Mental Health and Wellness for Public Safety Personnel
IT IS THEREFORE RESOLVED THAT the Alberta Urban Municipalities Association request that the Government of Alberta work cooperatively with public safety personnel organizations and allied stakeholders to research, develop and implement evidence-based solutions to address mental health and wellness of public safety personnel in the Province of Alberta.
WHEREAS: Public safety personnel are defined as those professionals who work in a field that, due to the nature of their operational duties to protect the safety of others, are necessarily exposed to potentially psychologically traumatic events with exceptional frequency (Carleton et al., 2019);
WHEREAS: Public safety personal appear to be at an increased risk for developing a psychological injury due to their nature of their work (Carleton et al., 2019, 2020) and 44.5% meet the criteria for one or more mental disorders (Carleton, 2018a);
WHEREAS: Posttraumatic stress disorder (PTSD) is a potentially disabling condition that is now a widely recognized public health issue, particularly among public safety personnel. A recent study conducted by Carleton et al. (2018) investigated the proportion of Canadian public safety personnel reporting symptom clusters consistent with various mental disorders. The results indicated that 23.2% of the total sample screened positive for PTSD (in contrast, estimates of the prevalence of PTSD among the general population range from 1.1 to 3.5%);
WHEREAS: Public safety personnel report suicidal behaviours at rates up to three times the rates for the general population (Carleton, 2018b);
WHEREAS: Significant stigmas associated with mental health remain, despite relatively recent improvements (Krakauer et al., 2020; McCall et al., in press; Ricciardelli et al., 2020). Public safety personnel require resources that are confidential and career specific; policies and procedures that normalize mental health disorder as a job hazard, not a personal failure; effective education to increase awareness and buy-in (beginning with leadership); social support from peers and leaders; and integrative return-to-work policies; and
WHEREAS: Municipalities are the employers of public safety personnel and derive community safety benefits from an engaged mentally healthy and resilient workforce, which requires coordinated evidence-based solutions to support the best interests of these jurisdictions.
*They run in when everyone else runs out
Public safety personnel are people who respond to the scenes of emergencies, and include police, firefighters, and paramedics, among other emergency personnel. Public safety personnel work by definition involves frequent exposures to potentially psychologically traumatic events, such as witnessing deaths and injuries, including the deaths or major injuries of children and mass casualty events; as such, the number of exposures public safety persons can have in one week may be more than what members of the general public experience in a lifetime! Public safety personnel report having varied responses to the events depending on numerous dynamic factors, Public safety personnel have typically worked in a “suck it up” culture – for themselves and for others – often facing problematic and punitive comments for the public, such as “you knew what you signed up for”. Thus, various types of stress reactions, including posttraumatic stress disorder symptoms, can gradually and progressively build up over time. Increasing exposures can result in cumulative trauma. The stigma associated with being a “helper” who then asks for help has been and remains unacceptably prevalent in public safety personnel organizations, and can be a significant barrier to seeking much needed help.
Other factors can impact the mental health of public safety personnel, including shift work, disruptions to family and social lives, and perceived levels of organizational support.
Public safety personnel have often continued to work for a long time after becoming injured, despite reduced ability to cope and continued subsequent exposures to potentially psychologically traumatic events. Eventually, public safety personnel may reach a “breaking point”, even after what may appear to be a relatively common place exposure, as a result of the cumulative stressors. A comparison can be made to injuring one’s ankle. If one continues to walk on the ankle without allowing time for healing, the ankle may become increasingly vulnerable to re-injury.
Historically, public safety personnel have, at times, experienced difficulty having the cumulative impact of exposures and stress be recognized by employers and worker’s compensation boards. Some have even had compensation claims denied due to difficulty identifying a singular work-related event that could be considered “uncommon enough” relative to their other work experiences to “explain” or “justify’ a mental health diagnosis, such as Posttraumatic Stress Disorder.
In a 2016 study, the Canadian Institute for Public Safety Research and Treatment (CIPSRT) found that 75% of public safety organizations who reported having a mental health program in place failed to meet the basic standards of the program’s model (Authors, 2016). Another study warned against such variations from a model’s validated protocols with the potential of such unfounded variations causing iatrogenic harm (Fikretoglu et al., 2019). In another 2019 study, CIPSRT found that most programs overlook the type of help public safety personnel are most willing to access (Carleton et al., 2019b). Thus, with the current research, we have never been more informed to improve the mental health and wellness programming we provide to our public safety personnel - those persons whose every workday is responding to the worst days of the publics’ lives.
