Family functioning

OSI Clinic

Mandate:

• Standardized Assessment & Diagnosis

• Empirically Supported Treatment

• Networking & Education

• Research & Program Evaluation

Population

3% 3%

9%5%

12%

59%

9%

World War II

Korea War

Afghanistan

Domestic

High Frequency, Short Duration Deployments*UN Peacekeeping

No deployments

Deployments

Psychiatric diagnoses

15

5

8

12

5

2

67

14

3

10

10

12

69

0 10 20 30 40 50 60 70 80

Other Diagnoses

Pain Disorder

Substance Abuse/Dependence FSR

Subtance Abuse/Dependence

Other Mood Disorder

Bipolar Disorder

Major Depression

Other Anxiety Disorder

Obsessive Compulsive Disorder

Panic Disorder

Generalized Anxiety Disorder

Anxiety Disorder NOS

Posttraumatic Stress Disorder

% of Clients

37

5

7

10

12

13

16

18

18

21

60

63

0 10 20 30 40 50 60 70

Other

Cancer

Respiratory

Diabetes

Migraine/Headac…

Arthritis

Gastrointestinal

Sleep Disorder

Hearing/Vision

Cardiovascular

Chronic Pain

Musculoskeletal

% of Clients

Medical Conditions

30

7

12

16

19

23

30

39

41

42

0 5 10 15 20 25 30 35 40 45

Other

Housing/Moves

Loss/Bereavement

Military Related

Health

Financial

Marital/Romantic Relationship

Employment/School

Social Relationships

Family

% of Clients

Psychosocial problems

Treatment need

• Most officers and vets do not get help for their symptoms

• Of those who do, treatment is often delayed

• Untreated OSI’s result in significant personal and societal costs (lost productivity, medical costs, lives lost)

Barriers to help seeking

• Stigma

• Impact on career

• Officer/soldier identity

• Belief about treatment outcome

• Ambivalence about symptoms

Effective Treatments are Available

• Based on models of “natural recovery”

• Target maintenance rather than causal factors

• Response rate: 85%

Treatment targets

Behaviours

Emotions

Thoughts

Treatment modalities

• Psychological treatment

• Emotion Regulation

• Cognitive Behavioural Therapy for anxiety/depression

• PTSD-specific: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT)

• Psychiatric treatment

• Medication management

• Family support

• Psychoeducation

• Couples therapy

Treatment modalities - community

• Social & occupational support

• OSISS

• Referral to vocational rehabilitation

• Physical recovery

• Pain management

• Sleep study

• Adjunct services (yoga)

Treatment Planning

Stabilization:

•Safety

•Trust

•Emotion

regulation/

coping skills

Symptom

reduction:

•PTSD therapy

•Depression

•Substance Use

•Related concerns

Transitioning:

•Meaning

•Identity

•Relationships

•Work

Recovery

• Full remission is possible

• Defining Recovery

– Being symptom free

– Coping vs. forgetting

– Reestablising identity and relationships

– Living according to goals, values

Bill and Alana Q & A