Earlier, we identified the three converging pathways that each of our nine subjects traveled to the ultimate point of their tragic deaths by suicide.  Throughout our deliberations, we also uncovered seven new pathways that we believe will point the way to better outcomes for all police members in the future. 

In Part Five of this report, we list a number of specific recommendations, and where appropriate, we also identify potential roles associated with each. 

In this section of our report, we will first discuss these pathways as they emerged for us as clear themes for action, as areas of opportunity, and as new ways of understanding and approaching the challenges outlined above.  These themes are cross cutting in nature, and many of our specific recommendations derived from several of these pathways to change.  They are discussed here in no particular order of priority.  In the view of the panel members, every one of them will play an important part in any comprehensive plan of action.

1: Normalizing mental health challenges

Removing stigma from mental health in general society is an important goal for everyone.  In policing, it is a goal that must be recognized and acted upon as an urgent priority.  The goal must be to make mental health as normal a subject as any other form of health, well-being and fitness for duty.  To be effective, this normalization must begin prior to recruitment, it must extend through basic training at academies and remain evident in on-the-job orientation training with well-prepared coach officers.  It must continue throughout policing careers, and it must extend to include the families and significant others of police service members at every stage. 

Family members can play vital roles in the recognition, management and support of mental health issues at every stage of prevention and treatment, but only if they are included in an open conversation from the outset and gain continuing knowledge and awareness of what to look for, how to respond, and most importantly, how to directly and urgently access help without barriers and procedural delays.

Current attitudes about mental health issues among serving police members at all levels represent a clear and present danger.  It matters not whether these attitudes have derived from general society, or have been cultivated within police ranks through their prolonged exposure to mental health crises and the suicides of others to which they frequently must respond.  Policing as a system must transition to a point that their own mental health risks, mild to moderate mental health issues, and advanced mental health conditions are recognized early and acted upon consistently with the support of accessible care and suitable services.  For this to occur, mental health in policing must come out of the shadows.

We believe much can be gained by linking mental  wellness to peak performance, a concept that most police officers recognize and value.  This will require taking conversations and training events well beyond 'mental readiness'.  Such events must also include a greater awareness and understanding of the secondary and tertiary prevention and care models that are available.  They must demonstrate that even so-called 'broken toys' can be repaired, and that the path to recovery can and will be fully supported without diminished identity and without marginalization from the core mission of policing.

One model for helping to normalize mental health issues, worth considering and perhaps adapting for police, is the Well-being Framework (Source: Veterans Affairs Canada - full reference to follow) developed by Veterans Affairs Canada and now used to guide their programs and policy decisions.  Notably, the dimensions included in this framework give consideration to the whole person in the context of his or her full environment, rather than taking a narrow, disease-related clinical focus.

We envision that a broad and multi-faceted campaign will be necessary to bring about this transition.   In many ways, it is already underway as reflected in our own review and others occurring in parallel, and in the promising initiatives undertaken by Ontario police services and their varied associations.  But in our view, it must be scaled up and amplified.  Openness, awareness and supportive behaviours toward fellow members experiencing mental health issues should become essential competencies tied to performance and promotion systems at every level, and other forms of recognition should also be explored.

It has been said that police officers are prepared to die for one another.  They must also be prepared to live for one another, and at the same time, to live fully for their families and friends without suffering in silence.

2: Navigating through transitions

When it comes to mental health issues in policing, the devil seems to lurk in the transitions.  Our studies revealed consistently that some of the greatest risks for interruptions in care, for denial and suppression of symptoms, and for aggravated levels of stress tend to occur most during pivotal transitions in an individual's deployment status in the workplace.  Critical transitions may include: periods of repeat short term absence necessitated by mild to moderate symptoms, whether diagnosed or not; initial disclosure and while applying for benefits and psychological services; reassignment to modified roles due to conditions affecting fitness for duty; reassignment back into full service; and, periods of extended leave due to escalated conditions and/or to access more intensive levels of care and treatment.

Of all of these transitions, return to work (RTW) stands out as the point of greatest risk.  The complex decision-making processes about returning to modified duties or to full reinstatement can generate significant stress for individuals, their families, their co-workers, their care providers, and their benefits administrators including the WSIB.  Among our nine subjects, RTW factored heavily and frequently into their worsened health conditions, triggered open conflict with their organization and peers, initiated or aggravated performance and professional standards issues, and often led to financial stress.

