From answering distressing 9-1-1 calls to being first at the scene in a life-and-death situation, public safety personnel provide essential services to the public. However, these work-related experiences can also increase the risk of post-traumatic stress injuries (PTSIs).
PTSIs refer to mental health injuries that occur after a singular or repeated exposure to potentially traumatic events. These injuries may take workers off the job for long periods as part of their recovery. Between 2017 to 2021, an estimated 19 per cent of workers in paramedic services, as well as six to eight per cent in police services and five per cent in firefighting, made a mental health injury compensation claim for PTSI or other mental health injuries to Ontario’s Workplace Safety & Insurance Board (WSIB).
Mental health injuries and their symptoms are complex and can vary for individuals. These injuries also pose return-to-work challenges that are different from those related to physical injuries. That’s why the WSIB tasked Trillium Health / Insight Health Solutions to create a program to assess and treat public safety personnel with PTSI arising from work—called the First Responder Mental Health Treatment Program (FRMHT).
As the program is in its early stages, a joint team of researchers from the Institute for Work & Health (IWH) and the Institute for Better Health (IBH) collaborated on a multi-part evaluation of the program.
A recently completed part of the evaluation, co-led by Dr. Basak Yanar, a scientist at IWH, and Dr. Cameron Mustard, an adjunct scientist at IWH, aimed to identify the needs, experiences and challenges of employers in helping public safety workers with PTSI return to work. Although this component of the evaluation did not focus on the treatment or post-treatment experiences in the FRMHT program, the findings in this report can inform the continued evolution of the program.
IWH researchers conducted 39 interviews with representatives of 28 Ontario public safety organizations—including police, corrections, paramedic and fire services—and 11 unions and associations. Employer representatives were individuals in roles related to human resources, disability management or health and wellness, and who were involved in supporting employees with PTSI to return to work. For the purposes of the study, PSTI included clinically diagnosed or non-diagnosed mental health injuries such as PTSD or anxiety.
The representatives we spoke to recognized that PSTI is a consequence of this kind of work,
says Yanar. In general, returning public safety workers with a mental health injury back to work is seen as quite challenging for organizations. Though many of the representatives we talked to had taken their own steps to try to improve the return-to-work process for these workers, challenges remained in several areas.
The researchers found that the experiences and challenges of interviewees supporting workers with PTSI centred around four themes, namely:
- prevalence and complexity of PTSI;
- organizational factors;
- collaboration with external stakeholders; and
- communication and trust.
Prevalence and complexity of PTSI
Interviewees noted that PTSIs are complex injuries. The type and duration of symptoms or work limitations can vary widely between individuals. Events or locations that could trigger symptoms will also vary, and workers may not know what these triggers are until they experience them on the job. For these reasons, a given accommodation might work for one person, but not another.
For workers with a mental health injury, it can be very difficult to identify what they can and cannot do on the job, and how to accommodate them,
says Yanar. It’s important to understand the different cognitive and interpersonal limitations these workers can have when preparing them to return to work.
Organizational factors
The ability to support or accommodate public safety workers with PTSI also depends on characteristics of the employer. Larger organizations likely have more means than smaller ones to manage PSTI claims or accommodate staff by moving them to different departments or job roles.
Stigma within organizations about mental health can also complicate return-to-work processes. Interviewees noted that managers may not think that staff receiving accommodations for a mental health injury can do their job properly. Self-stigma can also prevent people in public safety jobs from asking for help if they’re experiencing a mental health injury.
There’s been a shift in society to be more understanding of these types of mental health injuries, as we heard in our interviews,
says Leslie Vesely, research associate at IWH and member of the research team. Younger or newer employees are often more open about these issues, but employers saw that stigma persists in a lot of these organizations.
Collaboration with external stakeholders
In the return-to-work process, public safety organizations collaborate with the WSIB, community mental health-care providers and unions and associations. Interviewees noted that a key challenge was related to communication and information sharing among stakeholders—such as a lack of timely updates or check-ins by case managers to employers or injured workers.
The researchers also heard that health-care providers often lacked specialized knowledge about public safety roles and experiences. As a result, they may not know about possible work accommodations or document restrictions and limitations that are too vague or too impractical to put in place.
And though unions and associations were generally thought to play an important advocacy and support role for these workers, they may not always have the time or resources to do so.
Communication and trust
An overarching theme was the importance of communication and trust in all aspects of a successful return-to-work process,
says Yanar. Timely and accurate communication between all the different stakeholders involved and the public safety worker or the employer is important and can be impacted if there is a lack of trust.
A challenge the researchers heard was that some workers can have a strained relationship with their employers. They may not trust that their employer cares for their wellbeing if they’ve felt unsupported in the face of challenging work conditions. Because of this lack of trust, the injured individual may be reluctant to communicate with their employer while they’re off work.
Facilitators of a successful RTW
Most of the interviewees wanted to be more involved and to find better ways to support workers with PTSIs. During the interviews, many shared innovative practices they were using to improve these processes.
Employers are thinking about preventative approaches that promote mental health,
says Yanar. It’s refreshing to see, as historically this wasn't often the case. They’ve been creative in their approaches to supporting these workers, like making the effort to tailor accommodations to the person or the job tasks that workers have difficulty with.
Employers also spoke about improvements to the RTW process and workers’ compensation system that they would like to see. These include establishing procedures to track workers’ mental health over their career, and especially after critical incidents. Some employers also wanted to see regular mental health training for staff and managers and dedicated wellness teams. Other recommendations involved more cohesive systems for working with community mental health providers and case managers, and more graduated and tailored reintegration model that can be adapted to the pace of a public safety worker’s recovery. Employers also highlighted the importance of creating an organizational culture that values psychological safety, communication and trust—a work environment in which someone with PTSI would feel comfortable voicing their needs and help guide their return to work.
During our interviews, we heard about public safety personnel who experienced mental health injuries from their jobs and were then unable to work for years,
says Mustard. This issue is prevalent and complex. Supporting these workers to return to their jobs requires a lot of coordination between different stakeholders, and it’s important to strengthen these processes to make sure no one falls through the cracks.