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
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.
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
AUMA does not currently have a position on this specific issue, but the topic generally aligns with AUMA advocacy on the need for enhanced mental health supports. If this resolution is passed, it would be forwarded to the Government of Alberta for response and further advocacy would be recommended to AUMA’s Board by AUMA’s Safe and Healthy Communities Committee within the context of related priorities and positions.