Employers face a range of challenges when supporting workers in public safety occupations return to work following a work-related post-traumatic stress injury (PTSI), a recent Institute for Work & Health (IWH) study has found.
But in the face of these obstacles, how can employers improve their ability to help these workers return to work?
One out of every 100 first responders in a typical year is going to be disabled by a work-related post-traumatic stress injury,
says Dr. Cameron Mustard, IWH adjunct scientist who co-led the study with Dr. Basak Yanar, IWH scientist. That includes public safety personnel (PSP) in police, fire, paramedic and corrections services. These workers tend to be off work for long periods, with over 40 per cent having a compensation claim that lasts two or more years.
As previously outlined, the return-to-work challenges faced by employers range from the complexity and individuality of symptoms to organizational stigma, and communication issues with third parties involved in the return-to-work process.
In their IWH Speaker Series presentation on February 25, 2025, Yanar and Mustard provided an on-the-ground picture of what some employers have been doing to improve return-to-work outcomes for public safety workers with PTSI, as heard in their interview-based study.
What are employers doing to improve return-to-work outcomes?
Strengthening organizational capacity
The researchers heard that some employers were looking within their own organization to find ways to improve return-to-work for these workers.
Many employers expressed that they either had or wanted to create a dedicated abilities management team. They described the importance of bringing in staff who have expertise in HR, wellness and abilities management who can bring in new and creative perspectives to the organization, effectively support PSPs and build trusting relationships with PSPs,
says Yanar.
They also heard about organizations providing ongoing mental health supports such as by bringing in staff psychologists and creating peer support programs. One fire service employer described a peer support program that pairs a worker who is beginning to return to work with a peer who will guide them through the process.
Tailoring return-to-work processes
As PTSI symptoms and recovery tend to vary across individuals, employers also spoke about their efforts to tailor return-to-work processes. This included having reintegration programs that tailor the pace at which workers return to work and the duties they perform upon their return on the workers’ individual needs.
In one employer’s approach, the individualized support began when the PSP went off work,
says Yanar. The participant described speaking with the PSP about how often they would like to be contacted, by whom, and how, trying to meet these needs while being transparent about the organization’s limitations
.
They talked about a plan that gradually increases hours and exposure to the pre-injury role, at a pace that is negotiated with the PSP,
notes Yanar.
Managing external relationships
Supporting return-to-work of PSPs is a team effort that involves multiple stakeholders,
says Yanar. Some employers spoke of providing information packages to workers’ compensation case managers and health-care providers with a list of potential accommodations and the supports that the organization can provide. They noted that having case managers and health-care providers who are knowledgeable about an organization’s specific profession was also helpful. Some spoke about inviting care providers to the organization to learn about aspects of the work and their accommodations, or to conduct exposure therapy on-site.
Working with third parties to improve internal processes
Employers also spoke about using third-party expertise to bolster the return-to-work process. Some talked about contracting a third-party disability management company to support the management of the claim process. Others spoke about partnering with community health-care providers to provide interim support if a public safety worker is struggling to find a permanent care provider. Organizations with ties to municipalities or the Ontario Public Service were also able to reach out to find alternative accommodations when they could not provide meaningful work for a returning worker in their own organization. This was especially beneficial in situations where a PSP was permanently unable to return to work in their pre-injury job,
says Yanar.
Additionally, unions and associations played an important role in facilitating relationships between employers and PSPs,
says Yanar, adding that study participants noted that PSPs tended to trust their associations. For this reason, involving these stakeholders in return-to-work planning—if a worker preferred—was seen as a way to build trust with the public safety worker.
Study background
As of 2016, a diagnosis of post-traumatic stress disorder (PTSD) in a public safety worker is automatically assumed by the Workplace Safety and Insurance Board to have been caused by work. (PTSD refers to a clinical diagnosis, whereas PTSI is a non-clinical term that refers to a range of mental health injuries, including PTSD, operational stress injuries, anxiety, and depression.) Since then, in Ontario, there have been between 1,200 and1,400 accepted compensation claims for PTSD per year. This, paired with long claim times for these injuries, prompted the development of a mental health treatment program specifically aimed at public safety workers worth PTSI.
Yanar and Mustard, along with a team at the Institute for Better Health, were tasked with evaluating the program.
One part of that evaluation was a series of very valuable conversations with representatives of public safety employer organizations about their practices and challenges in supporting recovery and return-to-work among their members,
says Mustard. These perspectives will help to inform any changes to the design of the program.
In facing the challenges of an increasing number of PTSI claims it is heartening to see that some workplaces are trying to put in place systems or approaches to help workers get back to work,
says Yanar. It’s important to note that we don’t yet know if these activities are making a difference, but it is an important area for future research.