Evaluation of Before Operational Stress: A Program to Support Mental Health and Proactive Psychological Protection in Public Safety Personnel

Workplace Programs to Reduce Post-traumatic Stress Injuries Work Disability: First Responder Experiences

PURPOSE

First responders (FR-police, firefighters, paramedics) are exposed to trauma which can result in post-traumatic stress injuries (PTSI). Despite a lack of strong evidence on interventions to address PTSI work disability, workplace PTSI programs and policies are necessary to prevent work disability. The study objective was to examine experiences and perspectives about workplace programs, policies, and experiences related to the prevention of PTSI work disability among FR in Alberta, Canada.

METHODS

This qualitative study collected the perspective of police members, firefighters, and paramedics in Alberta, Canada regarding current workplace PTSI programs and policies. Qualitative interview data underwent descriptive thematic analysis.

RESULTS

Interviews were conducted with 47 FR members from police (16), fire (16), and paramedic (15) services who shared their experience with PTSI and workplace programs and policies. Three key themes emerged: improving culture, programs under development, and trusted communication. Three additional themes related to recommendations to improve programs and policies in the workplace were also identified: streamlined processes, better resources, and continue to reduce stigma. The themes and recommendations from participants provide practical information about how programs and policies can be improved.

CONCLUSION

Interviews provided rich descriptions of current FR workplace PTSI practices and policies. While participants noted that awareness about PTSI and the culture of FR workplaces has improved, more needs to be done. Paramount were recommendations regarding the need for streamlined processes and better resources to reduce PTSI work disability. Study findings suggest that the development and implementation of workplace PTSI programs have a positive impact on FR organizations and on the mental wellbeing of the FR workforce. Future research should examine FR workplace program and policy development as well as implementation.

Psychological health and safety of criminal justice workers: a scoping review of strategies and supporting research

BACKGROUND

People working in the criminal justice system face substantial occupational stressors due to their roles involving high-risk situations, trauma exposure, heavy workloads, and responsibility for public safety. Consequently, they have a higher prevalence of mental health problems than the general population. Employees identifying as women, Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, Intersexual, Asexual, and all others (2SLGBTQIA+), or Black, Indigenous, and People of Color (BIPOC), may experience additional stressors due to discrimination, harassment, and systemic barriers to seeking and receiving support. Psychoeducational and psychosocial programs have shown mixed effectiveness for preventing or reducing occupational stress, emphasizing the urgent need for multi-level, comprehensive, system-wide approaches. This scoping review aimed to capture and consolidate recommendations from strategies, frameworks, and guidelines on supporting the psychological health of criminal justice workers.

RESULTS

The scoping review of 65 grey and 85 academic literature records presents recommendations aimed at improving the psychological health and safety of criminal justice system workers. Findings were mapped by occupational groups to the Social-Ecological Model and accounted for factors across the individual, interpersonal, institutional, and policy levels. The most common recommendation across all criminal justice occupational groups was workplace mental health training to reduce stigma, encourage help-seeking, prepare workers for traumatic incidents, and promote culturally responsive approaches. At the individual level, physical health, healthy lifestyle choices, and coping strategies were widely recommended. Interpersonal interventions, including peer support and models emphasizing wraparound care, were also recommended. Institutional factors such as fair workloads, safe working conditions, and harassment-free workplaces were emphasized. At the policy level, presumptive coverage policies and adequate funding for staffing needs were highlighted.

CONCLUSION

This scoping review captured intersecting strategies and recommendations, consisting primarily of individual- and institutional-level supports and services. Fewer records discussed the need to address structural and policy considerations such as labor shortages, patchy mental health benefits, underfunding, and discrimination. The review highlights the need for shared responsibility across different levels, providing a framework for improving the psychological health and safety of criminal justice workers.

Examining the Role of Psychological Symptoms and Safety Climate in Shaping Safety Behaviors Among Construction Workers

Construction workers are often subjected to strenuous manual labor, poor working conditions, and prolonged separation from family, leading to psychological symptoms such as stress, depression, and anxiety. These psychological factors, combined with safety climate elements like risk perception and safety attitude, significantly influence workers' safety behaviors, including risk-taking, safety compliance, and safety participation. To address these issues, this study investigates the interplay between psychological symptoms, safety climate, and safety behaviors among construction workers in Mainland China. Data were collected through a survey of 160 construction workers, with results analyzed using correlation and regression techniques. The findings reveal that: (1) risky behavior is primarily driven by anxiety and risk perception; (2) safety participation is influenced by safety attitudes and levels of depression; and (3) safety compliance is affected by risk perception, safety attitude, stress, and depression. Interestingly, an inverse relationship is observed between depression and both risky behavior and safety compliance. These results underscore the importance of addressing psychological well-being to improve safety outcomes. Practical implications include providing psychological counseling, stress management training, and improving social connections for workers, such as facilitating regular video calls with family members or offering travel reimbursements.

