Good morning, Mr. Chair, and members of this committee.
We'd like to thank you for the invitation to appear before you today and for this opportunity to contribute to this crucially important focus on the effects of operational stress injuries and post-traumatic stress disorders upon public safety officers and first responders. It's my distinct pleasure to represent the Paramedic Chiefs of Canada today. It is an association that represents the paramedic chiefs in leadership across all of our provinces and territories.
We're pleased to participate in this national dialogue on this important issue that is crucial to the safety of our men and women on the frontline, regardless of the role they assume, and crucial to their families as well, who are often affected.
Our association recently participated in a round table on this important topic hosted by the , Minister of Public Safety. We prepared for that meeting by polling and interviewing a number of colleagues across Canada in trying to address three fairly simple questions. What is the problem? What are we doing about it? What do we need?
While the feedback and the answers are likely as complex as the overarching issue at hand, there certainly were themes that prevailed. I'm pleased to try to outline these to the best of my ability here today.
The message that we heard clearly though from our community is that this is a complex issue. To state that the impact is significant would definitely be an understatement. In terms of scope, we feel there is some difficulty in terms of the accepted definitions and terminology or measurements. Based solely on the limited research to date, we can easily surmise that the impact is alarming.
For perspective, Ontario has about 8,000 paramedics, and with some studies predicting that PTSD or OSI affects 22% of them, we can estimate over 1,700 of our medics are suffering from operational stress injuries.
Speaking from the paramedic community, initial steps have been and are being taken to get a better understanding of the magnitude of the problem, but that work is in isolation of a broader scope, and the research is difficult to verify. The magnitude of the problem appears to be growing in terms of its human effect, system performance, and financial burden.
The overarching message heard from our community is that there is a need to treat the problem as a whole, and not just the disorder or disease—or worse yet, an event or a symptom. With frontline work, the damage is likely to be cumulative from multiple exposures, and more research is required to determine just how the multiplicity of stressors experienced by first responders manifests into disorders or syndromes, and what we can do to intervene.
As system leaders and practitioners, we feel that it's imperative to have a coordinated and collaborative effort among and involving the first responder communities, who are here at a national level, in order to stop the hemorrhage of emotional and psychological damage that's occurring.
Peer support and critical incident stress management teams and training are needed to be supportive in the field. I think that's clear and broadly accepted, but further research is needed to employ effective methods of intervention in the field, with a greater understanding of the impacts and limitations. We feel there are gaps evident around treatment options, which are relatively new. We feel there doesn't appear to be a lot of peer reviewed literature around the efficacy of these treatment options among our paramedic community.
These identified concerns have led the paramedic community to express a need for greater understanding of the problem at hand, and for our leaders to have access immediately to tools to begin an effective and evidence-based approach to addressing the situation.
We also see the need to address gaps that have been missed, such as workplace reintegration. Presently workplace health and safety programs are challenged as to how to reintegrate some staff into the workforce safely. Small collaborative programs exist in some areas, but in many areas the only programs that exist focus on reintegrating persons with physical injuries back into the workplace, and a gap certainly exists.
Broadly, our community has concerns about the lack of coordinated research in all areas surrounding operational stress injury topics. We feel that efforts should be made to find opportunities to share research more broadly and effectively.
What is our association and our community doing to date? The Paramedic Chiefs of Canada, along with our partner here today, the Paramedic Association of Canada, have been trying to frame the discussion around mental health and wellness, both physical and mental, and not just the manifested PTSD. We believe that mental health incorporates a holistic approach that recognizes mental health promotion as part of preventing the disease's symptomatic progression to a state of disorder.
Our association has been collaborating on the following projects: the national EMS research agenda, the national research gap analysis, and the Canadian safety and security program's paramedic community of practice. Each of these has priorities that recognize that research is important for the health of the profession and, in particular, this area of focus. As an example, a current study is underway, supported by CSSP, examining mental health wellness through Queen's University, and with Frontenac as our municipal partner.
Our association has joined others to form a tri-services working group collaborating with Public Safety Canada and other key partners in an effort to continue toward meeting the federal mandate to form a national PTSD strategy.
The Paramedic Chiefs of Canada have also created an ad hoc committee and drafted a report dedicated to operational and psychological stress injuries. We've provided a copy of that today.
