On June 21, 2018, the Federal Framework on Post-Traumatic Stress Disorder Act became law, after receiving all-party support in the Parliament of Canada. This ground-breaking Act acknowledges that those in certain occupations, including public safety personnel (PSP) such as police, firefighters, paramedics, search and rescue personnel, Indigenous emergency managers, correctional employees, operational and intelligence personnel, border services personnel, and public safety communicators, along with healthcare professionals (HCPs) and military personnel, are at greater risk of exposure to potentially traumatic events, and therefore a re more likely to develop posttraumatic stress disorder (PTSD) than the general population, just by doing their jobs (Public Health Agency of Canada [PHAC], 2019). The Act mandated PHAC to lead a coordinated, national approach to recognize PTSD among those within these occupational groups and, through this recognition, to help lay the groundwork for more timely access to mental health and well-being supports for those affected. As such, the Federal Framework on PTSD was created by PHAC in collaboration with multiple stakeholders. Through research, promotion, and implementation of best practices, education, awareness, and evidence-based treatments, this framework seeks to ensure the creation of solutions for those affected by occupation-related PTSD. The Federal Framework on PTSD Act was passed in 2018, and its relevance has only increased in significance during the COVID-19 pandemic.
According to preliminary data from a study on the mental health effects of working the frontlines of the COVID-19 pandemic, 35% of Canadian PSP scored above 33 on the PCL-5, a self-report psychological instrument that assesses for the diagnostic symptoms of PTSD. Scores above 33 on the PCL-5 are compatible with the presence of symptoms severe enough to require formal treatment for PTSD. Furthermore, when screened for symptoms of depression, anxiety, and stress using the Depression, Anxiety, and Stress Scale 21 (DASS-21), an alarming percentage of PSP scored within the moderate to extremely severe range for depression (41%), for anxiety (over 38%), and for stress (32%) (Ritchie et al., 2022). In addition to these findings in PSP, research indicates that 86.5% of HCPs reported feeling more stressed at work during the pandemic, and nearly 18% indicated that they intend to change jobs or leave their current job within the next 3 years, with job stress or burnout being the most common reason, followed by concerns about their mental health and well-being (Statistics Canada, 2022). Other Canadian-based studies reported similar findings (Brophy et al., 2020; D’Alessandro-Lowe et al., 2022; Wilbiks et al., 2021). These results shed light on the devastating effects of the pandemic on the mental health of Canadian PSP and HCPs, and on the urgent need for resources to help support and rebuild their mental health and well-being in the face of COVID-19.
In response to such findings, the Government of Canada, in its 2021 Budget, committed an investment of up to 50 million dollars over 2 years to support the creation of evidence-informed projects and resources to address PTSD symptoms and other mental health conditions in frontline and essential workers and their families, as well as caregivers, who have been most affected by the pandemic. As part of this commitment, in June 2022, the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health, announced a 28.2-million-dollar investment to create mental health supports for these workers (PHAC, 2022). During that announcement, Minister Bennett stated:
Canada’s frontline and essential workers have sacrificed much to keep us healthy and safe throughout the pandemic, and they deserve our support. With [this] investment, our government is helping create new tools to support those most at risk for PTSD, and is encouraging their healing process, all while reducing stigma and removing barriers to care. To all frontline workers – we are incredibly grateful for your continued dedication and commitment to caring for our communities. Thank you!
This funding supports the work being done by nine applied research projects to develop these resources for Canadian PSP, HCPs, military personnel, Veterans, their families and the people who support them. In addition, this funding is supporting the creation of a Knowledge Development and Exchange Hub, the Canadian Institute for Pandemic Health Education and Response (CIPHER), which will host, promote, and share the resources developed by the nine projects and will help to inform and enhance Canadian COVID-19-related mental health literacy, policy, and practices going forward. Following is a brief description of CIPHER and the nine research projects.
CIPHER curates and mobilizes the information and resources developed by the nine government-funded projects, supports evaluation and measurement of outcomes, and provides a space for knowledge exchange and collaboration among the projects. CIPHER activities encourage the creation of high-quality, evidence-informed, accessible, and practical interventions, training materials, and supports for Canadian PSP, HCPs, military personnel, Veterans, their families, and the service providers who care for them. CIPHER will serve as a template for networking with existing organizations to provide rapid responses that address significant mental health challenges for these “first-responders,” now and into the future.