*Canadian Mental Health Association
SOURCES:
Authors et al., (2016). Peer Support and Crisis-Focused Psychological Intervention Programs in Canadian First Responders: Blue Paper. University of Regina. Canadian Institute for Public Safety Research and Treatment.
Bikos, L.J. (2020) “It’s all window dressing:” Canadian police officers’ perceptions of mental health stigma in their workplace. Policing: An International Journal, 44(1), 63-76. https://doi.org/10.1108/PIJPSM-07-2020-0126
Carleton, R. N. et al. (2020). Assessing the Relative Impact of Diverse Stressors Among Public Safety Personnel. International Journal of Environmental Research and Public Health, 17. https://doi.org/10.3390/ijerph17041234
Carleton, R. N. et al. (2019). Exposures to Potentially Traumatic Events Among Public Safety Personnel in Canada. Canadian Journal of Behavioural Science, 51, 37-52. https://doi.org/10.1037/cbs0000115
Carleton, R. N. et al. (2018b). Suicidal ideation, plans, and attempts among public safety personnel in Canada. Canadian Psychology, 59, 220-231. https://doi.org/10.1037/cap0000136
Carleton, R. N. et al. (2018a). Mental Disorder Symptoms Among Public Safety Personnel. Canadian Journal of Psychiatry, 63, 54-64. https://doi.org/10.1177/0706743717723825
Krakauer, R. L. et al. (2020). Examining mental health knowledge, stigma, and service use intentions among public safety personnel. Front Psychol, 11, 949. https://doi.org/10.3389/fpsyg.2020.00949
McCall, H. C. et al. (in press). Stakeholder perspectives on Internet-delivered cognitive behavioural therapy for public safety personnel: A qualitative analysis. Canadian Journal of Behavioural Science. doi: 10.1037/cbs0000242
Ricciardelli, R. et al. (2020). "Playing the system": Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel. Health, 24(3), 259-278. https://doi.org/10.1177/1363459318800167
Summary prepared by E. Kossick Reviewed & edited by B. Barootes and Bikos, L.J
The Minister notes in his response to the resolution that the province provides funding to the following programs and services:
- Supporting Psychological Health in First Responders Grant Program:
- This program has two funding streams.
- Stream 1 (Services) provides funding to non-profit organizations that provide services to first responders and emergency health care workers living with or at risk for PTSI.
- Stream 2 (Research) provides funding to researchers engaged in applied research that generates evidence on prevention or intervention for first responders and emergency health care workers living with or at risk for PTSI.
- $1.5 million was available annually through this grant program in both 2021-22 and 2022-23. A list of funded projects in 2021-22 is attached (Attachment 3).
- Heroes in Mind, Advocacy and Research Consortium:
- This consortium is a partnership between Alberta Health Services, the Canadian Armed Forces 3rd Canadian Division, Covenant Health, the Faculty of Rehabilitation Medicine, University of Alberta, the Glenrose Foundation, the Northern Alberta Institute of Technology, the Royal Canadian Legion Alberta and NWT Division, and Veterans Affairs Canada.
- The consortium works to determine effective prevention strategies, interventions, services, and supports that enable military members, veterans, and public safety personnel to be resilient, ready, and growth-oriented.
- The province provides funding to the consortium through the Supporting Psychological Health in First Responders Grant Program.
The Minister also states that “Alberta Health Services provides a full continuum of addiction and mental health services and initiatives that target trauma broadly and encompass specific solutions for those diagnoses with post-traumatic stress disorder.”
ABmunis’ Rating of the Government’s Response
Intent not met – further action will be taken at a medium to high level of engagement.
ABmunis’ Notes and Actions
While it is encouraging that the province has a designated program to support mental health for public safety personnel, it is not clear that there is adequate funding to support all public safety personnel in all regions of the province. The Alberta Emergency Medical Services (EMS) Provincial Advisory Committee made several recommendations on improving working conditions for first responders, including providing mental health supports, along with other actions to support staff recruitment and retention. Although these recommendations were accepted, it is unclear when and how the province will implement them. Additionally, predictable, ongoing funding for service providers would be preferable to one-time annual grants. Lastly, all Albertans continue to face barriers to accessing mental health supports and services, including lack of transportation, lack of local services providers, and lack of health insurance to cover mental health services. Accordingly, ABmunis highlighted this issue in meetings with the Minister and AHS EMS staff; our monitoring of the implementation of Alberta EMS Provincial Advisory Committee recommendations; our 2023 election strategy; and our analysis of the
2023 Budget.