Ontario Expands Mental Health Services for Paramedics

The Ontario government is investing more than $32 million to support access to mental health services for paramedics and other first responders. The new Mental Health Supports for Public Safety Personnel program will provide specialized services for public safety personnel, who face serious challenges every day in their work.

The new program will include a web portal for access to core services (including internet-based cognitive behavioral therapy and peer-support tools), a 24/7 call line, and other trauma-informed mental health services.

The new program will also support the creation of a strategy to remove the still-pervasive stigma about asking for help and support. The goal will be to create work environments where people feel confident to seek the mental health support they need. The anti-stigma strategy will include the following components:

• A website with mental health resources designed for public safety personnel
• A leadership support network
• Training to equip leaders with the skills and knowledge to support mental health in their organizations
• Recommended mental health practices for organizations

Warrior Health, the vendor that will deliver these services, will draw upon mental healthcare experts from organizations such as Homewood Health, Wounded Warriors Canada, the Centre for Addiction and Mental Health (CAMH), Trillium Health Partners, and Boots on the Ground.

“Wounded Warriors Canada is a not-for-profit that has been providing mental health support for first responders for many years, and it has now created Warrior Health, which links together clinicians and other service providers who are all focused on providing mental health services for public safety personnel and their family members,” Greg Sage, chief of paramedic services for the Halton Region of Ontario, Canada, told Medscape Medical News.

“We know that paramedics tend to be diagnosed with posttraumatic stress disorder (PTSD) at a greater rate than the public, and data show that of the three emergency services, paramedics have the highest proportion of the workforce that is off with PTSD claims at any given time. This announcement that the province made is going to be incredibly important,” Sage added.

“All emergency services face challenging situations on a regular basis. The clinical care that paramedics provide is not provided in a traditional hospital or healthcare facility environment. We help the community out on the street under unpredictable situations daily. Some of that work includes exposure to traumatic events. It includes challenging and emotionally difficult situations and circumstances that can have a lasting impact on people,” said Sage.

Anti-Stigma Strategies

The anti-stigma strategies included in the program are crucial, he said. “There is still a certain stigma attached to seeking support for mental health, although it is much better than it was a few years ago. Twenty years ago, the message was, ‘Keep a stiff upper lip and carry on. Just suck it up and deal with it.’ We’ve worked hard to shift that dialogue, but there’s still concern about being perceived as weak.”

For many, the stigma associated with seeking care for mental health issues has been a barrier to seeking help, agreed Donna Ferguson, PhD, a clinical psychologist at CAMH in Toronto, Ontario, Canada. Ferguson has worked with paramedics for many years.

“Paramedics deal with several mental health issues stemming from cumulative trauma and ongoing traumatic events on the job. They see a lot of things that the public would not normally see, and we can’t imagine what their world looks like from day to day,” said Ferguson.

In addition to PTSD, paramedics often develop depression, anxiety disorder, and substance abuse. Individuals contemplating careers as paramedics should think about what challenges they will face every day, Ferguson suggested.

“The new paramedics I see are young and idealistic, and I wonder, ‘Doesn’t anyone tell you what you’re getting into? How much psychoeducation have you received prior to getting into this field? How will you be able to sustain this constant exposure to trauma?’”

Physical, Social Difficulties

“While I cannot comment on any specific or current patient, I have worked with various paramedics over the years,” said Simon Sherry, PhD, professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia, Canada. “Paramedics, police officers, firefighters, and other first responders often suffer from PTSD, burnout, addictions, and depression. They also tend to die by suicide at higher rates.

“The high intensity and high stakes of a paramedic’s job are stressful. They often work long hours and deal with life-or-death situations. This stress can carry over into other areas of their life, causing physical ailments and problems in their romantic relationships,” said Sherry.

“Paramedics and first responders give a lot of themselves to serve others; they deserve support in return. I commend this much-needed increase in support and hope that other provinces take note of the Ontario Ministry of Health’s initiative,” he said.

Sage, Ferguson, and Sherry reported having no relevant financial relationships.