Return to Work Experiences of Ontario Public Safety Personnel with Work-Related Psychological Injuries.

PURPOSE: Public safety personnel (PSP) perform work that puts them at greater risk of psychological injury than the general public. PSP who subsequently develop posttraumatic stress disorder (PTSD) or other mental health conditions may need to take time off of work and use the workers compensation system. Very little is known about the experiences of PSP making this type of claim in Ontario to the Workplace Safety and Insurance Board (WSIB), or which healthcare professionals (HCP) PSP access as part of the treatment and return to work (RTW) process. This study captures the experiences of Ontario PSP in their RTW journeys, including with employers, WSIB, and HCPs. METHODS: A survey-based study was conducted, using email and social media platforms to distribute the survey to PSP across Ontario. Quantitative data were summarized using means and frequencies, and open text results were analyzed using qualitative framework analysis. RESULTS: 145 survey respondents met the inclusion criteria for the study. On a scale out of 5, PSP rated their experience with WSIB and employer support as poor on their first RTW attempt with an average rating of 2.93 and 2.46 respectively. The top three HCPs accessed by PSP were psychologists (61%), occupational therapists (OT; 60%) and general practitioners (GP; 44%). Respondents identified the cultural competence of HCPs in understanding their work demands and work culture as very important. CONCLUSIONS: To improve RTW experiences for PSP who make a workers compensation claim for a psychological injury, an increase in HCP cultural competence related to PSP work is indicated, as well as improved RTW processes and workplace support.

A review of workplace mental health interventions and their implementation in public safety organizations.

OBJECTIVE: Workplace mental health is relevant to public safety organizations due to the exposure that many public safety personnel (PSP) have to psychological trauma in the course of their daily work. While the importance of attending to PSP mental health has been established, the implementation of workplace mental health interventions is not as well understood. This scoping review describes workplace mental health interventions and their implementation in public safety organizations. METHODS: English published primary studies with any publication date up to July 3, 2020 were considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed. RESULTS: 89 citations met inclusion criteria out of the 62,299 found. Articles and reports found were largely published within the last decade, most frequently from Western nations, and most often applied to police, followed by firefighters. The focus of interventions was commonly stress management and resilience, and a frequent implementation strategy was multi-session group training. Comprehensive quality improvement initiatives, a focus on supervisors and managers, and interventions across primary, secondary, and tertiary prevention, were infrequent. CONCLUSION: Public safety organizations are frequently reporting on stress management and resilience interventions for police and firefighters, implemented through multi-session group training. A focus across a range of PSP, including paramedics, corrections officers, and emergency dispatchers, using implementation strategies beyond group training, is suggested. This area of research is currently expanding, with many studies published within the past decade; ongoing evaluation of the quality of interventions and implementation strategies is recommended.

Occupational Therapy and Public Safety Personnel: Return to Work Practices and Experiences.

Background. Public safety personnel (PSP) are frequently exposed to psychological trauma through their work. Evidence shows that worker's compensation claims for work-related psychological injuries are on the rise for PSP. Occupational therapists increasingly provide return to work (RTW) services for this population. Purpose. To explore the therapeutic practices and personal experiences of occupational therapists working with PSP who have work-related psychological injuries. Method. This mixed methods descriptive study included a chart review of available occupational therapy client records from 2016 to 2020 for PSP with work-related psychological injuries from two Ontario companies. Additionally, a web-based self-report survey for Ontario occupational therapists providing RTW services to this same population was available from November 1, 2021 to June 1, 2022. Findings. The chart review included 31 client records and the online survey was completed by 49 Ontario occupational therapists. Therapists commonly provided services in clients' homes, workplaces, and communities, and focused on functional activities. The evidence base drawn on by therapists was not always occupation-based. Barriers to RTW included challenges with interprofessional collaboration, stigma, and the COVID-19 pandemic. Implications. Occupational therapists are commonly working with PSP with work-related psychological injuries and have the opportunity to contribute to the evidence base for occupational approaches to RTW.

Mental health of public safety personnel: Developing a model of operational, organizational, and personal factors in public safety organizations.