The scope of the report was to examine how organizations themselves can best respond to operational stress injury. As with other forms of injury, we believe that the paramedic services at the forefront of proactive action on this issue must address the following four core elements: first, comprehension and championing of the issue within the paramedic service; second, developing prevention strategies that target those who may be at risk, their environment, and the sources of injury; third, creating intervention services and strategies for those who are at risk; and fourth, ensuring that treatment and recovery programs are accessible to those affected by an operational stress injury.
Our community continues to focus on these areas, but we know that we would be much more successful with broader collaboration. We need wholesome programs that span the first responder's career and provide support at any position they may currently hold within the mental health continuum, whether they be healthy, reacting, injured, or ill.
Support needs to be holistic in its approach, spanning readiness for career, resilience training, exposure response, critical incident recovery, restoration and and return to work, and retirement/career changes or returning to the workforce as a non-first responder. These ideas and best practices need to be evidence-based, bolstered, and shared among our communities, covering pre-evaluation, prevention, resiliency, and recovery throughout the mental health continuum.
We think it's clear that broad collaboration will be the key to having a significant impact in addressing this problem and supporting the people in our communities who do great things to protect us each and every day.
A multi-pillar strategy or approach for the support of mental health for first responders is critical from the day they're hired until well after they retire. We need research, and we need the funding and support required to pool our resources.
Once again, the Paramedic Chiefs of Canada applaud the right hon. for calling in his mandate letter to Minister for him to work with stakeholders to develop a national action plan on post-traumatic stress disorder, which disproportionately affects public safety officers, our people.
We welcome the opportunity to work with the federal government and partners to assist in coordination, research and communications, to ensure the safety of our first responders and the citizens of Canada in providing evidence-based national standards for the assessment, treatment, and long-term care of public safety personnel.
Thank you, Mr. Chair.
Mr. Chair, I would like to thank the committee for giving me the opportunity to talk about the health and well-being of paramedics in Canada.
I'd like to frame our discussion in terms of what the Paramedic Association of Canada is and isn't, and to talk a little bit about mental health. Paramedics are in distress, and I have some information that highlights the severity of the issue. I'll also talk about some good initiatives that are taking place. Lastly, I'll speak about how we can work together. I think there are some great opportunities to work with the chiefs, the different levels of government and, in particular, the Canadian safety and security program.
First, the Paramedic Association of Canada is an association of paramedics. It's not the union. That's a distinction I'd like to make. We take care of the competency profile of paramedics—the things that define paramedics. We determine the skills, abilities, and knowledge of paramedics as well as the roles they undertake in providing service to the community.
It really is about the education that a paramedic needs to do the job and do it well. By the year 2025, we hope to be at a baccalaureate level in the training that's required. The job has changed that much.
There are 20,000 members of the Paramedic Association of Canada, and there are around 40,000 paramedics in the country. Often we say it's about 1,000 paramedics for every million people. That's a broad number but it's pretty accurate. This makes the paramedic community the third-largest health care provider group in the country.
In defining paramedics, the terminology is usually primary care paramedic, advanced care paramedic, and critical care paramedic. We have those three designations. The nomenclature surrounding paramedics has been consolidated in the last 15 years or so. Across the country there's a fair bit of uniformity in the terms and the titles.
Where we work is an important thing. People used to think paramedics worked strictly in ambulances. Today you see paramedics in helicopters, in clinics and hospitals, and you're starting to see them in community health centres. A great example of that is the Health Bus in Saskatoon, where paramedics form part of a team in the community paramedic program. In the spectrum of health services, the job of a paramedic has evolved from being focused on urgent care to also providing preventative care.
Mental health has become important for paramedics. There has been some fantastic research done over the last number of years. Dr. Lori Gray and the Paramedic Chiefs of Canada did a fantastic report a couple of years ago looking at occupational stress injury in paramedics. Since then we've identified that the disease process at the end of the spectrum is not the only thing that matters. We also need to focus on general wellness. We are investigating how to build up people's capacity so that they don't fall into the illness category. This is important. With PTSD, in some ways there has been a failure. We still haven't figured out how to take care of people so that they don't fall into this category.