Correctional officers and the ongoing health implications of prison work

Correctional Service Providers (CSP), including Correctional officers (COs), are key front-line figures in prisons globally, with responsibility for a wide range of daily prison operations. Over the past decade, research on prison staff has massively grown. However, the portrait this scholarship draws is concerning. Research focusing on the physical, mental, and social wellbeing of prison staff consistently paints a picture of a deeply unhealthy group of people, with above-average levels of physical health concerns. Likewise, recent literature suggests correctional employees are facing a mental health crisis, with high prevalence of mental health disorders and self-harming behaviors, even when compared to other law enforcement personnel. Further, scholars have expressed concerns about the social and cultural wellbeing of staff, factors that directly impact daily prison operations. We conduct a broad overview of the literature on correctional worker health and wellness, identifying key themes and major areas of concern. We conclude by identifying key challenges and proposing areas for future research.

Strengthening the military stoic tradition: enhancing resilience in military service members and public safety personnel through functional disconnection and reconnection

This paper addresses operational stress injuries (OSIs) among military service members (SM) and public safety personnel (PSP) resulting from prolonged exposure to potentially psychologically traumatic events (PPTEs). While psychotherapeutic interventions for post-traumatic stress injuries (PTSIs) are well established, there is a significant gap in evidence-based mental health training programs addressing proactive mitigation of negative outcomes from PPTEs. Building on the Functional Disconnection/Functional Reconnection (FD/FR) model, we introduce FD/FR 2, emphasizing early identification and management of psychological risks. FD/FR 2 discusses the practice of emotional suppression, or "pseudo-stoicism," and its potential negative impact on mental health. By integrating authentic Stoic principles, FD/FR 2 offers practical exercises to enhance resilience and well-being, addressing a critical need in current training approaches for military SM and PSP.

Evaluating the before operational stress program: comparing in-person and virtual delivery

Introduction

Public safety personnel (PSP) are at increased risk for posttraumatic stress injuries (PTSI). Before Operational Stress (BOS) is a mental health program for PSP with preliminary support mitigating PTSI. The current study compared the effectiveness of delivering BOS in-person by a registered clinician (i.e., Intensive) to virtually delivery by a trained clinician (i.e., Classroom).

Methods

Canadian PSP completed the Intensive (n = 118; 61.9% male) or Classroom (n = 149; 50.3% male) program, with self-report surveys at pre-, post-, 1 month, and 4 months follow-ups.

Results

Multilevel modelling evidenced comparable reductions in anxiety (p < 0.05, ES = 0.21) and emotional regulation difficulties (ps < 0.05, ESs = 0.20, 0.25) over time with no significant difference between modalities. Participants discussed benefits of the delivery modality they received.

Discussion

The results support virtual delivery of the BOS program (Classroom) as an accessible mental health training option for PSP, producing effects comparable to in-person delivery by clinicians.

Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis

BACKGROUND

Research supports that public safety personnel (PSP) are regularly exposed to potentially psychologically traumatic events and occupational stress, which can compromise their well-being. To help address PSP well-being and mental health, peer support is increasingly being adopted (and developed) in PSP organizations. Peer support apps have been developed to connect the peer and peer supporter anonymously and confidentially, but little is known about their effectiveness, utility, and uptake.

OBJECTIVE

We designed this study to evaluate the functionality and use of the PeerConnect app, which is a vehicle for receiving and administering peer support. The app connects peers but also provides information (eg, mental health screening tools, newsfeed) to users; thus, we wanted to understand why PSP adopted or did not adopt the app and the app's perceived utility. Our intention was to determine if the app served the purpose of connectivity for PSP organizations implementing peer support.

METHODS

A sample of PSP (N=23) participated in an interview about why they used or did not use the app. We first surveyed participants across PSP organizations in Ontario, Canada, and at the end of the survey invited participants to participate in a follow-up interview. Of the 23 PSP interviewed, 16 were PeerConnect users and 7 were nonusers. After transcribing all audio recordings of the interviews, we used an emergent theme approach to analyze themes within and across responses.

RESULTS

PSP largely viewed PeerConnect positively, with the Connect feature being most popular (this feature facilitated peer support), followed by the Newsfeed and Resources. App users appreciated the convenience of the app and felt the app helped reduce the stigma around peer support use and pressure on peer supporters while raising awareness of wellness. PSP who did not use the app attributed their nonuse to disinterest or uncertainty about the need for a peer support app and the web-based nature of the app. To increase app adoption, participants recommended increased communication and promotion of the app by the services and continued efforts to combat mental health stigma.

CONCLUSIONS

We provide contextual information about a peer support app's functionality and use. Our findings demonstrate that PSP are open to the use of mental health and peer support apps, but more education is required to reduce mental health stigma. Future research should continue to evaluate peer support apps for PSP to inform their design and ensure they are fulfilling their purpose.