The work of public safety personnel (PSP) such as police officers, firefighters, correctional officers, and paramedics, as well as other PSP, makes them vulnerable to psychological injuries, which can have profound impacts on their families and the communities they serve. A multitude of complex operational, organizational, and personal factors contribute to the mental health of PSP; however, to date the approach of the research community has been largely to explore the impacts of these factors separately or within single PSP professions. To date, PSP employers have predominantly focused on addressing the personal aspects of PSP mental health through resiliency and stress management interventions. However, the increasing number of psychological injuries among PSPs and the compounding stressors of the COVID-19 pandemic demonstrate a need for a new approach to the study of PSP mental health. The following paper discusses the importance of adopting a broader conceptual approach to the study of PSP mental health and proposes a novel model that highlights the need to consider the combined impacts of operational, organizational, and personal factors on PSP mental health. The TRi-Operational-Organizational-Personal Factor Model (TROOP) depicts these key factors as three large pieces of a larger puzzle that is PSP mental health. The TROOP gives working language for public safety organizations, leaders, and researchers to broadly consider the mental health impacts of public safety work.

Organizational Factors and Their Impact on Mental Health in Public Safety Organizations.

Public safety personnel (PSP), including correctional officers, firefighters, paramedics, and police officers, have higher rates of mental health conditions than other types of workers. This scoping review maps the impact of organizational factors on PSP mental health, reviewing applicable English language primary studies from 2000-2021. JBI methodology for scoping reviews was followed. After screening, 97 primary studies remained for analysis. Police officers (n = 48) were the most frequent population studied. Correctional officers (n = 27) and paramedics (n = 27) were the second most frequently identified population, followed by career firefighters (n = 20). Lack of supervisor support was the most frequently cited negative organizational factor (n = 23), followed by negative workplace culture (n = 21), and lack of co-worker support (n = 14). Co-worker support (n = 10) was the most frequently identified positive organizational factor, followed by supervisor support (n = 8) and positive workplace culture (n = 5). This scoping review is the first to map organizational factors and their impact on PSP mental health across public safety organizations. The results of this review can inform discussions related to organizational factors, and their relationship to operational and personal factors, to assist in considering which factors are the most impactful on mental health, and which are most amenable to change.

Workplace mental health implementation strategies in public safety organizations: a scoping review protocol.

OBJECTIVE: This scoping review aims to map workplace mental health implementation strategies in public safety organizations and describe the characteristics, participants, and contexts of these strategies. INTRODUCTION: Workplace mental health implementation strategies are relevant to public safety organizations due to the exposure that many public safety personnel, such as firefighters, paramedics, and police officers, have to psychological trauma in the course of their daily work. While the importance of attending to public safety personnel's mental health has been established, workplace mental health implementation strategies have historically varied in public safety organizations. INCLUSION CRITERIA: This scoping review will address workplace mental health implementation strategies used in public safety organizations. It will exclude studies that do not focus on workplace mental health, do not report on the implementation strategies used, or do not take place in a public safety context. METHODS: Primary studies published in English with any publication date up to the present will be considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be followed. The search will be carried out in five databases and reference lists will also be searched for additional studies. Duplicates will be removed, and two independent reviewers will screen the titles, abstracts, and full text of the selected studies. Data collection will be performed using a tool developed by the researchers, based on JBI's model instrument for extracting study details, characteristics, and results. A summary of the results will be presented in diagrams, narratives, and tables.

COVID-19 and the Mental Health of Canadian Armed Forces Veterans: A Cross-Sectional Survey.

BACKGROUND: There are no data on the impact of COVID-19 and associated public health measures, including sheltering at home, travel restrictions, and changes in health care provision, on the mental health of older veterans. This information is necessary for government and philanthropic agencies to tailor mental health supports, services, and resources for veterans in the peri- and post-pandemic periods. The objective of this study was to compare mental health symptoms between Canadian Armed Forces (CAFs) veterans and the general Canadian older adult population in the early months of the COVID-19 pandemic. MATERIALS AND METHODS: This was a secondary analysis of a cross-sectional study of older adults in the national Canadian COVID-19 Coping Study. Individuals aged 55 years and older were eligible. A convenience sample of older adults was recruited through a web-based survey administered between May 01, 2020 and June 30, 2020. Canadian Armed Force military service history status (yes/no) was ascertained. The eight-item Center for Epidemiological Studies Depression Scale, the five-item Beck Anxiety Inventory, and the three-item Loneliness Scale were used to measure mental health symptoms. Multivariable logistic regression compared the odds of screening positive for depression, anxiety, and loneliness between veterans and non-veterans. RESULTS: Of 1,541 respondents who answered the final question (87% survey completeness rate), 210 were veterans. Forty percent of veterans met criteria for at least one of the mental health diagnoses compared to 46% of non-veterans (P = .12). The odds of reporting elevated symptoms of depression, anxiety, and loneliness were similar for veteran and non-veteran respondents after adjusting for confounders. CONCLUSION: Veterans' report of mental health symptoms was similar to the general population Spring 2020 of the COVID-19 pandemic. Although veterans' military training may better prepare them to adapt in the face of a pandemic, additional research is needed to understand the longitudinal impacts on physical and mental health.

Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness.

OBJECTIVE: We assessed the efficacy and clinical utility of a new occupational time-use intervention, Action Over Inertia, designed to improve occupational balance and engagement among community-dwelling people with serious mental illness. METHOD: Using a randomized controlled design, we assigned 24 participants to an intervention group or standard care group. Participants were community-dwelling people with serious mental illness receiving assertive community treatment services. Data on time use, occupational balance, and engagement were collected and compared at baseline and 12-wk posttest. RESULTS: Eighteen participants completed the pilot study. Treatment group participants increased their occupational balance by spending an average of 47 min more per day in activity than the control group (p = .05). Differences in occupational engagement were not shown, but evidence of clinical utility was found. CONCLUSION: This pilot study of Action Over Inertia has shown evidence of efficacy and clinical utility.

Mental Health of Canadian Firefighters: The Impact of Sleep.

Volunteer and career firefighters are at risk of major depressive disorders, posttraumatic stress disorder (PTSD), alcohol use disorder, and other mental health disorders due to the demanding and unpredictable nature of their employment. The mental health risks are exacerbated by the need to work extended hours, night shifts, and/or rotating schedules, or the competing demands of other employment, especially in volunteer firefighters. The mental health disorders and risk factors interact with altered sleeping patterns. In the current study, we examined volunteer and career firefighters regarding the association between mental health and sleep, drawing from a national Canadian mental health survey of 1217 firefighters. Most (69%) of the firefighters reported less than ideal sleep quality and 21% screened positive for clinical insomnia, with no significant difference between volunteer and career subgroups. Firefighters with insomnia had higher odds ratios (OR) and frequencies for PTSD (OR = 4.98), generalized anxiety disorder (OR = 7.15), panic disorder (OR = 6.88), social phobia (OR = 4.98), and major depressive disorder (OR = 7.91), than firefighters without insomnia. The burden of sleep disorders and their association with mental health disorders suggests that sleep should be considered in health monitoring and self-management, environmental design, fire service work-organization policies, and health programming.

Occupational therapy return to work interventions for persons with trauma and stress-related mental health conditions: A scoping review.

BACKGROUND: Trauma and stress-related mental health conditions can impact a person's ability to participate in work and can cause disruptions in employment. Best practice guidelines for occupational therapy return to work interventions with these populations are limited. OBJECTIVE: To identify and describe occupational therapy return to work interventions for trauma and stress-related mental health conditions. METHODS: Using a scoping review methodology, research databases were searched for papers relating to occupational therapy, return to work interventions, and trauma and stress-related mental health conditions. Three reviewers independently applied selection criteria and systematically extracted information. Data were extracted and synthesized in a narrative format. RESULTS: The search produced 18 relevant papers. The interventions described were more often person-focused versus environment- and occupation-focused, and many were carried out by multidisciplinary teams, making it difficult to identify best practices for occupational therapists in this area. CONCLUSION: Emerging practices include the Swedish "ReDO" intervention, support for active military members to manage operational stress to remain at work, and multidisciplinary team treatment. Further research, including studies with direct focus on the implications of occupational therapy interventions for return to work with trauma and stress-related mental health conditions, is required.

Occupational therapy and posttraumatic stress disorder: A scoping review.

BACKGROUND.: People who are diagnosed with posttraumatic stress disorder (PTSD) can experience disruptions in their daily occupations. Occupational therapists may assist clients with PTSD to reengage in meaningful occupations. PURPOSE.: This scoping review aims to identify and describe the ways occupational therapy addresses PTSD in clinical practice. METHOD.: Scholarly databases were searched for documents relating to occupational therapy and PTSD. Two reviewers independently applied selection criteria and systematically extracted information. Data were extracted and synthesized in a narrative format. FINDINGS.: Fifty sources met inclusion criteria and three major themes were identified: recognizing trauma within specific populations, PTSD's impact on a range of occupations, and occupational therapy's response to PTSD. IMPLICATIONS.: Occupational therapists are working in multidisciplinary teams to reduce the impact of PTSD on the daily occupations of their clients. More effectiveness studies are required to understand the outcomes of occupational therapy interventions for clients with PTSD.