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Battling Operational Stress Injuries

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Battling Operational Stress Injuries

  1. 1. Battling Operational Stress Injuries Ottawa OSI Clinic Michele Boivin, PhD, CPsych Jakov Shlik, MD, FRCPC
  2. 2. 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.
  3. 3. 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
  4. 4. Modern non-medical terms  Combat stress reaction  Combat stress injury  Operational stress injury
  5. 5. 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
  6. 6. Belief injury  Safety  Control  Moral order  Righteousness  Value of life  Goodness of people
  7. 7. 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
  8. 8. Suicide
  9. 9. Homecoming  Distress hypervigilance, memories fatigue, insomnia, dreams,  Identity change  Anger and impulsivity  Alcohol and drugs
  10. 10. Adjustment  Family  Loneliness  Work  Health  Society
  11. 11. Leaving the service  Loss of support  Loss of goals  Loss of health  Loss of financial security  Bureaucracy  Civilian life
  12. 12. Operational stress in law enforcement • Critical incidents • Cumulative stress • Exposure to crime and depravity • Internal and external pressures
  13. 13. 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
  14. 14. 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
  15. 15. OSI treatment • Mental health care • Social support • Medical care • Vocational recovery • Physical recovery • Family functioning
  16. 16. OSI Clinic Mandate: • Standardized Assessment & Diagnosis • Empirically Supported Treatment • Networking & Education • Research & Program Evaluation
  17. 17. Population
  18. 18. 3% 3% 9% 5% 12% 59% 9% WorldWar II KoreaWar Afghanistan Domestic High Frequency, Short Duration Deployments* UNPeacekeeping No deployments Deployments
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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)
  23. 23. Barriers to help seeking • Stigma • Impact on career • Officer/soldier identity • Belief about treatment outcome • Ambivalence about symptoms
  24. 24. Effective Treatments are Available • Based on models of “natural recovery” • Target maintenance rather than causal factors • Response rate: 85%
  25. 25. Treatment targets Behaviours Emotions Thoughts
  26. 26. 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
  27. 27. Treatment modalities - community • Social & occupational support • OSISS • Referral to vocational rehabilitation • Physical recovery • Pain management • Sleep study • Adjunct services (yoga)
  28. 28. Treatment Planning Stabilization: •Safety •Trust •Emotion regulation/ coping skills Symptom reduction: •PTSD therapy •Depression •Substance Use •Related concerns Transitioning: •Meaning •Identity •Relationships •Work
  29. 29. Recovery • Full remission is possible • Defining Recovery – Being symptom free – Coping vs. forgetting – Reestablising identity and relationships – Living according to goals, values
  30. 30. Bill and Alana Q & A

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