Putative risk and resiliency factors among Royal Canadian Mounted Police cadets

Objective

Mental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons.

Methods

Cadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations.

Results

Cadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex.

Conclusion

Cadets’ significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers’ comparatively higher prevalence of mental health disorders over time.

Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.

Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review

OBJECTIVES

Increasing access to mental health support is a key factor for treating mental disorders, however, important barriers complicate help-seeking, among them, mental health related stigma being most prominent. We aimed to systematically review the current evidence for interventions focusing on reducing stigma related to mental health problems in small and medium enterprises (SMEs).

DESIGN

Systematic review with a focus on interventions targeting mental health related stigma in the workplace in accordance with PRISMA guidelines. The methodological quality of included articles was assessed using the Quality Assessment Tool for Quantitative Studies Scale.

DATA SOURCES

PubMed, Ovid Medline, PsycINFO, Scopus, and Cochrane databases and Google Scholar were searched from January 2010 until November 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included experimental or quasi-experimental studies about workplace interventions aiming to reduce stigma, where the outcomes were measured in terms of stigmatisation against depression, anxiety and/or other mental health problems.

DATA EXTRACTION AND SYNTHESIS

Records were screened by two independent reviewers after inspecting titles and abstracts and a full-text read of the articles to assess whether they meet inclusion criteria. The results were synthesised narratively.

RESULTS

We identified 22 intervention studies, 3 with high quality, 13 with moderate quality and 6 with weak quality. Only 2 studies included SMEs, but no study focused on SMEs exclusively . The mode of delivery of the intervention was face to face in 15 studies, online in 4 studies and mixed in 3 studies. We found a significant reduction in stigmatising attitudes in almost all studies (20/22), using 10 different instruments/scales. Effects seemed to be independent of company size. Online interventions were found to be shorter, but seemed to be as effective as face-to-face interventions.

CONCLUSIONS

Although we did not find interventions focusing exclusively on SMEs, it is likely that antistigma interventions also will work in smaller workplaces.

TRIAL REGISTRATION

PROSPERO: ID: CRD42020191307.

Development of an Evidence-Informed Solution to Emotional Distress in Public Safety Personnel and Healthcare Workers: The Social Support, Tracking Distress, Education, and Discussion CommunitY (STEADY) Program

Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.

Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review

Chronic exposure to stressors and potentially psychologically traumatic events contributes to the high prevalence of mental health disorders in correctional workers (CWs) and other public safety personnel (PSP). Digital mental health interventions are an accessible and scalable method of improving and maintaining the mental health of this population. The current review explores the benefits of digital mental health interventions for PSP-with a focus on CWs-and how these innovations can address the limitations in in-person mental health care. A systematic literature search of five databases (Medline, PsycInfo, Embase, CINAHL, Google Scholar) was conducted until March 2022. The search yielded 16 publications that focused on digital mental health interventions or care available to CWs and other PSP. The benefits of digital innovations were summarized into five categories which discussed (1) their ability to enhance accessibility and reduce stigma; (2) the provision of evidence-based and structured psychotherapy programs; (3) variability in the degree of therapist engagement; (4) the integration of proactive interventions; and (5) enhancing engagement by acknowledging unique experiences and interpersonal relationships. Although digital mental health technologies for CWs are still in their infancy, there is strong evidence to support their effectiveness in ameliorating symptoms of mental distress. Future research should consider how ethnicity, gender, culture, sexual orientation, and socioeconomic status can be integrated into these therapies and how the interplay between different stakeholders and organizations can impact the effectiveness of online therapies and programs.

Peer Support for Public Safety Personnel in Canada: Towards a Typology

Public safety personnel (PSP) are frequently exposed to potentially psychologically traumatic events (PPTEs) which can impact mental health. To help mitigate the negative effects of PPTEs, PSP commonly rely on peer support. Peer support generally refers to a wide variety of mental health resources that offer social or emotional assistance to a peer, and in some cases professional assistance. Despite the use of and demand for peer support, there is relatively little empirical evidence regarding effectiveness. The evidence gaps regarding peer support effectiveness may be due, in part, to inadequate guidelines and standards of practice that are publicly supported by a consensus among peer support providers. The current study was designed to explore the current conceptualization and implementation of peer support among Canadian PSP using a document analysis. The results indicate that peer support can be conceptualized via three models (i.e., peer-enabled, peer-led, peer-partnership) and implemented via two delivery methods (i.e., program, service). The research team proposed a novel diagram towards a typology of peer support to highlight the diversity in peer support conceptualization and implementation and provide a foundation for the development of mutually agreed-upon language and a shared framework. Overall, the current study can help inform peer support resources within and beyond PSP communities.

Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site

There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.