Most distressing of all is the number of suicides that have been related to mental health and mental health issues. I think the number was 14 or 15 last year. My apologies, I don't have the exact number, but that is a wake-up call. It's a flashing red light for us that more has to be done. Recently, the Paramedic Association of Canada did an online survey of paramedics, and there were 6,000 respondents. The numbers are startling. Thirty per cent of paramedics have contemplated suicide, sixty per cent know of a colleague who has contemplated suicide, and seventy per cent are concerned that a paramedic colleague is at risk of suicide. So in spite of all the evolution in what we do and where we do it, paramedics feel that in some ways they haven't been taken care of. All of us, really, are accountable. I'm not singling out any one group. It's a societal issue that we have to address. That's why both Randy Mellow and I are so appreciative of the mandate letter that was given to Minister Goodale. This is an issue for all first responders, including paramedics.
Talking about some of the good initiatives that have taken place, there has been presumptive legislation with respect to PTSD in several provinces, including just recently in Ontario, but also Manitoba and Alberta.
There's an initiative with the University of Regina, and a round table took place at the beginning of this year, which we think is a great foundation for the first responder community to work together on this issue. That's an important piece. Recognizing that paramedics still have their own uniqueness, there's a commonality among the public safety occupation, or the first responders, that this round table is addressing quite well. We advocate that those kinds of initiatives be supported.
Recently Queen's University did a study to solicit how paramedics “feel”, but it's about understanding the scope of the issue in a research-based study. Dr. Renée MacPhee and Queen's University started this process. Other good work is going on about rooting out and defining the problem and the problem space.
The whole idea of that first responder community coming together and this committee being willing to listen to us is an important piece of starting the process of understanding what the problem is, so that we can work back. We can deal with the disease process, but we can also look back at the wellness component.
With respect to the ask—and Randy Mellow and the chiefs and the Paramedic Association are very much on the same page on this—we continue to support initiatives such as the round table at the University of Regina, and what's come out of that round table.
Recognizing that paramedics still have a unique job—we're not firefighters; we're not police officers—the understanding of how we get to the illness phase, whether it's cumulative or whether single events are triggers, we don't know. There's research to be done there.
There's an opportunity with the Canadian safety and security program, which has been very much an advocate going back the last 10 years or so in support of our community. Targeted investments could be coming from that group in support of research for paramedics, not just on PTSD but also on mental health and wellness.
Thank you very much for the opportunity to speak. I'm willing to answer any questions.
Thank you, Mr. Chair, and members of the committee.
I'm pleased to be back here before you. I always enjoy appearing in front of this committee and all the honourable members to talk about this serious issue that you've taken on to study, because it does affect a number of staff in Correctional Service Canada.
Mental health in the workplace has always been a difficult topic to address, both for those who struggle with mental health issues, as well as from a management perspective. Addressing this topic in a meaningful and effective way is very important to me personally and professionally. I am very happy that we are starting to see an increase in the awareness of the importance in maintaining a healthy workplace, and that there have been a number of concrete steps taken to improve the situation across this great country of ours.
This committee's decision to study operational stress injuries and the effects of post-traumatic stress disorder, for example, has placed a spotlight on this issue, and hopefully this will continue to foster more open dialogue in society to allow those who may be struggling in silence to come forward. One of the best approaches to improving understanding of afflictions such as PTSD is awareness and prevention, and in this regard, maybe I'll just share with you some of the highlights of the work that CSC has been undertaking.
As most of you are aware, our staff members operate in a unique environment, which can often take a significant toll on the mental well-being of the staff. Given the nature of the work performed by front-line correctional staff, they are likely to witness stressful and traumatic events, including death and violence. In our 180-year history, we have had 34 members who have been killed in the workplace, 33 of those within the penitentiaries, and one in the community.
Consequently, employees are vulnerable to developing operational stress injuries. While CSC recognizes the significant challenges associated with working in a correctional environment, we are committed to providing a workplace that is conducive to the health and safety of all of its employees, including their mental health. I am proud of the work done by the Correctional Service Canada staff on a daily basis. Particularly of note is their dedication and commitment during the stressful and potentially dangerous circumstances that are common in a correctional environment.
