Firefighter post-traumatic stress disorder

Todd Nelson felt it coming. And he started running. He darkened again, retreating to where he curled into a fetal position with his thumb in his mouth and watched from behind closed eyes as his personal horror reel unfolded. There were images and sounds from three decades of firefighting – he screams from behind an impenetrable wall of flames, limbs severed in car crashes, and the eyes of the terrified and dead he was supposed to save.

Nelson ran on the Foresthill Bridge, the tallest in California, fleeing from cops and firefighters after his wife reported he was feeling suicidal. He jumped over a concrete barrier and straddled the railing of a bridge at the foot of the Sierra Nevada, staring at a large rock 730 feet below. As rescuers approached, Nelson tentatively leaned over the edge. His strategy is to make his fatal jump look accidental, which allows his family to take away his life insurance.

This wasn’t Nelson’s first suicide attempt – the former Cal Fire captain had tried to take his own life multiple times. However, after this ordeal in 2021, which led to an involuntary 72-hour detention in a psychiatric hospital, something changed in him. He was ready to admit the problem and seek medical help.

The incident marked the beginning of the firefighter’s arduous, multi-year journey toward wellness, one that took him through a bureaucratic maze riddled with more obstacles than he ever encountered during a California wildfire: finding qualified medical help, fighting the insurance company to pay for it, and navigating the tangled quagmire of a California insurance company. working class. All without going bankrupt and returning to your dark place.

No one monitors how many of Cal Fire’s 12,000 firefighters and other employees suffer from mental health problems, but department leaders say post-traumatic stress disorder and suicidal thoughts have become a silent epidemic at the agency responsible for fighting California’s increasingly erratic and destructive wildfires. In an online survey of wildland firefighters across the country, about one-third reported contemplating suicide, and nearly 40% said they had colleagues who had committed suicide; many people also reported depression and anxiety.

California’s workers’ comp program, which is designed to help people get medical help for workplace illnesses and injuries, can be a nightmare for firefighters and others suffering from post-traumatic stress disorder (PTSD).

Claims from firefighters and law enforcement officers are more likely to involve post-traumatic stress disorder than claims from the average worker in California, and they are denied at higher rates than claims for other conditions, according to the RAND Research Institute.

From 2008 to 2019 in California, workers’ comp officials denied claims of post-traumatic stress disorder (PTSD) reported by firefighters and other first responders, rates that were more than twice the rate of other work-related conditions such as back injuries and pneumonia, RAND reports. About a quarter of the 1,000 firefighter PTSD claims were denied, a higher rate than for post-traumatic stress disorder (PTSD) claims filed by other workers in California.

“It’s a system where the breakdowns are paramount. You have to break a leg to show that you need support. With mental illness, we have to constantly prove to everyone why we’re sick. It takes suicide,” said Jessica Cruz, executive director of the National Alliance on Mental Illness in California.

Jennifer Alexander, Nelson’s therapist, says patients in acute crisis simply don’t have the mental capacity to follow the claims of stubborn workers. Alexander said she was once suspended for more than six hours from a Cal Fire mental health specialist trying to pay one of her bills, and she also waited years to be paid for treating firefighters.

“People are giving up. It’s a battle… They’re not fully functional,” said Alexander, who has specialized in treating first responders with trauma and post-traumatic stress disorder for 21 years and has spent about 25,000 hours treating them. “You’re not talking about healthy people who can sit on the phone for hours.

Cal Fire and other workers also struggle to find qualified therapists, especially outside of large cities in rural areas where many are based. In 2021, fewer than half of people with mental illness in the U.S. had access to timely care. Therapists are reluctant to take out workers’ compensation insurance, or any insurance at all, because they often have to wait months or years for reimbursement.

Michael Dworsky, a senior economist at the RAND Research Institute and one of the study’s project leaders, called the workforce composition “difficult and bureaucratic.”

“Even if your claim is upheld, there may be disputes about the medical necessity of individual bills. Just because your claim is upheld doesn’t mean you’re done fighting with your insurance company,” he said.

Presumption of pain, but still a tangled web

Employers in California are required to provide workers’ compensation insurance to cover medical expenses if an employee is injured on the job. But in reality, the workers’ compensation system that serves 16 million Californians can be clunky, confusing, and sometimes unhelpful. The system, run by the state’s Department of Industrial Relations, is massive: Nearly 750,000 workers’ compensation claims were filed statewide in 2022.

When a firefighter requests medical treatment, insurance adjusters review the case to determine whether it is medically necessary. If a claim is denied, delayed or modified, the patient can request an independent medical evaluation by so-called “ghost doctors” who review the case.

Across California, patients who appeal denied workers’ compensation claims are not faring well: Last year, 3,238 appeals for mental health claims were filed, but workers’ compensation officials denied three-quarters of them, or about the same number , every 10-yearly average, according to Department of Industrial Relations data requested by CalMatters. (Agency officials said they could not provide data on claims filed by first responders.)

For decades, the California Legislature has grappled with the problem of fixing worker layoffs — in one year, lawmakers proposed nearly two dozen bills.

In 2020, lawmakers took an important step by adding a legal shorthand, or “presumption,” to the state labor code stating that firefighters and other first responders are considered at high risk of developing post-traumatic stress disorder (PTSD) due to their jobs.

This means that first responders no longer bear the burden of proving that their illness is work-related. However, the claims adjuster may still dispute the diagnosis or claim that the injury was caused by other factors, such as military service or family events. A law passed last year extended this presumption until 2029.