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Supportive HR and Insurance Policies and Practices for Injured Aid Workers

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DO NO HARM PRINCIPLE in the AID Industry should be applied to staff care around PTSD risk and prevalence.

Please sign and demand that the aid industry through the CHS alliance representing a change agent in the NGO world, The United Nations Economic and social Council representing the UN, the RCRC and the DAC Chair Development Co-operation Directorate OECD to mobilize global donors and form and adequately fund an interagency working group for reviewing current medical research on PTSD and other mental health issues plaguing aid workers because of the work we do and its implications for policy and practice particularly for staff care and insurance. Suggestion for the scope of work for the working group appear below.

Also bring attention to the National Centre for PTSD US and the Australian National Health and Medical Research Council (NHMRC), and Phoenix Australia regarding how the lack of reference to well established biological risk factors and biological markers in the "Diagnostic Statistic Manual V" and the "Australian Guidelines
for the Treatment of Acute Stress Disorder & Post-traumatic Stress Disorder Promoting recovery after trauma" allows insurance companies to use subjectivity to diminish their liability and increase the suffering of mentally injured people.

This petition recognizes the work of the CDC and Antares Foundation but sees awareness, prevention and treatment and compensation of PTSD being more than just stress management . The biological risk factors for and markers of PTSD must be incorporated into policies and practices for prevention detection diagnosis and treatment ( as they come on board) with minimal lag. Also the protection mechanisms must be in place that will allow mentally injured workers to get insurance settlements without being subjected to biased evaluations nor the constant need for legal action in a complex global context. By making an inter-agency effort greater awareness and utilization as well as commitment to industry wide research gained. Donors can also require utilisation where their grants fund aid.

Aid workers develop PTSD at the rate of 3/10 international aid workers over the course of their career and up to 5/10 national aid workersin one study with not enough studies to suggest a uniform career percentage. Of those 40% of the international and national aid worker who develop PTSD will have symptoms that last more than 6 years. A 50% incidence in national staff is a severe crisis and a 30% prevalence for international aid staff is a crisis for the individuals and their families affected but also affects productivity and workplace environment. I was four years symptomatic but undetected in the workplace despite a known critical incident and my condition was probably reinforced  due to encouraged hypervigilence and security linked trainings. It took a second work related critical incident (with many others in between) to cause my collapse.

The insurance process that supported my treatment was great for one year when the insurer started to attempt to limit its liability. From then on the insurance became a hinderance to  stabilization of my chronic PTSD and the reward for dedicating my work life to help others was the insurance company using the subjectivity of psychology/psychiatry to label me a malingerer and exaggerator of symptoms. I engaged with my Employer to try and get fairer insurance treatment without the need for legal action but though coming across as supportive they seemed to be powerless in the current system.

Even in my injured state I am trying to make sure if I cannot help myself I can somehow help others to avoid this damaging process and hopefully avoid the work injury or at least its chronic state altogether.

The difference between rates of PTSD for international and national staff may reflect differing levels of trauma exposure  and even intergenerationally related to epigenetics. International aid workers work in challenging environments but national staff have lived in them their whole lives. The fields of biological psychiatry endocrinology and neurology related to PTSD markers are fairly robust and have some very definitive markers and ways to check for PTSD risk and PTSD biological prevalence. PTSD is currently defined on fairly subjective psychological measures but the less subjective medical fields are now coming to the forefront and will eventually be used to diagnose and even prevent and treat PTSD and hopefully cure PTSD. Medical practice typically follows research at a rate of 20 years lag time. With the internet access to research this lag time should reduce and the Aid industry including NGOs, the UN and Donors  have  a responsibility to be at the cutting edge of practice in regard to stemming this human resources related Mental Health Crisis.

The working group should at least be tasked with developing draft guidelines to inform regularly updated best practice with regard to

  • PTSD prevention, detection and treatment in the aid industry  based on the latest confirmed and accepted research especially related to biological markers
  • Policy changes in foreign voluntary workers compensation insurance to make sure there is adequate and supportive coverage and truly independent evaluation ( perhaps linked to research) for settlement
  • transparent information on workers compensation insurance conditions processes and jurisdiction for unresolved claims for legal settlement.

