Preventing PTSI work disability at first responder organizations: perspectives from the workplace

IWH study drew on interviews in Alberta, Canada, and beyond to identify barriers and facilitators when supporting first responders with post-traumatic stress injuries

Across Canada, police, fire and paramedic services have become increasingly aware of the toll of post-traumatic stress injuries (PTSI) on their public safety workers. The effects of PTSI can include reduced work performance, increased work absence, poorer relationships with others, feelings of hopeless, and self-harming behaviours—all factors that increase the risks of work disability.

Despite employers’ interest in workplace programs and policies aimed at preventing work disability due to PTSI, the evidence on the effectiveness of workplace programs is not yet strong enough to warrant recommendations. That was one of the findings from a multi-part study conducted by the Institute for Work & Health (IWH). The study also found that workplaces report the need to take measures to help address the challenges for their workers. They cannot wait for the evidence base to improve before they act, says study co-lead IWH Scientist Dr. Dwayne Van Eerd.

To examine what first responder organizations were doing to address PTSI, the study used an evidence synthesis approach that integrates research evidence with on-the-ground practical experience. We wanted to examine the evidence from the literature and international field experience, in conjunction with the current practices of first responder organizations, says study co-lead IWH Senior Scientist Dr. Emile Tompa. How can we take those sources of knowledge to inform policies and practices for the prevention of PTSI work disability?

The study included three parts: (1) a field knowledge scan of first responder organizations’ policies and practices for the prevention of PTSI work disability, both within Canada and abroad; (2) a summary of the scientific evidence; and (3) interviews with occupational health and safety practitioners, managers, supervisors and workers within first responder organizations in Alberta (the province that funded the study) to gather detailed information about current PTSI work disability prevention needs and management practices in the province.

We conducted the international scan to get a sense of what we can learn from the experiences first responder organizations outside of Alberta and Canada, says Tompa. With the Alberta interviews, our team probed more for details about current needs and practices in PTSI work disability prevention within the province, adds Van Eerd.

Findings from the first part, the field knowledge scan, were shared by Tompa at an IWH Speaker Series presentation. The third part was published in May 2025 in the peer-reviewed Journal of Occupational Rehabilitation (doi:10.1007/s10926-025-10299-y). A plain-language summary of the project’s findings has also been created with first responder workplaces as the target audience. That summary is available on the IWH website.

10 themes from the field knowledge

As outlined by Tompa in his Speaker Series presentation, the international scan of field knowledge drew on 35 interviews with professionals and experts in emergency organizations from within Alberta, other Canadian jurisdictions and outside Canada. The key informants were individuals in police, fire and paramedic services, as well as health-care professionals or insurance claim managers who worked with first responders.

The field knowledge scan revealed 10 major themes, briefly described below.