CSC openly encourages employees to seek assistance in dealing with any personal or work-related problems that may impair their well-being. To this end, we have established an employee assistance program to encourage employees experiencing personal or work-related problems to voluntarily seek assistance, recognizing that our staff are the strength and major resource of the service, and that the well-being and productivity of employees can be affected by personal or work-related problems.
Also, CSC employees have access to the critical incident stress management program. This is a joint labour-management initiative, which was introduced to employees in the 1990s. Currently, the CISM teams, as they are referred to in short, comprise mental health professionals, chaplains, and peers from various disciplines who are trained to conform to national standards. They are used whenever there is an incident that meets policy guidelines for the provision of CISM services, such as an event that includes death, suicide, injury of any person during use of force in the conduct of duties, being the victim of physical violence, or any other incident deemed critical by management in joint consultation with our EAP coordinators.
Most recently, we have also taken steps to educate CSC employees about the potential mental health injuries that can happen as a result of their work in corrections by offering the road to mental readiness training. As you know, this was first pioneered by the Department of National Defence for its staff. This leading-edge training equips our CSC employees with the same tools and knowledge as other first responders across the country.
We formed a steering committee for workplace mental health injuries in May of last year, and we are developing an integrated mental health strategy using the new psychologically healthy workplace standard developed by the Mental Health Commission of Canada and the Canadian Standards Association as a framework. We have produced a new and comprehensive internal web page for our employees who experience a mental health injury, where they can find information about what to do and where to go if they need assistance. Just last week, we shared with all our CSC employees across Canada an internal publication about workplace mental health injuries within CSC. This publication includes CSC employees sharing their personal experiences in written format, contributions from an institutional CISM and EAP agent and a registered psychologist, a poster to help staff determine where they are on the mental health continuum, as well as a video about CSC's Steering Committee for Workplace Mental Health Injuries.
I will cut it short there, but I could talk more about the employee assistance program, our return to work program, or our duty to accommodate program. There is no question, from my perspective, and I've been in corrections now for over 38 years, that this is a very meaningful topic and one worthy of discussion.
Although I represent the federal correctional system, I'm glad to see this applies equally to provincial and territorial correctional workers. I'm glad to see that they're being recognized in these discussions going forward.
To give you a sense of some of the stress that we do deal with, last year alone, I had 27 employees or former employees either commit suicide or attempt to commit suicide. To the greatest extent possible, this is a reflection of what they've had to deal with throughout their career. Being in the service as long as I have, I know a lot of these people, and so it's a very troubling situation.
Once again, I'll cut it short there. I'm glad to see the committee doing this review, and I look forward to answering any questions that you may have.
Thank you, Mr. Chair, and I'd like to pass any of my remaining time to my colleague, Mr. Mendicino.
Thank you all for being here and for your incredible work and service. Through you, we'd like to thank all the people you represent who are in the field, day by day, shift by shift. We're grateful for what you're doing.
I'd like to start with the representatives from the paramedic community. I have a number of questions in the areas of definition, awareness and prevention, and then also treatment.
As the committee moves into the stage of contemplating how to frame our report, I'm wondering if you could tell us, with respect to definitions and terminology, what do we make part of this exercise. We've put the label “PTSD/OSI” on it, but there are a number of things and concepts embedded in it that we need to be very mindful of.
Monsieur Poirier, you spoke about wellness, and that takes us all the way along the spectrum into the most unfortunate outcome, namely suicide or attempted suicide. Some of the things include depression, substance use or substance abuse, panic disorder, and other diagnosable mental health injuries, if you will, that we need to be mindful of and potentially bring in.
I wonder if you have some comments on how we can not only be as precise as possible, but also as comprehensive as possible, in our terminology and definition of the problem.
I have a series of things you may want to consider.
Part of it is looking at how we make available standardized awareness training for people to eliminate the stigma and to allow people to come forward and freely engage the supervisors. We also want to look at how we prepare managers to deal with situations of staff coming forward. These are very difficult situations for managers to deal with. How do we prepare managers to deal with those types of situations?
There is also support for family members. Through our road to mental readiness training, not only are we looking at staff and managers but we will, in our second and third phase of our initiative, also look at how we provide assistance to family members.
