For the third consecutive year, Rep. Steve Casey (D-Woonsocket) has introduced a bill in the General Assembly that would allow Rhode Island firefighters and police officers diagnosed with post-traumatic stress disorder to receive pay for injury on duty and made eligible to apply for a disability pension.
Casey told The Herald that the bill allows first responders, firefighters and police officers “to go get the help that they need.” After consulting with a mental health professional, first responders would be able to take paid time off without having to use their sick days, Casey explained. That time off would be "qualified as an injury on duty." For firefighters and police officers who are no longer able to work following PTSD diagnoses, the bill would also allow them to apply for an “accidental disability retirement allowance.”
PTSD is characterized by a cluster of symptoms including intrusive thoughts and nightmares, emotional numbing, outbursts of anger and difficulty sleeping, according to M Tracie Shea, professor of psychiatry and human behavior, who has conducted research with individuals diagnosed with PTSD, particularly veterans.
Shea said that in recent years, “people are just much more aware of (PTSD) both within the mental health field and outside of it.” While she believes it's unlikely for practitioners to fail to diagnose patients, “a lot of people don't go and get treatment because … they don't understand what's wrong with them," she said.
The bill is "near and dear to me," said Casey, who also works as a firefighter in Woonsocket. In his work, Casey said he has “seen some really horrific accidents and instances of what people might consider pretty stressful events.”
As a result of experiencing one of those situations or multiple of them, Casey witnessed some of his colleagues struggle with their mental health, including one who took his own life in 2018, he said.
Casey has presented this legislation annually for the last three years, explaining that financial concerns have prevented its passage.
State law requires that bills and resolutions “having an effect on the revenues, expenditures or fiscal liability of the state” must be paired with an estimation of their financial impact, in addition to their impact on city and town finances.
According to Casey, an updated fiscal note has not yet been issued for this year's bill.
The Rhode Island League of Cities and Towns, which represents “municipal government interests before the state legislature,” has expressed concerns about the proposal.
“The injured-on-duty system needs to be reformed before we expand any additional benefits," Associate Director Jordan Day said.
Day said the organization recognizes the issue of PTSD among first responders in Rhode Island and the need to consider "how to best support their treatment," she said. "We, of course, respect and appreciate Representative Casey and his advocacy for public safety officers."
But the bill “will significantly increase the spending on injured-on-duty benefits, which is already an administrative and fiscal challenge for cities and towns,” Day said. A solution requires “thoughtful and critical reform” and a change in the injured-on-duty threshold before the state is able to extend benefits, she said.
For Day, the most successful approaches to addressing PTSD in first responders come from states that are "focused on treatment, not simply payouts, with the goal of returning people to work,” she said.
She cited a 2019 law passed in Connecticut, which created a one-year limit for workers’ compensation benefits for PTSD-triggering events and "creates a pathway for (first responders) to get the care and support that they need, including peer support networks and their mental health services,” she said.
According to Casey, “the goal is not to affect the pension system." Though Casey recognized that there will be added expenses, he said he believes many of the previous projections overestimate that cost. The 2021 fiscal note estimated that the bill would add between $1.2 and $7.1 million in state expenditures in its second fiscal year.
“Fire departments are very expensive. Police departments are very expensive. So in a lot of ways, they look at us as a cost center,” he said. “We’re trying to really approach this from the perspective that it's more important to have good mental health for everybody.”
Casey said that he is “meeting with people and entities that will be affected by this ahead of time" to discuss potential concerns. “It's important to have compromise and agreement with any piece of legislation, not just with what we're doing here,” he said.
According to Shea, treatments for PTSD include “present-centered therapy that tries to understand patients’ current life issues and how they might relate to their PTSD symptoms and interpersonal therapy which focuses on relationships,” Shea said.
Written exposure therapy and eye movement desensitization and reprocessing, also known as EMDR, have also become common treatment methods, Shea said.
For Casey, calling PTSD a "disorder" can be misleading.
"I like to call it a post-traumatic stress injury or an incident because … this isn't something you're born with," he said. "This is an event or an effect that happens over time," he added.
Casey noted that awareness about first responders affected by PTSD in Rhode Island began increasing after the 2003 Station nightclub fire in Warwick — when the public realized first responders witnessed serious injuries and deaths over an extended period of time, he said.
On March 7, the Rhode Island Ethics Commission authorized Casey, as a firefighter, to preside over the bill as chairman of the state House Committee on Municipal Government & Housing."If this legislation passes, I have no more advantage from it or benefit from it than any other fireman in the state," Casey said.
Casey said he is hopeful that this bill will act as “encouragement to people to go ahead and get the help that they need and create a more safe environment for everyone else on the job.”
Injy El-Dib is a metro staff writer at The Brown Daily Herald. She has previously covered activism and public health in the Providence area. In her free time, Injy enjoys playing volleyball and crocheting stuffed animals.