Further aggravating these stressors is the current fragmentation that individuals and families must navigate.  Certain services and supports may be available from the employer, while others may be provided only through their Police Association.  Individuals may be directed to some services by peer support providers, by extended health benefits and EFAP providers, and by clinical care providers.  Some of these same agencies may provide 'system navigator' supports.  But, experience has shown that rarely do such navigation supports cross the full spectrum of clinical guidance, procedural assistance, and educational programs to help the individuals and families affected.

A full scope of navigation supports should be readily available to all members in all police services, built upon consistent best practices, yet remaining flexible to the needs of each individual, family, and police service involved.

3: Continuing access to quality care with evidence-based treatment and solutions

Based on our lived experience sources including the voices of survivors, the confidence level among police members and their families in the current patchwork of care providers is at best moderate to low.  We heard of service professionals with little to no familiarity with policing or first responder issues, including the role played by recurrent trauma.  We heard of others who initially established a strong connection with their patient, only to later refuse to continue providing care under established benefit fee schedules.  And, we heard of well-qualified and policing-knowledgeable professionals who established strong bonds and achieved successful outcomes with their patients.

Given the often fragile state of any police member who is coming to terms with symptoms or with a mental health diagnosis amid the cultural dynamics described earlier in this report, any barrier to access can be a reason for them to revert to suppression, denial and withdrawal from care.  For some of our nine subjects, the last years and months of their lives were clearly punctuated with stop-start patterns in their care path.  For others we heard from, their descriptions of their own care paths ranged from successful, to frustrating, to futile.

It is imperative in our view that access to quality care become universal among police members in Ontario, and the quality of care options must extend to include policing and trauma informed clinicians and the application of evidence-based treatments and solutions.  It is our understanding that some of the volunteer agencies and police associations in Ontario have begun to establish referral lists of suitably qualified professionals and support networks.  This work should be accelerated and made widely available as soon as possible.

4: Resourcing, accommodation and burnout

For most municipal police services in Ontario, Police Service Boards are responsible to maintain adequate staffing levels to meet demand for service in their jurisdiction.  For the OPP and First Nations police services, this responsibility rests with the provincial and federal governments.  Most police budget-setting processes establish an 'authorized strength' of members.  The authorized strength model is built on the premise that all the police positions are filled and all members are at work.  The model does not adequately take into account that staffing vacancies occur when recruitment numbers fall short, and also when members are away from the workplace on medical leave or accommodated in other positions.  This gap translates to an additional workload for members who are working.  Through intensified workload demands in regular deployment, and often through increased overtime levels, essentially it falls to the members to subsidize the shortfall in the authorized strength.

The repercussions of this model are that those left working are forced to function in an environment where they are short-staffed which may lead many to burnout.  Some may also develop a feeling of contempt toward members that are on medical leave or accommodated in other positions.  And, all of this leads to further erosion in the identity issues occurring for those absent or accommodated members.

Under the current model, staffing gaps contribute to an ongoing systemic deterrent to disclosure of mental health issues, create a significant barrier to those who need to access and maintain proper care paths, and uphold a false expectation of fit-for-duty capacity that perpetuates stigma and self-stigma surrounding mental health and occupational stress injuries.  The reality of staffing gaps must be confronted.

Each individual police service will undoubtedly continue to face fiscal pressures, and in the short term at least, most may be unable to resolve their current staffing gaps on their own.  Attention should be given to acting collectively to establish a province-wide system for exceeding authorized staffing that will allow for sufficient resourcing to fill vacancies when members are away from the workplace on medical leave or require accommodated work away from their substantive position. 

5: Preserving identity: The criticality of criminal or Police Act charges and social media

The RTW transitions described above represent the most frequent high-risk points for police members with mental health issues, but situations where officers face charges and/or public embarrassment through mainstream or social media could be described as the most acute.  In our review of deaths by suicide, if not managed with care these 'hand-off' situations can clearly rise to the level of a precipitating event with an impact equivalent to the loss of a primary personal relationship.

Recognizing the significant role that police identity has for members deeply invested in policing culture, police services have a heightened responsibility to ensure that any sudden and extreme damage to that identity is managed with care and support.  We reviewed situations and practices where special hand-off arrangements are in place and applied to ease the negative consequences.  Among our nine, we also reviewed some situations that, whether intended or not by the service, were experienced by the subject member as outright abandonment.  We reviewed others that fell somewhere in between.

