Thank you for inviting me here today.
I'm here to speak about evidence-based interventions to prevent OSI and PTSD among first responders. My background includes more than a decade of working with first responders, combat veterans, and police, both as a research scientist in two U.S. veterans hospitals and most recently as an academic at the University of Toronto. My research is focused on the health and performance costs of severe and chronic stress experienced by trauma-exposed first responders. I will cover a number of key points and then provide recommendations.
First, operational stress injury and post-traumatic stress disorder are associated with significant health costs, physical disease, and early mortality. My colleagues and I have demonstrated that officers are two and three times more likely to develop chronic health conditions, such as cardiovascular disease, diabetes, and even cancer, when compared to the general population. The U.S. Department of Veterans Affairs data says that the cost of health care for treating a first responder with PTSD is almost five times higher than it is for treating a first responder without PTSD, due to the costs of comorbid physical and mental health treatment.
Second, research clearly indicates that first responders are most likely to develop OSI and PTSD following highly stressful critical incidents in which they are exposed to traumatic material, such as a severely abused child, or when they are forced to use lethal use-of-force options. Yet, during use-of-force training, first responders do not receive adequate training in managing the severe psychological and biological stress responses that do put them at risk for OSI and PTSD.
My colleagues and I have witnessed this first-hand. We've collected thousands of hours of biological and psychological data with first responders, both during their training and in active duty emergency calls. We've collected data on things such as heart rate, breathing, body movements, sensory distortion, fear responses, and stress hormones. Our research indicates that these extreme stress responses actually negatively affect their performance, raising the risk that during a lethal use-of-force encounter they may not use the de-escalation techniques that are available to them and may make a lethal use-of-force mistake. These are directly the types of incidents that are related to getting OSI and PTSD.
Third, scientifically validated resilience interventions for addressing the stress associated with critical incidents in use of force are essential in preventing OSI and PTSD. Science-based methods are the only way we can test that an intervention is working and achieving the intended outcome and worth the financial investment.
Canada is at a critical juncture in deciding the best course of action to address OSI and PTSD among first responders. This committee will be considering the available and proposed interventions with limited training dollars, so it's critical to clarify what we mean by an evidence-based resilience intervention. Large-scale resilience-building programs, originally developed for military personnel, such as the road to mental readiness, have been rolled out in some police organizations. However, there are no randomized, control trial, evidence-based studies showing the efficacy of this for preventing OSI and PTSD among first responders.
An issue is that classroom-based material, as research has shown, is not easily transferred when you're trying to learn motor movement skills in such things as use-of-force training and so forth, so it may be misleading to assume that resilience programs delivered in classroom environments would generalize the use of force and behavioural outcomes in the real world. In fact, our biological objective data show that if we want to reduce the maladaptive stress physiology that is associated with OSI and PTSD, we must intervene directly in the training for these high-stress critical incidents, and this entails use-of-force training.
There are few researchers globally working on evidence-based—meaning randomized, control trial evidence—OSI and PTSD prevention programs. I know of one group in the United States. As far as I know, our group is one of the only ones in Canada doing this type of work. I'll present for you the basics of our program.
First, our science-based method, based on all the objective data we've collected, has shown that use-of-force training and de-escalation techniques are best delivered by use-of-force trainers, not in classroom settings by health professionals or so forth. You get the best buy-in from the actual officers in this very tough environment if it's taught by use-of-force trainers. The topics should be helping officers consider their full range of options, including verbal de-escalation and less lethal use-of-force options, so that encounters do not escalate unnecessarily, leading to potential OSI and PTSD.
Second, we use strategies that maximize how humans form brain pathways to learn new information and retain it. This is critical, because in high-stress encounters, responses result from the most automatic, instinctual reactions. Applying some of our techniques for physiological control during critical incidents can override these natural human responses that block an officer's ability to consider all their use-of-force and de-escalation appropriate options.
Third, training should be personalized and individualized, tailored to the individual officer. In our program, devices for officers were taking advantage of new developments in technology, which can analyze an officer's sensory nervous system readings during highly realistic police training scenarios—events like hostage-taking, school shootings, and calls to distressed persons. It's very important that they are exposed, in training, to these highly realistic scenarios.
When they receive their own information about their own body and their stress responses, the expert use-of-force trainers then can create an individualized use-of-force instruction for them so that they can learn what their triggers are and how to overcome those in the use-of-force situations. Currently training for use-of-force situations is in blanket form. Everybody gets the same. Clearly some officers' needs are not being met in this form. We found this even with the most highly trained tactical teams on the federal level. They still benefited from personalized training. They were less likely to shoot the wrong person, such as a person holding a phone and not a gun. Those are directly the events that lead to OSI and PTSD.
We have recommendations based on this data. We need greater support for scientific evidence-based research and intervention. We need more just-in-time funds allocated for researchers. Currently, grant cycles of eight or nine months are too long. We are missing opportunities to work with organizations that are trying to answer the public's outcry for more police training and end up adopting non-evidence-based training programs. We don't have funding in to actually provide them with evidence-based training.
Second, we need to develop minimum standards for assessing performance outcomes of police training programs in terms of the quality of the training program offered and the value returned for the officers and the public they serve. There are programs available, as I mentioned, but they are not evidence-based. Standards regarding program quality need to be established. Things like evidence, scientific studies, and randomized control trials are critical, as are data from pilot studies. We need funding for large-scale longitudinal follow-up to understand how often and how intensely we need to be training these officers before they have OSI and PTSD, in order to avoid it. There are ever-changing threats in society for police officer safety and wellness. We need to take advantage of the most current technological devices and neurobiology of learning in order to meet these changing demands in society.
Three, we really need to establish a centre for excellence in evidence-based police training. Surprisingly, currently there's no global centre for excellence in police training. By establishing a national centre, Canada is poised to take an international lead in developing the highest quality police use-of-force training and critical incident stress management. Canada can create and export new police training programs, further benefiting the field of law enforcement internationally and building Canada's reputation and goodwill.
Finally, we need to require certification for police trainers and facilities based on high quality standards and best practices.
We recommend that police trainers be required to be certified regularly and to maintain a high degree of current knowledge through continuing education programs much like what is required of health professionals and physicians. There is a cost benefit to doing interventions for OSI and PTSD. A U.S. program, though not as comprehensive as our program currently, did find a 14% reduction in annual health care costs among first responders, so as you can imagine, if it's over $1,000 per year per employee, in an organization of 500 officers, that would be a cost savings of over half a million dollars that could be redirected to police training.
Thank you.