The Advancing Peer Support Programming project is working to provide a coordinated national approach to peer support for PSP and Veterans and enabling evidence-based improvements and standardization—ultimately leading to independent nationally recognized accreditations. This project is also developing and deploying a mobile health platform that provides private and secure access to peer support.
The Beyond Silence project is creating and testing a new and innovative peer support e-mental health app that improves opportunities for HCPs to build mental health literacy, reduces barriers to seeking support, and provides real-time access to confidential peer support. The app is designed to promote early intervention and mental health support for frontline HCPs to reduce their risk of PTSD and the mental health impacts of the COVID-19 pandemic.
The Bringing Mental Health Resources to Long-Term Care project equips long-term care staff with the capacity to deliver training that builds a common baseline of knowledge on what mental health is, why it matters, and what to do when mental health needs are identified in oneself or ones’ peers. This program builds on the unique complexities in long-term care through a customized version of The Working Mind program and implements a train-the-trainer model, so staff can administer the customized course in their long-term care home.
The Expansion and Evaluation of the Before Operational Stress (BOS) project offers training to support Canadian PSP and HCPs who are regularly exposed to traumatic events and posttraumatic stress injuries in the context of the ongoing COVID-19 pandemic. The BOS program is being deployed by Wayfound Inc., and the Canadian Institute for Public Safety Research and Treatment (CIPSRT) is conducting an independent research study to evaluate the effectiveness of BOS across delivery modalities.
The Healthcare Salute project is designed to support the mental health and well-being needs of Canadian HCPs serving throughout the COVID-19 pandemic. This project is developing evidence-based resources for affected and at-risk healthcare populations using HCPs’ own experiences and equipping healthcare support and allied organizations to recognize and support HCPs affected by trauma and PTSD during the COVID-19 pandemic.
The Promoting Positive Mental Health and Well-being project is adapting Canada’s Department of National Defence’s mental health literacy and resilience program, Road to Mental Readiness (R2MR), and tailoring it to meet the unique mental health and well-being needs of Canadian HCPs who have been impacted by the COVID-19 pandemic. This includes creating user-friendly tools that highlight elements such as moral distress, organizational structures, institutionalized practices, and leadership.
PSPNET Families serves the needs of PSP family members experiencing mental health challenges and stressors related to the occupational risks faced by their PSP loved ones. PSPNET Families is complementary to PSPNET, a federally funded online service that offers internet-delivered cognitive behavioural therapy to PSP.
Resilient Minds™ is a trauma-informed, peer-to-peer training program designed to enhance the personal resilience of fire services personnel. The Canadian Mental Health Association is adapting, translating, piloting, evaluating, and implementing Resilient Minds™ for both Francophone fire fighters and Indigenous fire fighters who have been affected by or are at higher risk of trauma-related psychological impacts due to their line of work and the COVID-19 pandemic.
The Training and Development Program for Public Safety Personnel project improves access to relevant and urgent training for PSP and stakeholders. It expands upon CIPSRT’s existing training program, the R2MR Train the Trainer Program, provides new modalities and increased reach for existing training, such as an electronic R2MR, and pilots the testing and expansion of the CIPRST’s newest training opportunities, such as “Treatment 101.”
The important work being done through these projects is a crucial part of the larger pan-Canadian effort to support the mental health and well-being of PSP, HCPs, military personnel, Veterans, and their families to heal, recover, and thrive in the COVID-19 environment and aftermath. The team at CIPHER is honoured to support, highlight, and promote the resources being created by these nine projects, and to support the well-being of all those who have sacrificed so much to ensure the health and safety of all Canadians.
CIPHER and the nine research projects are currently being supported though the Public Health Agency of Canada’s investment Supporting the Mental Health of Those Most Affected By COVID-19. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
The authors declare that they have no conflicts of interest to report.
*Canadian Institute for Pandemic Health Education and Response, Regina, SK, Canada,
†Department of Psychiatry and Behavioural Neurosciences at McMaster University, Hamilton, ON, Canada..
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1Adapted from “The CIPHER mandate: Addressing the mental health impacts of COVID-19 on Canada’s public safety personnel, healthcare professionals, their families and caregivers,” by A. Heber & A. Schick, in press, JUSTICE Report, 38(2). Copyright 2023 by Canadian Criminal Justice Association (CCJA). Adapted with permission. ( Return to Text )
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Journal of CSWB, VOLUME 8, NUMBER Suppl 1, February 2023