Every police service must take on the responsibility to establish and apply hand-off procedures that will ensure that no matter the severity of a member's infraction or breach of duty, or whether the scope of any disciplinary action contemplated is seen as a minor set-back or a career-ending criminal charge, supports will be in place to maintain a connection to the member and his or her family, and to ensure a continuity of professional care as may be required.

6: Managing suicide events

We cannot manage, improve or learn from things we do not know about.  In our view the unique nature within, and the place of policing in society, requires that we closely track and learn from every situation that results in a death by suicide, with a view to continuous improvement across the entire police and mental health ecosystem.

As important steps towards improving outcomes for all police members in Ontario, all coroners should be directed to record and report on any death by suicide of a first responder, a database should be established to permit ongoing data capture and analysis, and any death by suicide of a police member should trigger a death review in the Office of the Chief Coroner. 

Much of the foregoing discussion has centred on opportunities in the prevention and intervention stages of mental health.  Postvention is also recognized as a best practice in suicide prevention, and there are two aspects to it that warrant priority attention and action from our review.  One of these involves extending caring support to the bereaved, including direct actions to prevent collateral mental health conditions among family members, close friends and associates, and the other addresses the need to minimize the risks of a contagion effect across the policing community.

In the first, we note that among the survivors of our nine, some degree of bereavement support from their loved one's employer, association, and colleagues was evident in most cases, but it can best be described as uneven in its execution, its scope and its duration.  When properly planned and constructed, postvention practices are designed to achieve a number of aims in the aftermath of a death by suicide, specifically to:

  • prevent suicide among people who are at high risk after exposure to suicide;
  • facilitate the healing of individuals from the grief and distress of suicide loss;
  • mitigate other negative effects of exposure to suicide; and,
  • in a policing context, some means to respectfully memorialize the deceased.

All police services should have a prepared organizational response plan for postvention services designed to assist the bereaved in managing the immediate crisis of a death by suicide and coping with its long-term consequences.

With regard to the broader community, there exists in the literature some evidence of a risk for contagion effects.  In other words, particularly among others in the same population group who may already be experiencing mental health challenges, one or more suicides in that same group may have a triggering effect.  Clusters of deaths, as seen in our nine cases in a single year, certainly heighten concerns in this regard.  It is important to note that the contagion need not necessarily amount to additional suicides for us to be concerned.  The potential to initiate or exacerbate the mental health issues of any police member or group of members is also worthy of our concern.

Postvention is a critical part of suicide prevention, and can also be part of a comprehensive strategy for mental wellness in general.  Ensuring that postvention activities take place after any police member suicide should not be the responsibility of one group, one police service or one individual.  This will require a whole-of-community commitment, extending also to the role of the media in reporting such incidents with care.

7: Joint ownership and collaborative action

The police and mental health ecosystem model shown earlier in Figure 2 illustrates both the scope of resources and capacities that currently exist to lend support to positive outcomes in police member mental health, as well as the complexity and potential for fragmentation that currently exists across this system (see Sidebar above).  We also noted earlier the range of promising initiatives and policy considerations that are underway to bring improvement to the level and quality of services at every stage of prevention, intervention and postvention.  Our deliberations led us to some concern that if left unchanged, continued fragmentation may undermine much of this promise.

Policing as a system must adopt a no-wrong-door mindset in order to ensure that every member and family affected by mental health issues, at their earliest presentation, faces no barriers in seeking, accessing, and affording the professional care and treatment they require.  To fully achieve this, policing must act as the unified system that it is in the eyes of its members.

We recognize recent collaborative undertakings among the OPP, its associations and its not-for-profit partners as one promising model, but little will change if that same approach must be replicated across the remaining police services that serve Ontario communities.  Similarly, we were encouraged by collaborative discussions described by the OACP and PAO, and by TPA with its employer partner the Toronto Police Service.  We also recognize that member mental health has become a priority agenda item for the Ontario Association of Police Service Boards (OAPSB), as it has nationally with the CACP and the Canadian Association for Police Governance (CAPG).  But, in our view there is a growing risk of lost effectiveness and efficiency from an emerging patchwork of bilateral and multilateral initiatives taking shape, without the full involvement of all parts of the ecosystem moving in common directions. 