The above should be informed by consultations with/regarding

  • aid workers who have developed PTSD and experienced the existing systems and practices with regard to prevention, detection and treatment/insurance settlement
  • research leaders at the forefront of PTSD research around the world – including in countries where we work( for example Dr Rachael Yehuda at Mt Sinai)- especially the emerging Biological aspects of PTSD
  • document reviews especially summaries of the biological issues of PTSD
  • existing best and suboptimal practices – to inform changed policy and practices – more of/ less of and definitely nots.
  • consideration of research on PTSD in the aid industry in collaboration with the leading researchers. We already have pre employment and exit medicals – we just need to share the data and ensure we are testing for the PTSD biological markers. Many current and past employees would willingly share or participate to advance the industry specific knowledge
  • Regular Review of revised global guidelines on PTSD diagnostic and treatment manuals.

Some examples and detail of the knowledge that is available in the public sphere but generally unknown or underutilized by GPs, Psychologists, Psychiatrists, insurance and human resource departments and aid agencies can be found at:

Currently PTSD diagnosis and treatment in Australia is as per this. Other countries have different guidelines with the DM V being widely referred to – none as yet mention the biology of PTSD as known in the fields of endiscrinology, neurology, biological psychiatry but their next version will hopefully – and in Australia new guidelines are out in 2018 – your staff are global and having a picture of the manuals used around the world is important.

http://phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-ASD-PTSD-Guidelines.pdf new guidelines are coming out in 2018.

Publication Bias on the use of SSRIs for depression often comorbid with PTSD . This has been a huge issue for me as my treating psychologist is cognizant of this while most Drs and Psychiatrists remain invested in the belief of the value versus harm of SSRIS based on publication biased knowledge http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=article research findings  that say negative impact or no/ambiguous impact compared with positive impact found and heaps of serious side effects noted – and often not or understated outnumber  positive finding research by 12:1 but the publication bias hides this fact.

neuroendocrinology stuff on PTSD:
Biological Studies of Posttraumatic Stress Disorder – The accepted findings of biological psychiatry.

MDD vs PTSD – commonalities and differences
Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations – The HPA Dysfuntion and cortisol level differences  are critical and not subjective. This HPA dysfunction can also be accounted by other biological conditions and an endicrinoogist should rule out that these do not exist when someone is diagnosed with PTSD.

endocrinology of PTSD
  Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment. - PubMed - NCBIis a description of a chapter from a 1700 USD text of the latest research in PTSD that was released in June 2016. You can get it for free from one of the links.

chemical imbalance/HPA axis dyssfunction and endocrinology of PTSD and impact it has on emotions and behaviour
Posttraumatic Stress Disorder and Neurochemical Processes - Posttraumatic Stress

an example of changed personality as a measure of psychopathology. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0853-2

accelerated aging – oxidative stress and PTSD- why is the life expectancy of adults who develop PTSD ten years less than average and survivors of child sexual abuse have life expectancy 20 years reduced – current thinking of biological mechanism

https://www.ptsd.va.gov/professional/newsletters/research-quarterly/V27N3.pdf

The article below highlights that 95% of the people who recover from PTSD do so within one year of the causational traumatic event. Ironically for me this article was pubished 7 months after my critical stress incident experience. Had I read it then and the articles above – I would have been doing everything in the toolbox to try and recover in the first year even if I did not suspect PTSD but was identified as biologically at risk. There is a critical window for treatment. By recover I don’t think this includes a reversal of the epigenitically linked  biological dysfunctions that currently appear to be a new permanent state– merely a dampening of symptomology and I suspect that it is remission rather than recovery – there is apparently still no cure for PTSD at the biological level.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746940/pdf/nihms127533.pdf

 

Putting this request together has taken four years of experience and effort given my reduced cognitive capacities and tendency towards dysregulation and overwhelm. Interestingly it’s the adversial position of insurance companies  biased and perhaps fraudulent psychological evaluation  that got me into looking into the biology of PTSD. The world does work in mysterious ways.

I have reached the end of my capacity to struggle on this issue and I urge the addressees of this petition to take up the charge of looking after the most vulnerable future current and past servants of the aid industry, so that they may continue to look out for the most vulnerable in our global communities. I also think that as we know the difference between national and national staff we will also find ways to help our beneficiary communities with similar mental health issues – looking after staff will lead to innovation in core programming for mental health in vulnerable communities as well. If you have not seen Amy Braithwaites short film …. I urge you to do so now …and sign the petition and take action.

http://amybrathwaite.com/portfolio_page/kick-at-the-darkness/



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