There was an initial idea for my character in the book I am currently writing, to mention him having attended a residential/local program for PTSD. So this is how my research journey began on this subject and now this essay/post.
Because I trained to be a journalist, I tend to base my fiction in real life — or at least I like my story to have some basis/roots in reality. Over ten years and almost twenty years ago, I worked on a case about a firefighter who had PTSD — his case was actually not about PTSD — it was about damage to his knees when he was injured while fighting a fire. A combination of that chronic physical injury and also other other issues related to his PTSD led to his self-medicating and a downward spiral that was far from pretty.
This was all back in the late 1990’s and early 2000’s when PTSD wasn’t really identified as a formal disorder at least it was not recognized legally. It was sort of a new medical diagnosis chiefly given to veterans back from service in Afghanistan and Iraq. As treatment for PTSD has progressed — most of it has been tailored to military/veterans.
This does make sense, since so many veterans or active military also work as first responders: Firefighters, Police Officers and EMTs/Paramedics.
To note, after the 1995 Oklahoma Federal Building Bombing — it first came to light that many of the First Responders there struggled in the aftermath — there were several First Responder suicides documented in the media and investigated by researchers, but I think this was studied/noted as a response or phenomena related to an isolated and/or specific and horrific event as well as Survivor Guilt.
Now there is more research confirming that PTSD can be a cumulative over a career. More and more, PTSD seemed to be diagnosed or confirmed in studies as being prevalent in First Responders as building after years of being “on the job” and seeing and responding to many horrific events. Many former First Responders are now going public as well and sharing their stories and struggles — at least in the local media here in the Boston area, many others online with blogs and other ways of trying to reach out and support each other and also inform the public.
Going back to my fictional inspiration — by the time this actual firefighter got himself both the mental health and medical treatment he required — well many things had happened to him, as he tried to continue to work and function, and again it went into a downward direction. However, he was able to retire and get a disability pension but proving the physical disability was accidental was a challenge. The PTSD-issues regarding his disability was secondary even though he had letters from co-workers and supervisors confirming his involvement and participation in some horrendous events. However, it did not impact the legal decision of his mental incapacity related to work because he compromised certain actions of his with his self-medicating, mostly with alcohol.
To note, I’ve read over a lot of similar cases doing my paralegal job — now that I’ve become more familiar with PTSD and it’s impact there were probably others over the years caught in a similar situation and struggle, but I did not realize it then as I worked reviewing their documentation and preparing it for the court to review.
As for my fictional character, I used the physical injury/event of this firefighter as one of the PTSD triggers for my lead male character. My fictional male character went straight into the Academy in the late 1980’s, quite young, following in his father’s footsteps although he is longing for college and perhaps another path, until a few other things happen to him and it all seals the deal for him to become a firefighter — holding back spoilers from the book here. This all leads him to make some different life decisions including going back to college and he decides to transition from being a firefighter to training with a goal to become an advanced paramedic to work on an ALS/Advanced Life Support/ambulance.
Again, I did research all the qualifications and I found that at least in my state and my city have some very specific certifications/requirements if you are to become an advanced paramedic — there a select few of these advance certified paramedics and they work on a few ambulances with special life support equipment. Actually I was kind of shocked how few ALS ambulances we have in a major U.S. City — but that’s another tangent.
In my U.S. State, the EMS/EMT requirements seem to be tiered from basic to a medium level and it depends on the job requirements. For something like medical transport from a rehab or a nursing home to a hospital for medical appointments such as dialysis treatments, basic requirements are all that are generally needed but again, it varies by job and where you live.
The other research I did was for PTSD treatment for First Responders. Shockingly I learned there aren’t that many tailored/specific residential programs. A few of the major hospitals my metropolitan area, do have PTSD programs, one in particular HomeBase at Mass. General/Partners but again this program is mostly tailored to military/veterans.
There is one nonprofit residential program in my state for PTSD treatment, the On-Site Academy in Gardner, MA — often mentioned now by First Responders speaking publicly about their PTSD sometimes in articles/other press, and also in some of the cases I’ve prepped.
On their website they note many of the staffers are First Responders/former First Responders which seems to be an important part of the treatment process because they obviously know where their patients are coming from. However, their website warns for prospective patients to check and see how much their employers/city/towns will pay and what their union will cover. They have a limited amount of financial aid/scholarships and they do not accept health insurance. The rest must be out of pocket on a credit card and and 5-day program as of April 2019, was about $2K USD. Pretty steep.
Adcare and some of the other private counseling services/residential treatment programs also offer substance abuse programs for First Responders but it’s unclear if these programs also can/will address the PTSD that often leads and become intertwined with chronic substance abuse.
As previously noted, there is some medical help available in different hospitals in and around our metropolitan area where I live — but you have to go through the system which may prove both problematic and overwhelming for someone struggling with PTSD. I am unsure what is available in other parts of the country. It seems thin here and my city, the Boston-area has a lot of hospitals and medical research located here.
Partners one of the larger hospital groups in my city/metropolitan Boston area/Eastern Massachusetts, does offer a PTSD program for First Responders through a mental health facility McLean Hospital, which it acquired awhile ago. McLean sadly has a long and often infamous reputation. Many local First Responders may be reluctant to go to a special program there just because of the stigma associated with going there and in general there needs to be removal of the stigma for first responders getting treatment for PTSD and related mental health issues. To note, the new Boston Police Chief recently went public with removing this stigma about getting help and it’s a first step. But a lot more needs to be done.
Programs offered by hospitals/their affiliations will have both positives and negatives — positives — I’m thinking positive, in that they are covered by health insurance, at least partially but negative in the sense that they are not staffed by First Responders/former First Responders so there is that removal of the importance and connection of having that same cultural experience that only First Responders share. To note, the IAFF Firefighters Union also have a PTSD treatment program/facility in Maryland but again this through the union. Right now, I have not been able to find a similar program through online searching for Police or EMTs/EMS/Paramedics.
Sadly these days, in many places it is a struggle just to get First Responders basic medical coverage/insurance to pay for certain tests and treatment — because many First Responders are at a higher risk for certain cancers — mostly this is for firefighters because of routine exposure to toxic, hazardous chemicals, etc.
First Responders are people who take on a lot: emotionally and mentally, as well as physically to protect the public. We need to remove the stigma and get them specialized treatment for PTSD and related mental health issues that is paid for by their employers — so they can remain healthy. And yes essentially I’m advocating that taxpayers need to kick in and help cover this expense — these are the folks that are keeping us safe we need to get them sufficient medical and mental health care.
Training of First Responders to help members of the general public is very important but treating them for this cumulative stress earned on the job is very important as well.