Kara Dewaine lost her father, Jeramie Dewaine, to suicide two years ago. A corrections officer at Corrigan Radgowski Prison, he would sometimes work 72 hours straight, and witnessed horrific violence, including being one of the first to find an inmate who took their life by hanging, his daughter said.
“These weren’t things he could talk about at home,” she said. “It was like he had to become a different person when he was home to protect us from everything he was going through. He was expected to see these extreme things at work and deal with them as if they were normal, go home to his family, and then go back to work and deal with it again.”
Over the years that he worked at Corrigan-Radgowski Correctional Center, Dewaine saw her father grow distant and anxious, unable to sit in public places when he couldn’t see the door. She knows his experiences are not unique. More than one-third of officers report that someone in their lives has told them they have become more anxious or depressed since they started working in corrections. Another study found that corrections officers in Massachusetts have a suicide rate 12 times higher than the state’s average rate of suicide.
If Dewaine had been physically injured in an incident at work, he would have received paid time off and had medical treatment covered through workers’ compensation. However, even though Jeramie Dewaine could likely have been diagnosed with post-traumatic stress disorder as a direct result of incidents in the workplace, medical treatment for a mental illness is excluded from workers’ compensation, so paid time off, therapy, or other mental healthcare would not have been covered.
A long-fought battle
Workers compensation in Connecticut used to cover treatment for mental health issues caused by workplace incidents before a series of 1993 legislative reforms amended the system. After the reforms, most workers could only receive mental health treatment through workers’ compensation if there was also a physical component to the injury. Some exceptions remained, such as officers who use deadly force and seek mental health treatment after the fact, but nearly all other workers were excluded.
State Sen. Cathy Osten, who worked for more than two decades as a corrections officer and lieutenant for the Department of Corrections, has spearheaded the fight for mental health coverage through workers’ compensation since she first entered the legislature in 2012, the same year as the Sandy Hook shooting that led to the deaths of 26 children and staff. In its aftermath, labor advocates, municipalities, and legislators debated whether workers’ compensation should cover first responders who witnessed the shooting and experienced PTSD as a direct result, or just those who were the victims of physical violence.
Seven years later, a legislative compromise in 2019 led to workers’ compensation coverage of mental illness for police and firefighters who are diagnosed with post-traumatic stress disorder after experiencing one of six qualifying events, all of which relate to witnessing death or severe injury. Throughout the legislative debate, city and town leaders expressed concerns about the fiscal burden of the proposal, which would be funded through local property taxes.
In this session, Osten says she hopes to expand the bill beyond just police and firefighters. She has proposed two bills, one that would return workers’ compensation to its pre-1993 state, where any worker who develops a mental illness as a direct result of a workplace incident would be eligible to receive workers’ compensation. She has also introduced a more narrow bill, which would only cover corrections staff, 9-1-1 dispatchers and EMTs.
Osten said leadership in the legislature has indicated that this issue will be a main priority of the session, and she anticipates that municipal leaders and insurers will again testify against the proposals. Joy Avallone, general counsel for the Insurance Association of Connecticut, testified in 2019 that family and medical leave could render additional expansion of coverage unnecessary. In response to questions about the new proposal, she emphasized that the Insurance Association still saw the financial burden as too high.
“The IAC opposes proposals to expand workers’ compensation coverage for mental and emotional injuries because they are multifaceted, of complex origin and highly subjective,” Avallone said. “Such expansion will likely result in an increase of claims and cause the cost of workers’ compensation insurance to significantly increase for businesses, many of which are already struggling financially.”
However, Osten said that in other states where mental illness claims are covered, they make up less than two percent of all workers’ compensation costs, and less than 0.5% of all cases. She also referenced a bill she passed to develop a hospital fee structure for workers’ compensation, which brought the state’s workers’ compensation cost down 50 percent in the last six years.
First responders left behind
Kara Dewaine testified in support of Osten’s 2019 bill, but was frustrated that corrections officers were excluded. Dewaine said she knows that workers’ compensation coverage for mental illness would make a meaningful difference for officers, especially for those unable to afford therapy or time off.
“My dad was doing all of these overtimes just to make ends meet, which a lot of correction staff do because they have families to support, so the additional financial burden of mental health treatment definitely plays into this,” she said. “The bill would also cover time off from work, which would be such a big thing, since officers are constantly at work, especially in the beginning.”
In the aftermath of Jeramie Dewaine’s death, the Connecticut Department of Correction implemented an employee assistance unit that has now worked with hundreds of corrections employees.
“We can offer free peer-to-peer support, but we are not a treatment program,” said Diane Moynihan, behavioral health clinical director for Connecticut Department of Correction. “We may be the initial call, but we’re really a bridge to getting them to the higher level of care that they need. We help figure out how to get them into treatment, and find something that is covered by their insurance, or find programs that offer fees on a sliding scale. Finances definitely come into play.”
As director of the employee assistance unit, Moynihan said she hears from officers who experience distressing events on a daily basis, like witnessing inmates harming themselves and each other, but lack an avenue for psychological support.
