CLEVELAND — The mental health of first responders continues to be a pressing issue as suicides among those in public safety continue to grow at alarming rates. In Ohio, however, workers' compensation does not cover PTSD-related treatment if a physical injury does not accompany it. Legislation aimed at reversing this policy sailed through the Ohio House earlier this year but remains stalled in the Senate.
In February, the Ohio House overwhelmingly passed HB 308, authored by Rep. Tom Patton (R-Strongsville). The legislation would have allowed first responders across the state, including firefighters, paramedics, EMTs and law enforcement officers to have their PTSD treatments covered by workers' compensation without an accompanying physical injury.
More than three dozen states have some PTSD provisions under their workers' compensation systems. Currently, in many cases, first responders have to pay for PTSD treatment either out of pocket or through their own private insurance despite mounting evidence that much of the mental trauma they experience occurs while on the job.
“Anywhere between 19 and 34 percent of police officers suffer from some kind of PTSD and upwards of 50 percent will experience some sort of psychological trauma throughout their career," said Brian Holb of the Ohio Patrolmen’s Benevolent Association. The OPBA has spent nearly a decade trying to expand Ohio’s PTSD coverage for first responders.
A veteran police officer serving at a department in Northeast Ohio knows the struggle well.
“John” asked for anonymity because he is still an active police officer and has received treatment and therapy for post-traumatic stress. Although John said there have been several traumatic experiences over the course of his career, one particular incident proved to be his breaking point. Details of the incident are being withheld because it could reveal John’s identity.
“It involved me taking somebody’s life to save somebody else’s. It was a very up close and personal incident,” John said. “There was a lot of visual trauma that went with it. It sometimes still haunts me today. Incidents like that bring up visual pictures that go through your head. Sometimes they go through your head non-stop. It’s a movie that plays over and over and over again.”
John’s incident was deemed to be an obvious and justified use of force. The suspect was killed in the incident. In the months that followed, John experienced one of the hallmarks of post-traumatic stress: sleep disturbance. Researchers have found a large majority of first responders suffer from at least some level of sleep disturbance.
The still frames in his mind from the incident were the first and last things John would think about each day.
“We kind of equate it to being eaten by ducks. All these ducks just peck at you for the longest time,” John said. “Then, finally, that one duck just does it. There are instances where police officers have to use deadly force and those instances only sometimes other people who have used deadly force can really understand what that officer had to go through or the aftermath that comes with it.”
John said even after treatment and therapy, some days are better than others, especially around the time of the anniversary of the incident. John has come to reckon with the fact that he can’t choose his own memories — he can only work through the haunting ones.
“I wish I would have sought treatment before or faster. Even now, some of those thoughts still come back,” John said. “That’s really the only thing that has helped me with my incident is talking to my doctor or to people.”
Holb said John’s story is far from unusual.
Whether its shootings, stabbings, violent car accidents, child or domestic abuse, first responders are frequently tasked with and confronted by traumatic events. Additionally, Holb said sometimes the most debilitating injuries are mental — not physical.
“There has been a disconnect with some not believing that these types of things that police officers see throughout their career are as bad as what someone would see on the battlefield. To be clear in some cases that is true,” Holb said. “But they have significant instances of violent crimes, police officers being shot at, terrible car accidents. You don’t have to look any further than what happened this past year in Dayton.”
During committee hearings on HB 308 earlier this year, organizations like the Ohio Chamber of Commerce and Ohio Manufacturer’s Association publicly opposed the legislation, primarily citing the costs of such a policy change as well as the potential "slippery slope" that it might create. The longstanding practice of the state's workers' compensation system has been that a physical injury must accompany the mental one.
"I believe that some of those mental injuries could be more drastic than the physical injury itself, you know?" John said. "Let's say I hurt my knee, I can have it surgically repaired. I haven’t heard of anything that’s been able to repair the brain to get those pictures or images or trauma out of your head."
Those that opposed the legislation told state representatives that the legislation could potentially open the doors for employees of different industries to have access to the same benefits. According to the Legislative Services Commission, enacting HB 308 would cost $44 million in the first year but significantly less in the following years. However, according to Bureau of Workers’ Compensation data, the agency has frequently cut or refunded premiums that employers have to pay. To date, the agency said it has saved employers more than $10 billion in premiums since 2011.
“They don’t want to spend the money and, frankly, it is an unknown number for them,” Holb said. “There is not a lot of data out there to show that, ‘hey look if you have this many employees, you can expect this percentage of them to use this and that’s what you should budget on.’”
After passing the full House, HB 308 was assigned to the Senate General Government Committee, where it received three hearings in the spring and early summer. However, after the third and final reading, the bill was not voted on to determine whether it should leave the committee. The legislation has languished ever since.
You can read the complete bill below:
Research presented at a recent first responder summit hosted by state officials paints a concerning portrait of the prevalence of post-traumatic stress among first responders. As much as 20% of EMTs or paramedics and perhaps as much as 37% of firefighters have PTSD or PTSD-related symptoms. Additionally, more firefighters and law enforcement officers commit suicide every year than the number of those killed in the line of duty.
According to the Ruderman Foundation, the suicide rate among firefighters is 18 per 100,000 people and the suicide rate among police officers is 17 per 100,000. By comparison, the suicide rate for the general population is 13 per 100,000.
According to the advocacy organization Blue H.E.L.P., the suicides of more than 220 first responders had been reported to the organization in 2019, which was a significant increase over the 174 first responder suicides in 2018. The organization said the statistics may not indicate an increase in suicides but rather an increase of reporting to Blue H.E.L.P. However, researchers continue to point to the fact that more first responders take their own lives than are killed in the line of duty every year.
Despite the absence of a legislative remedy, officials at the Ohio Department of Mental Health and Addiction services joined with researchers from Ohio State University and Accentus Health to develop the F.I.R.S.T. app, a science-based mobile app for first responders dealing with PTSD-related symptoms.
After an extensive beta period, the app has been released on Android and the Apple app stores. The app had a simple goal in mind: bring scalable and sustainable mental health support to high-stress, high-trauma professions like medicine and public safety. The trauma and stress from their everyday professional lives often permeate into their personal ones. Burnout, turnover, difficulties sleeping and other productivity and quality of life issues are often symptoms of a deeper issue.
The app has been in development for three years and is driven by science, officials said. Once a user downloads the app, they complete a short, 10-minute assessment. Once the assessment is complete, scientific algorithms push content and exercises that are tailored to the user.
As for John, the veteran police officer involved in an officer-involved shooting several years ago, through treatment and therapy, he has returned to his calling: protecting and serving the community. The endless slideshow of still frames from that fateful night still come back from time to time. However, the movie is shorter now, he said, and, hopefully, the credits will roll.
“I usually tell people ‘I’m good’ or ‘I’m okay,’” John said. “Every day I’m working on my post-traumatic growth.”