In 2021, the Atlas Institute, in partnership with The Royal, conducted a study of the types of situations that violate the morals, values, and ethics of public safety personnel – those who work in services that play a vital role in protecting our communities and the people who live in them. The intent of the study was also to better understand moral injury in public safety personnel within the Canadian context specifically.

Executive summary: Experiences of moral injury in Canadian public safety personnel

Research report: Experiences of moral injury in Canadian public safety personnel

Research summary: Experiences of moral injury in Canadian public safety personnel

Who are public safety personnel?

Public safety personnel (PSP) includes paramedics, firefighters, police officers, communications officials, border officers, and members of search and rescue teams. They play a vital role in protecting our communities and the people who live in them. While on duty, they are often exposed to situations that are distressing and often traumatic. These exposures can have serious long-term impacts on the mental health of PSPs, including depression, anxiety and PTSD, amongst others.

Read the study’s executive summary

Read the full study report

What kinds of situations may lead to moral injury?

In order to better understand moral injury in PSP within a Canadian context, the Atlas Institute conducted a study involving 38 paramedics, communications officials and logistics technicians working for a service in Ontario. We looked at the types of situations that could result in moral injury. These included situations:

  • Involving the nature of the job – for example, having to provide treatment to a patient that was seen as either futile or harmful, or being unable to provide treatment.
  • Reflecting organizational culture – for example, where concerns or complaints about the PSP’s organization were not being taken seriously by leadership or there was pressure to be silent or concede.
  • Within the health care system as a whole – for example, having limited control or autonomy over work conditions, or having to implement policies with which PSP might not agree.

Situations such as these often resulted in feelings of powerless for PSP, where they could not effectively exercise professional judgement. This often created a sense of inner conflict and loss of confidence, along with other mental health impacts such as depression, anxiety and PTSD. Relationships were also impacted.

Read the study’s plain language summary

What coping strategies are PSP using to deal with moral injuries?

Apart from identifying the types of situations that violate core beliefs, key findings from the study also include the ways that PSP cope with these events, and with their work in general:

  • Strategies used by PSP to cope with distressing or traumatic experiences include: humour, exercise, taking breaks and spending time with friends and family. Having not enough time between calls, stigma, and COVID-19-related restrictions prevented some PSPs from using these strategies.
  • Many PSP sought the support of their peers to discuss difficult experiences, but did not use the time together to talk about the moral or ethical aspects of these experiences. Some were reluctant to use official peer support programs due to concerns about confidentiality and the qualifications of peer supporters.

Where do we go from here?

Along with more research and knowledge-sharing, immediate action can be taken. This includes:

For individual PSPs

  • More research on the effectiveness of peer support for individual PSPs.
  • Better understanding of the qualifications of peer supporters.

For PSP organizations:

  •  Iidentify ways in which moral injury may be caused by their own policies and practices and by workplace culture.
  • Organizations should identify ways to prevent situations that may cause moral injury, where possible.

For policy-makers:

  • PSP regulatory bodies can recognize the impact that competing policies and priorities, as well as the heavy demands of the health care system, can have on the mental health of individual PSP.

Read the full study report

About the research team

The team at the Atlas Institute designed this study, conducted participant interviews, analyzed data, and wrote the research report and accompanying knowledge outputs.

From the Atlas Institute for Veterans and Families:

  • Fardous Hosseiny*, MSc, President and CEO
  • Adelina McCall, MSc, Research Coordinator
  • Jean-Michel Mercier, MSc, Senior Research Partnerships Associate
  • Molly Nannarone, MPH, Research Coordinator
  • Sara Rodrigues*, PhD, Director, Applied Research
  • Shannon Tracey, MSc, Senior Implementation Specialist

*co-Principal Investigators

Our co-Investigators at the Royal:

  • Susan Farrell, PhD, CHE, C.Psych, FCPA, Vice-President, Patient Care Services and Community Mental Health
  • Karim Nashef, Psy.D., Psychologist
  • Meghan Perkins, MHA, Project Manager, Champlain Pathways
  • Paul Sedge, CD MD FRCPC, Psychiatrist
  • Jan Wilson, PhD, Psychologist

About the Moral Injury in Public Safety Personnel Advisory Committee:

The advisory committee was composed of frontline public safety personnel, public safety leadership, psychologists and researchers. The committee co-developed the research and interview questions, supported PSP recruitment, provided feedback on early observations and findings, and co-created the knowledge mobilization plan.