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Changing Minds: Advancing the Policy Landscape Around the Mental Health of Public Safety Personnel

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Changing Minds: Advancing the Policy Landscape Around the Mental Health of Public Safety Personnel Changing Minds: Advancing the Policy Landscape Around the Mental Health of Public Safety Personnel Report of the CAFC Mental Health Committee September 2020 Canadian Association of Fire Chiefs 1 Rideau Street, Suite 700 Ottawa, Ontario K1N 8S7 Tel: 1-800-775-5189 [email protected] | www.cafc.ca From the CAFC President and Committee Chair It is our pleasure to present “Changing Minds: Advancing the Policy Landscape Around the Mental Health of Public Safety Personnel”. This report takes stock of significant national and federal policy and initiatives that were put in place over the last decade. It highlights the progress we have made and the challenges that remain before us. In the report you will find a description of the major federal initiatives as we see them and where they position the fire sector. It will also speak to where we believe Canada needs to go in first responder mental health as next steps. We caution the reader that this is a report about policy initiatives, not about services, treatments or supports available to the front line. Our hope is that these policy and funding initiatives will translate as quickly and as powerfully as possible. We hope you will find this report interesting. Our thanks to the members of the CAFC Mental Health Committee and to Ms. Lisa Lefebvre for their assistance with this report, and to our reviewers for their helpful comments on this paper. If you have any questions, please do not hesitate to contact CAFC’s Executive Director, Dr. Tina Saryeddine, at [email protected]. Thank you for your support of our sector. We look forward to discussing these issues further together. CAFC President CAFC Mental Health Chair John McKearney & Vice President Ken McMullen Canadian Association of Fire Chiefs | Association canadienne des chefs de pompiers 1 Rideau Street, Suite 700 Ottawa, Ontario K1N 8S7 | 1, rue Rideau, bureau 700, Ottawa (Ontario) K1N 8S7 2 Tel: 1-800-775-5189 | [email protected] | www.cafc.ca Executive Summary This report traces our understanding of select national and federal investments and initiatives in public safety personnel mental health. It then offers our recommendations for next steps. As far back as 2012, members of the Canadian Association of Fire Chiefs passed a resolution to make the mental health of first responders a key advocacy issue. By 2016, the then Minister of Public Safety held a round table discussion on mental health1 with the national public safety associations and other first responder groups. The Mental Health Commission of Canada (MHCC) was also pilot testing its Road to Mental Readiness (R2MR) program in fire departments. MHCC then began to sell the program at cost across the country. Renowned public safety mental health researcher Dr. R. Nicholas Carleton, the Tri Service Chiefs associations, and a former Department of National Defence (DND) staff person, Steve Palmer, also started the Canadian Institute of Public Safety Research and Treatment (CIPSRT)2, of which the CAFC was a founding partner. In 2017, members of the Canadian Association of Fire Chiefs reconfirmed that mental health must remain a topmost policy priority. To translate this into “boots on the ground,” the CAFC stepped up the mental health ask made of the federal government and requested $2.5M to offset the MHCC’s program delivery model to the Fire Service. It is important to note that the CAFC has no business interest in the Road to Mental Readiness (R2MR) program. The CAFC requested it because (1) it was familiar to the fire service; (2) it had a long track record of safe use by both DND and the Navy Seals; and (3) it was administered by a federally established not-for-profit, which made an ask from the CAFC to the federal government more logical than asking the federal government to fund a private company or other not-for-profit. In 2018, the Federal Budget had dedicated $30M to the advancement of research and treatment for public safety personnel through CIPSRT and the Canadian Institutes of Health Research (CIHR)3. The funding included $15M for CIHR to host three research competitions, $10M for CIPSRT to administer internet-based cognitive behavioural therapy, and $5M for a knowledge exchange hub at the University of Regina. Since then, 30 grant opportunities have been made available with the first 22 projects scheduled to complete in May 2020. As of August 2020, there remains 3M dollars of CIHR ring-fenced money available. Todd Doherty’s Bill C-2114, “An Act to Establish a National Framework on PTSD and Mental Health Challenges with First Responders, Veterans and Military,” was passed by the Senate in June 2018. The bill required the federal government to work