Regarding the issue of standardized accessible treatment, we're talking about everybody, and not just certain categories of first responders. It needs to be standard across the country. We can't differentiate between the military, the RCMP, corrections, paramedics, or whatever the case may be. There needs to be a standard approach and proper funding to support that.
We need to find a way through provincial WCB bodies to help people navigate through the system when they come forward. One of the most significant challenges we find is that people do not come forward.
We're talking a lot now about the statistics of individuals who come forward. We're not talking about the silent majority who do not forward because the system is very complicated. WCB processes are so complicated that within our own organization, we have to dedicate individuals to help people try to navigate through a system that we do not manage.
Thinking about those kinds of things will go a long way.
That is a very good question.
The Royal Canadian Mounted Police has had a complete mental health strategy for the past two years. The first year, templates were used to help managers communicate with our members. It really meant being sensitive to our members and their stories.
Constable Neily, in Cornwall, has produced some videos about this. He has done some very good work.
Constable Neily stepped up and became the face of mental health in our organization. We had members step up in the grassroots. What we noticed is that there was an appetite, and our members stepped up to talk about their experiences. That speaks more to our members than anything else, where they have a fellow member or a fellow officer saying, “Here is what's happened to me, and here is how I got that”. That was the first year it was released.
We had tool kits, and we had a lot of emphasis on destigmatization. For post-traumatic stress disorder, we do not use that terminology in our force. We avoid that terminology. We call it an “injury”. It's an operational stress injury, and we have to stop calling it a disorder. It's an injury, because otherwise it's a stigma.
The second part is training. Similar to everybody else, we are rolling out R2MR. We had tried it in New Brunswick, and we tried it before that unfortunate tragedy in Moncton happened. We had rolled out that program. We had research to show it was effective. We did roll it out, and we're rolling it out currently.
We have a peer-to-peer network that we have deployed across the country. These are members who are trained, employees who are trained, to pick up on these issues. Within the training component itself, we have it at our induction training. We start talking about this at the first stage, and then we supplement it as we go along throughout their careers.
It's still a work in progress, and that's where we are right now on that. We're doing the research project, and we're saying that we now have to go to a broader research project to find out, in our members' lifetimes—starting from training at Regina, and throughout the lifetime—what happens. What happens to an individual?
I believe a lot of people are asked, do you walk in with preconceived notions of what police work is? Yes, you do. Do you have certain conditions that may cause you to have this injury happen to you? Yes, you do. We're trying to find what those indicators are, so we're able to build resiliency or deploy better strategies to treat the members.
That's where we would be with our organization.
Mr. Chair, I am going to speak in English because I will be better able to answer the question.
I'd like to address it in three phases: the education, the recruitment, and then when an event happens, because I don't think we've spoken about that piece.
On the education, I spoke earlier about the changes in the educational structure of how we teach and educate paramedics, la formation des paramedics. It's evolving right now to recognize that mental health is an integral part of that educational process. That's taking place today.
Colleges have already started to adopt it, and it's becoming a greater portion of the whole educational structure. As we recognize that and as we move toward baccalaureate education, we look at the roles paramedics take. As part of being a professional, self-reflection is part of that concept. That's an important piece to understand where you are in your context, so the education is evolving to address mental health issues.
How paramedics are recruited across the country is a mixed bag, including their initial education with respect to how they understand themselves, their mental health issues, and how they fit into the organization. I think Randy Mellow spoke earlier about all of those other impacts upon our well-being from shifts, the hours of work, the randomness of incidents, and how they affect us.
The last piece—and we've seen a fair bit of change in this area, and haven't spoken a lot about it today—is when an event happens. My apologies, because I'll use a sudden infant death event. That event may affect different people in different ways. Right now, we don't know exactly how to support our paramedics in that regard, and that's an interesting piece that's going on.
There is critical incident stress management, and there is critical incident stress debriefing. There has been a lot of research about the best way to help that individual. We don't know specifically what the answer is.
Different services across the country have chosen different methodologies. Critical incident stress management appears to be the most common, but we don't have the research to say it is the best. That's an important piece if we're looking for an understanding of what the best intervention is. We don't know. I think we all struggle with it, and I think the first responder community struggles with it because of how individualized that event is to each individual intervenant.
A paramedic, a police officer, or a firefighter who attend to that event may each have a different perception of it. That is an area where we—