The challenge of representing clients who have PTSD

By Tony Poland, LegalMatters Staff • More understanding and support are needed for healthcare workers suffering mental health issues precipitated by the coronavirus pandemic, says Toronto and Markham-area disability lawyer Rupa Karyampudi.

Many healthcare professionals – among them paramedics, nurses, doctors and long-term care staff – have suffered under the strain of three waves of COVID-19 with a fourth wave on the horizon. 

Karyampudi, a partner at MK Disability Lawyers, says she is seeing more cases of post-traumatic stress disorder (PTSD) as the pandemic drags on.

“Since the first wave hit, the healthcare field has been stretched thin. We have noticed an increase of PTSD and the associated conditions, especially in those who were on the front lines at the beginning of the pandemic,” she says. “Unfortunately, with some, mental health issues continued to be retriggered with each new wave.“

Karyampudi says her firm’s approach as trauma-informed lawyers helps them to better understand the needs of those suffering from post-traumatic stress disorder.

Diagnosing PTSD can be a challenge

She says the “mind-body connect is so often mysterious” and diagnosing PTSD can be a challenge, which can make claiming long-term disability daunting.

“There are misconceptions about PTSD, the first being that some believe you have to suffer something catastrophic to trigger it, but that’s really not the case,” Karyampudi tells LegalMattersCanada.ca. “It’s quite subjective. What may be a trauma for one person may not be for someone else.

“The negative effects of trauma are generally short-lived for most people,” she explains. “Within a couple of months, they can recover. But when you are dealing with PTSD it becomes more difficult to treat.”

According to non-profit mental health agency The Lifeline Canada Foundation, symptoms of post-traumatic stress disorder can occur when someone re-experiences the traumatic event, attempts to avoid thinking about it, or suffers from high levels of anxiety related to the trauma. Common symptoms can include:

• recurring nightmares;
• flashbacks or acting or feeling the incident is reoccurring;
• difficulties experiencing positive feelings, such as happiness or love;
• increased irritability or outbursts of anger;
• a physical response, such as sweating or a surge in heart rate when reminded of the trauma;
• difficulty falling or staying asleep;
• constant feeling of impending danger;
• avoiding thoughts, feelings, or conversations about the traumatic event; and,
• loss of interest in activities once considered important.

PTSD can be triggered by any number of events and getting treatment can be difficult.

‘It is an invisible illness, which makes it difficult to prove’

“It’s complex. Much of it is not easily understood,” says Karyampudi. “It is an invisible illness, which makes it difficult to prove because there’s no quote-unquote objective medical evidence. It is not like you can take an x-ray of what’s going on inside your brain.”

But the problem is real and is taking a toll on healthcare professionals, she says, pointing to reports of medical staff at overburdened hospitals who are so stressed out from working in what has been described as a “battleground” that they are leaving their jobs.

One Ontario intensive care nurse says the impact of the pandemic was too difficult to endure so she resigned for the sake of her well-being, according to the Globe and Mail.

“It just kept getting worse and worse,” Lynnsie Gough told the Globe. “I was having anxiety attacks where I would feel or be physically ill. I felt like I was going off to war or prison every day going into work.”

Karyampudi says those thinking of quitting should consult a disability lawyer before making a final decision. Healthcare workers can apply for disability benefits to receive treatment instead of leaving the profession, she says.

Stigma can make it difficult to speak up

While getting help is always the best option, Karyampudi says the stigma associated with mental health issues can make it difficult to speak up.

Global News interviewed multiple healthcare professionals who said people in the profession will avoid admitting they are struggling in case they are viewed as incompetent or weak.

“You go through this traumatic event and if you ask for help it can be problematic,” Dr. Dawn Lim, an emergency physician at Toronto’s University Health Network, told Global, adding there needs to be a change in the culture.

The Ontario Nurses Association surveyed long-term care staff last year, concluding “the emotional and psychological impact of working during the first wave cannot be overstated. Over half (50.7 per cent) of respondents who worked in a home with an outbreak report symptoms of post-traumatic stress disorder. The percentage increases to 60.8 per cent in homes with a large outbreak.”

A Statistics Canada poll of Canadian healthcare workers released earlier this year found that seven in 10 reported worsening mental health during the COVID-19 pandemic and that eight months into the global crisis, one-third reported fair or poor mental health.

Healthcare workers often put the welfare of others before themselves

Karyampudi says the profession has been under constant pressure, often putting the welfare of others before themselves.

“Doctors and nurses are trained to soldier on. Sometimes at the risk of their own well-being,” she says “But failing to deal with mental health issues can make things worse. Some of the symptoms of PTSD can affect your cognitive functioning and if you’re dealing with life and death decisions, you need to have all your focus and concentration.”

Karyampudi says many people suffering from mental health issues are entitled to insurance benefits but don’t know how to access them or may not have a clear grasp of their legal entitlements, especially in marginalized communities.

Filing a claim for benefits in a PTSD case can be especially trying since “insurance companies are very skeptical when it comes to invisible conditions,” she says.

Karyampudi says those suffering from mental health issues can best serve themselves by seeking help and keeping records of the treatment they receive.

“One of the most important things to remember is to document everything because the success of your claim relies on recording your symptoms and your functional limitations and restrictions,” she says. “There is no objective diagnostic test. But if you are consistent in reporting your symptoms to your doctor and seeking treatment that strengthens your case.”

Those with PTSD can face hurdles when filing a disability claim

Those suffering from post-traumatic stress disorder can face hurdles when filing a disability claim, not the least of which is that the process itself can cause trauma.

“A denial by the insurance company can be a retriggering,” she says. “Litigation can be adversarial. Having your personal life revealed to strangers to prove you are suffering from PTSD can also have a retraumatizing effect.

“We take a trauma-informed approach with a client,” Karyampudi adds. “We are more sensitive when it comes to clients and do what we can to make the litigation process easier on them.”

She believes in establishing relationships to make clients feel secure as they navigate through the legal system.

Karyampudi says the first step is to ensure a client is seeking help.

“A common reason an insurance company might terminate a claim is if the client is not getting appropriate treatment,” she says.

Sensitivity is key when representing those with PTSD, says Karyampudi, and she works to take some of the stress out of the litigation process when appealing a claim denial. For example, a client may not be comfortable being face-to-face with the insurer’s lawyer answering personal questions.

‘Much of what we do comes down to preparation’

“If there’s some triggering questioning expected in discovery, I will ask opposing counsel if I can put their questions to my client and provide responses in writing instead,” she says. “Much of what we do comes down to preparation. It is important to go through the file thoroughly to flag any potential issues so you have a plan going in.” 

Karyampudi says in the end, she must rely on the good will of the lawyer on the other side of the table when trying to accommodate a traumatized client.

“There is a bit more of a cultural shift toward the trauma-informed practice in general. That’s partially due to awareness of these issues,” she says. “I believe people more and more are understanding.  

“However, that understanding is very individualized at the moment. If the opposing lawyer is empathetic, they will cooperate,” Karyampudi adds. “But more of a structural change is needed. We are a profession that deals with human beings. It’s not just about logic and reasoning.”

More from MK Disability Lawyers:

More to representing traumatized clients than legal acumen