1. Provide specialized programs and services: Program and service providers need to understand the unique experiences of first responders and their challenges. Generic programs, such as employee assistance programs (EAPs) and employee and family assistance programs (EFAPs), are of limited help due to their lack of awareness of first responders, the nature of their work and their workplace contexts.
2. Work to overcome stigma: Mental health challenges can carry considerable stigma among the first responder population. The culture of stoicism and machismo—which is more prevalent among older or more seasoned first responders and which is more pronounced in policing than in fire and paramedic services—can be a barrier for seeking help.
3. Ensure confidentiality/anonymity: Many first responders choose not to disclose their mental health challenges, fearing negative responses from others and negative career implications such as hindered promotions. They may even avoid accessing in-house services for fear that their use of such internal resources would lead to their conditions being shared with their supervisor.
4. Provide training at all levels: Mental health training programs need to be offered at all levels and throughout an individual’s career—not just to new staff at onboarding. Leaders should be encouraged to undergo training as they get promoted to better support their team members—especially in mental health first aid and training, active listening and crisis intervention.
5. Ensure open communication: A key factor in the implementation and use of PTSI and other mental health support programs, open communication carries two meanings. One refers to leaders’ openness about mental health and willingness to personally reach out to members. The other refers to the sharing and distribution of information about resources. An effective method for first responders to learn about available resources is through each other—that is, by word of mouth from trusted sources.
6. Take a whole-person approach: An important factor in establishing trust and rapport, a whole-person or holistic approach considers the individual as a whole and not just their injury. It incorporates other health and wellness concepts into programs, including nutrition, exercise and sleep hygiene. A whole-person approach also considers first responders’ family members and loved ones, not just because they’re often extensions of first responders’ emotional and mental support, but also because they may be at risk of vicarious trauma.
7. Provide multiple avenues for support seeking: Having multiple pathways to access support means individuals can seek support based on their needs and preferences. Some people may prefer external services to ensure anonymity and confidentiality, whereas others may find in-house services convenient and practical.
8. Ensure continuity of service: Whereas PTSI prevention and mental health training and resources are most typically offered to new recruits, supports, programs and training should be made available at various points in a first responder’s career, including during absences, while returning to work, and on through career advancement.
9. Build research into the evaluation process: To ground programs and resources in research and evidence, organizations use in-house assessments via surveys, audits, monitoring and evaluation. They cultivate ties to academics and research centres to support their understanding of best practices. They also employ continual improvement approaches, in the recognition that changes in the labour force or in society means that programs and policies always need to be revisited and reassessed.
10. Address resource constraints across regions: PTSI services can take considerable time to access because of high demands and a shortage of staff. A lack of mental health support services in rural areas can mean first responders have to wait longer or travel farther to access services, leading many to decide against seeking support.

Workplace perspectives from Alberta

Considerable overlap was found between the themes from the field review and the themes heard during the interviews with Alberta first responders who experienced PTSI, either directly or through having supported someone with PTSI (the third part of the project).

In the qualitative study with Alberta participants, the team heard that there have been improvements to the workplace culture of first responder organizations. Awareness about PTSI has grown, and the stigma associated with mental health and psychological injury has lessened. However, further work is needed—whether to support individuals to come forward and ask for help or to change the perception that someone’s lazy or loafing if they require time off work.

Another theme heard in the Alberta interviews was that programs were under development. Many of the training, reintegration or peer-support programs were described as being updated, newly introduced or not yet fully implemented. However, the research team also heard a sense of uncertainty from some interviewees around whether programs were actually available, whether they were available to some and not others, and whether they were easily accessible.

A third theme was the theme of trusted communication. This theme speaks not just to the importance of communication about program availability from trusted sources, but also to the importance of trust and safety to enable first responders to communicate about, and seek help for, their PTSI.

Turning to the literature review, the study team found a lack of strong evidence for PTSI-related work disability programs at the workplace level. Thus, leaning primarily on interviews with first responders , the research team identified five recommendations to improve PTSI-related work disability prevention at first responder organizations. The recommendations, which are also listed in the short summary aimed at workplaces, are:

1. Apply streamlined processes to ensure information about PTSI programs and supports is more accessible.
2. Continue to reduce stigma about PTSI in first responder organizations.
3. Provide better resources to develop and implement PTSI disability programs and supports.
4. Provide specialized programs, services, and training tailored to first responders’ unique needs and experiences.
5. Engage in partnerships with experts to increase knowledge about PTSI/ mental health.

The team also noted the importance of considering the workplace context when developing or expanding PTSI-related work disability prevention programs. The type of service, the size of the service, the geographical coverage of the service, the population served, the size and makeup of the workforce, and the service’s funding sources are all critical aspects to consider when talking about what kinds of programs were working well and what weren’t working well, and why, says Tompa.

Context is also important to program implementation, adds Van Eerd. Our findings show that while workplaces in Alberta are developing or adapting PTSI programs, they have challenges with implementing them. Poorly implemented programs may not have the desired impact to address work disability resulting from PTSI.