“There is such a negative stigma around officers seeking help,” she said. “They think they have to be strong and tough and put on this bravado because of the environment they’re in, and they don’t look for help. Their mental health conditions escalate to the point where if we could have intervened sooner, we might have been able to avoid long-term problems.”
Officer Michael Vargo, president of AFSCME-Local 1565, has also seen his peers face debilitating mental illness.
“Over the years, I’ve seen so many people struggle with addiction and other mental health issues because of what we see at work,” Vargo said. “This is happening because of the job, and so it should be covered by the state.”
Moynihan also sees little justification for workers’ compensation excluding coverage for mental illness.
“As a clinician, I can say that there should be absolutely no difference in how seriously we take a physical injury and a mental illness,” Moynihan said. “Just because one is visible and one isn’t doesn’t mean one is more real.”
Osten’s more narrow bill also expands coverage to include 9-1-1 dispatchers, another group that faces disproportionately high rates of PTSD. One study found that between 18 and 24 percent of emergency dispatch personnel report enough symptoms of PTSD that they would likely receive a diagnosis if seen by a psychologist.
Jo Samataro, a state dispatcher for more than three decades and member of AFSCME Local 610, said emergency dispatch personnel face distressing workplace events on a near-daily basis.
“I have seen dispatchers who are still falling apart from one bad call,” Samataro said. “I have colleagues who were literally on the phone during Sandy Hook, hearing the gunshots, hearing the employees begging for help, and hearing the children in the background. Those dispatchers don’t qualify for any treatment.”
Samataro has certain calls that still haunt her, and is in therapy, which she pays for out of pocket, to help herself process the disturbing incidents in her workplace.
“A firefighter once called 9-1-1 and told me he was going to kill himself, and I couldn’t convince him to stay on the phone,” she said. “It’s so hard not to blame yourself. People call because they want to say goodbye to someone or apologize before they kill themselves. Parents call because they have found their children after they overdosed or committed suicide. You can’t forget that.”
Amid the pandemic, frontline healthcare workers at risk
Osten’s narrow bill would cover corrections staff, 9-1-1 dispatchers, and EMTs, but she said she would much prefer the broader bill pass so any worker who develops PTSD due to an incident in the workplace could receive treatment. Osten particularly hopes those on the front lines fighting the pandemic might be included.
In April, Dr. Lorna Breen, emergency room director at New York-Presbyterian Hospital who had been treating COVID-19 patients, died by suicide, sparking a national conversation about mental health for frontline healthcare workers at the front lines of the pandemic.
These issues have only worsened throughout the pandemic. In one study from Italy, nearly 50 percent of healthcare workers treating COVID-19 patients surveyed reported PTSD symptoms. A similar survey in Canada found that almost half of frontline healthcare workers said they needed psychological support, and a look at healthcare workers in Wuhan at the height of the pandemic found more than half reported symptoms of depression, and one third reported experiencing insomnia.
“It’s like a warzone, and people are leaving in droves,” said Sherri Dayton, president of Backus Federation of Nurses. “The people that are caring for you are not getting cared for.”
Danielle Morgan, a psychiatric nurse practitioner in New Haven, echoed the war comparison.
“Most healthcare workers don’t feel very strong or heroic right now,” Morgan said. “They’ve been at war for a year, and it’s far from over. I really fear for the wave of anxiety and depression that will hit frontline workers when all of this is over, because right now, they don’t have access to the mental healthcare they need.”
Dayton said that in the last three months, an emergency department at Backus Hospital with 55 nurses lost ten of them, and a critical care unit of 12 nurses lost seven.
“On top of the regular death that we experience as part of our day-to-day jobs, you add the component of not having visitors, which means that doctors and nurses are often the only people there with patients for their last moments alive,” Dayton said. “One of our nurses had to hold a tablet for a 48-year-old guy as he said goodbye to his wife and 10-month-old child. As they were extubating him to let him die, his wife played their wedding song. That nurse will never be able to unhear that.”
At Backus Hospital, healthcare providers have an employee assistance program that includes some mental health treatment, but Dayton said it falls short, particularly during the pandemic.
“The hospital offers five sessions of free counseling, but especially right now, that’s not enough to even scratch the surface,” Dayton said. “A lot of my coworkers’ spouses have lost their jobs, and we have high deductible insurance. When you have to choose between paying for a therapy session or feeding your family, you choose feeding your family and defer the mental health treatment.”
Morgan said mental illnesses are often taken less seriously than physical ones, which is detrimental to her ability to treat them.
“As providers, we fight back against the stigma around mental health issues daily with our patients,” Morgan said. “Mental health issues are just as valid and important as physical health issues, and they go hand in hand.”
Even for medical providers, this stigma can be deeply ingrained, as is a desire to prioritize the well-being of others, even at their own detriment.
“All of our medical training tells us to help others and put others first,” Morgan said. “By nature, healthcare professionals are not good at reaching out for help, so the more messages doctors and nurses get that it is important to prioritize their well-being, it will really help to destigmatize mental healthcare. A bill like this that frames mental illness as equally valid to physical illness can only help solve that problem.”