with the provinces, territories, and members of the medical community to create a federal framework to fully address post-traumatic stress disorder, from recognizing symptoms to treatment. The report is now available5. Its translation is yet to be seen. The federal government also took two additional measures that were less publicized. Prior to the Budget 2018 announcement, the federal government made funds available for two pilot sessions whereby individuals from each of the public safety sectors would have access to R2MR training from DND and would be asked to spread and scale their training. CIPSRT ran the program. The idea was for nine individuals in fire to pay it forward. There was no formal tracking and it was unclear if the experiment would work. To date, over 1000 individuals have been trained through this program. After the March 2017 Halifax Tragedy, Edmonton, Halifax, and Red Deer began to explore how they could bring training to Halifax and Nova Scotia, and CIPSRT stepped in to provide another $50K in support for the departments’ costs. Canadian Association of Fire Chiefs | Association canadienne des chefs de pompiers 1 Rideau Street, Suite 700 Ottawa, Ontario K1N 8S7 | 1, rue Rideau, bureau 700, Ottawa (Ontario) K1N 8S7 3 Tel: 1-800-775-5189 | [email protected] | www.cafc.ca Public Safety Canada (PSC), aiming to make more concrete improvements in the mental health of first responders, provided an additional grant to CIPSRT and made an additional $400K available to complete the R2MR training for first responders. They have a vision to ensure all professions in all parts of the country have basic mental health awareness training. Before this became known, the CAFC continued to seek funding to finish the R2MR job in the fire sector. The CAFC’s National Advisory Council (NAC) worked together to identify what parts of the country were most in need. There were still gaps, particularly in Quebec, Northwest Territories, and Newfoundland and Labrador. NAC continued its advocacy and made a request to the Motorola Foundation. In late 2019, the Motorola Foundation came back with great news. They would award the grant, which would be used to ensure the Northwest Territories and Newfoundland and Labrador have coverage. It would also contribute to the PSC and CIPSRT effort to ensure all parts of the country have mental health awareness training capacity. To support this effort, CAFC administered a survey to identify where else mental health awareness training is needed and who is able to train where. However, with unexpected success came additional challenges. Who would ensure quality control? Who would track the training? How would we monitor the risk of any adverse events? In December 2019, CIPSRT agreed to take responsibility for the program and planned to release its national slate of sessions, protocols, and expectations early in 2020. They are currently reassessing the impact of COVID-19 on this program. With this history in mind, the report will focus on where to from here. The recommendations it contains are summarized as follows: Recommendation 1: Halting the Suicide Train While we’ve made a lot of progress in the area of mental health, we continue to have a major issue with suicide. This is the ultimate system failure. We recommend directing the remaining $3M at CIHR towards a collaboration with Crisis Services Canada to stand up a crisis service line using evidence informed practice and carefully evaluation, a mental health support line for individuals seeking care. Recommendation 2: Boots On the Ground - Without Kicking at Jurisdictional Roles Recognizing that healthcare is under provincial jurisdiction, the federal government should continue to take a leadership role in first responder mental health because of the implications on national safety and security. Its main role should be to provide investments and seek accountability for them. Recommendation 3: Strategic Leadership in the Structuring of Research Competitions Revamp the process by which CIHR offers research funds to researchers working to solve issues in first responder mental health, putting the emphasis on the deliverable and hosting competitions to find the best minds to deliver them. Recommendation 4: Transformation Opportunities Encourage and seek transformation activities that will lead to a freely available set of resources for public safety personnel. Recommendation 5: Gender Inclusive Lens to First Responder Mental Health Bring a more inclusive lens to address mental health issues in all firefighters. Canadian Association of Fire Chiefs | Association canadienne des chefs de pompiers 1 Rideau Street, Suite 700 Ottawa, Ontario K1N 8S7 | 1, rue Rideau, bureau 700, Ottawa (Ontario) K1N 8S7 4 Tel: 1-800-775-5189 | [email protected] | www.cafc.ca Table of Contents A Letter from the CAFC President and Committee Chair ...............................................................
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