Lessons on PTSD: the Importance of Management and Prevention

19 January 2018

The Effects of Post-Traumatic Stress Disorder (PTSD)

A recent study in the UK has highlighted the importance of employers actively looking to mitigate the likelihood of its employees suffering from PTSD. PTSD is a set of reactions developed in individuals who experience some kind of traumatic event. This is most commonly seen where serious accidents or injuries occur, where an individual witnesses a death or some other form of disaster, or experiences physical or sexual assault.

Although the study focussed specifically on emergency occupations, it illuminated a number of key principles that employers who see any level of employee trauma can learn from.

In “A Case Study of the Effects of Post-Traumatic Stress Disorder on Operational Fire Service Personnel within the Lancashire Fire and Rescue Service”, researchers surveyed over 100 operational country fire fighters as a means of investigating the varying dynamics which lead to PTSD.

The University of Central Lancashire study found the following results:

  • 30% of respondents showed signs of probable distress, including experience of somatic symptoms, insomnia, anxiety, social dysfunction and severe depression;4% showed symptoms of PTSD.

Based on questionnaire results, the researchers were able to deduce a number of factors which cause the psychological effects associated with PTSD. In particular, researchers noted how the combination of experiencing traumatic situations and failure to properly mitigate the risk factors leads to stress and behavioural problems down the track.

From the [questionnaires], it was determined that emotions affect physical symptoms, supporting the theory that co-morbid mental health issues could potentially bring about the development of PTSD,” they say.

The researchers say employers can mitigate the risk of PTSD by:

  • Educating workers on stress and PTSD indicators, allowing them to identify symptoms themselves;
  • Assessing workers regularly for behavioural issues;
  • Conducting screening for new employees to determine pre-existing dispositions;
  • Updating workplace policies and procedures to ensure that workers affected by such issues are treated by trained professionals in the area;
  • Encouraging an open dialogue with workers to encourage health and safety at work.

This is universally pertinent, and is just as applicable to employers looking to mitigate the risks of PTSD amongst their employees in Australia.

The Australian Legal Context

A 2015 decision in the NSW Supreme Court was thought to be the first case where an employer was found liable for PTSD. Although this decision was overturned this year, it has outlined multiple key considerations for employers where psychiatric injuries are concerned.

In Pel-Air Aviation Pty Ltd v Casey [2017] NSWCA 32, the Court of Appeal found in favour of Pel-Air Aviation, ruling that PTSD did not constitute a bodily injury and therefore did not come under the ambit of the Civil Aviation (Carriers Liability) Act 1959 (Cth).

The airline was being held vicariously liable for the negligence of its pilots after an emergency situation where the pilots had made an emergency sea landing, and decided to ditch the plane and its passengers. The passengers were rescued, although by this stage enough psychiatric damage had occurred to have the Plaintiff later diagnosed with PTSD.

Here, the relevant Australian legislation incorporates provisions of international aviation law, applying strict liability to air carriers for “damage sustained in case of death or bodily injury of a passenger upon condition only that the accident which caused the death or injury took place on board the aircraft or in the course of … embarking or disembarking…”

Given that Pel-Air Aviation accepted vicarious liability, at issue was whether the PTSD was a compensable injury.

At first instance the Court found that the psychiatric injury was sufficiently linked to the physical injury due to damage to the brain, and that the PTSD therefore was compensable. The injured passenger was duly awarded $4,877,604.

On appeal, the Court reconsidered the meaning of bodily injury and the composition of a physical injury to the brain. Considering similar international cases, the Court of Appeal found that evidence of abnormal brain function by itself was not enough to constitute physical damage; chemical imbalance is also insufficient. In quashing the earlier decision, the Court of Appeal found that, in this case, PTSD was not compensable.

The Court of Appeal found that mental injuries are only covered if they are a manifestation of physical injuries, or if they result from physical injuries to the brain. As the passenger’s injury was chemical, it was determined to be neither.

Lessons for Employers

Moving forward, the possibility of compensation being awarded for psychiatric injury is by no means extinguished. It is foreseeable that people will increasingly try to prove that physical damage has been caused to the brain as a result of an accident, and the progression of medical research may give rise to evidence proving that psychiatric injuries can cause physical and chemical changes to the brain.

This would have further ramifications for complaints arising in various compensable fields, including those through the course of employment. It is important for employers to consider the best strategies and policies to implement as a means of managing and reducing the risks to employees.