In Ontario, we believe the Ministry of the Solicitor General, guided by this report to the Ontario Chief Coroner, is best positioned provide the essential leadership and mobilization to achieve a whole-of-system approach.  We address this opportunity directly as the first of our recommendations for action.

Panel Observations on Current Strengths & Weaknesses in the Police Mental Health Ecosystem

Access to appropriate care and treatment

Privacy and fear of career repercussion

Many care and benefit paths begin with the human resources unit of the member's police service.  Many members fear reputational damage from disclosing their mental health issues to fellow employees and members of organizational management.

Access to walk-in support

Some agencies have introduced independent staff and outside psychologists and some have established out-of-office locations for walk-in support without risking disclosure.  Relatively few police services currently offer this option.

Limited access in small urban, rural and remote settings

Smaller police agencies may lack the resources to provide support-with-privacy options for their members.  As well, smaller communities may have limited clinical resources, requiring significant travel and potentially more absences from work for those seeking assistance.

Benefit limits

Some member associations (OPPA and Ottawa Police Association) recently negotiated no-limit arrangements with their benefits providers.  In most Ontario police services, there are restrictive limits on the length of care provided under existing benefits and insurance schemes, and co-pay costs vary significantly. 

WSIB claims face ongoing pressure to reduce or restrict uptake, duration and cost, and often require extensive efforts by member and families to justify the need for care, treatment and compensation for absence from work. An additional barrier is the requirement to be seen by only WSIB approved treatment providers.  The WSIB payment scheme is generally paid at a much lower rate than market.

Availability of trauma and police-informed clinicians

When seeking treatment, members face limited availability of practitioners who are familiar with the unique demands of police work and the role of trauma in mental health issues.  No universally reliable reference source currently exists, though some are under development.

Inconsistency in peer support models

Volunteer-driven police and first responder peer support providers have emerged in the past few years, and many are seeing demand grow for their services.  Currently, peer support practices and service offerings are viewed to be inconsistent in scope, quality, and integration with other MH services.

Balancing affordability vs. quality of treatment

When faced with benefit limits, or due to fear of disclosure to their employer and colleagues, members and their families often struggle to access and sustain affordable care paths, often forced to choose between high quality care and treatment for a very short duration, or questionable care over a longer period of access.  Many simply withdraw from this challenge and elect no continuing care.

Availability of supportive care for family members

Currently, family members are very often excluded from the care path of their loved ones dealing with mental health issues.  It appears that this is may be due to a lack of information about options available, lack of knowledge about mental health in policing, real or perceived privacy concerns, or it may be a symptom of the member's disconnecting behaviour.

System navigators & patient advocates

When police members find themselves in crisis they are often required to navigate unfamiliar and complex processes which can be a barrier to care, while also having a detrimental effect on the member’s well-being, especially for those already reticent to disclose.  Some members and families may also incur financial strain by paying for expenses which may be eligible for coverage.  A full scope of system navigator supports will span clinical, educational, and financial challenges.

Internal attitudes, behaviours, knowledge and skills

Unwarranted perceptions of malingering

Despite recent investments in mental health awareness and resilience training, suspicions and even outright accusations of malingering remain common in policing culture.  Evidence shows that incidents of malingering are rare, and in most cases, the requirement for care and accommodation is very real.

Limited knowledge among supervisors & managers about treatment and recovery

Anecdotally, many police managers, supervisors and peers continue to regard mental health conditions as a permanent disability.  Awareness of the true nature and success rates of treatment and recovery would greatly improve return-to-work transitions for members who have experienced a mental health issue, thereby aiding in stigma reduction

Limited creativity and sensitivity in assigning accommodated duties

The binary 'fit for duty, or not' attitude described elsewhere in this report continues to influence decisions on modified duty.  Members report the negative impact on their dignity from reflex assumptions about the limits of their ability to perform and to remain tied to the core mission with which they identify strongly.

Unclear guidelines on privacy and connection during accommodation

Supervisors, managers and peers report being uncertain of if or how they might maintain a connection to their colleagues who are absent from work due to mental health issues.  This is further aggravated if professional standards issues are also involved.  Greater clarity, established guidelines around consent, and the development of compassionate, trauma-informed skills would be of significant benefit in this regard.

Balancing workload pressures vs. compassionate support

When entire police organizations are under strain due to limited deployable resources, the pressure to return members to full active duty often overrides compassion for the individual, and reduces active support for their continuing accommodation and care.