PSP in Rural and remote Areas

Charlene O’Connor
Senior Manager, Research and Innovation, Elective Psychiatry
Homewood Health Centre, Guelph, Ontario
Adjunct Instructor, Department of Occupational Science & Occupational Therapy, University of Toronto

As we face the challenges of COVID-19 and the requirements for social distance, it can be difficult to find ways to connect and support each other. This can be particularly challenging for public safety personnel (PSP) who live and work in rural or remote areas.

All PSP, urban and rural, are at increased risk for developing mental health disorders given the nature of their work.  A recent national survey of Canadian PSP found that PSP who work in rural areas screened positive for clinical-level mental health symptoms as frequently as their urban counterparts (Carleton et al., 2018). Rural PSP serve smaller communities spread across large geographical areas. They may work alone or in small teams, perhaps volunteer, and have fewer operational, personnel, or support resources at their disposal. They may have to travel to calls over long distances in harsh physical conditions. Timely help or back-up may not be available. In smaller communities, PSP may respond to calls involving individuals they know. These factors can contribute to the emotional impact of work stressors of the rural public safety provider (Regembal et al., 2015).

The demands of this pandemic may increase the emotional toll of public safety work for rural and remote providers. Lack of resources and support may compound the stress of efforts to keep communities safe in the midst of a public health crisis.  Rural PSP may have concerns about the lack of sufficient PPE and feel frustration over longer delivery times. Providers in small departments and teams may worry about the capacity to respond to COVID-19-related calls if an outbreak occurs in their community or co-workers become ill. An outbreak in a small community means that PSP are likely to have social or family connections with those who become ill, placing additional strain on the rural PSP. In addition, it may be difficult to find relief from the isolation of working a shift in a remote area because of the requirement to stay at home in between shifts. Curtailed opportunities for community connection, so vital to the way of life of small communities (e.g. church, schools, community gatherings, service clubs and sports), may add to the sense of loss and isolation.

A common response to extreme stress is to withdraw. Struggling rural and remote PSP may notice that they are spending increasing amounts of time alone and socially disconnected. Efforts to avoid uncomfortable emotions may involve increased use of alcohol or other substances, excessive or compulsive behaviours (e.g., video gaming, gambling, exercise), or increasing amounts of time engaging in solitary, distracting activities. With social distancing rules in effect, these behaviours may go unnoticed by the outside world. However, family members may notice.  Awareness of any increasing tendencies to withdraw, isolate, or avoid uncomfortable thoughts and feelings is key to identifying the presence of early-stage psychological distress.

When dealing with overwhelming stress and anxiety, rural and remote PSP should take deliberate steps to maintain social connectedness as a positive coping strategy. An important way to maintain social connection is to talk about experiences and put thoughts and feelings into words. Spending time with members of the same household and reaching out by phone or other digital means to loved ones or close friends can help PSP feel understood and supported. Rural and remote PSP should monitor closely the amount of time spent alone and make conscious efforts balance their time with social interaction. Self-care activities like exercise and leisure pursuits, also critical for adaptive coping, can be opportunities for social interaction if family or other members of the immediate household are included.

As necessary, rural and remote PSP may need to seek formalized supports for mental health concerns. Stigma often prevents PSP from seeking help but living and/or working in small communities or geographically remote locations may make it even more difficult. Rural PSP may be reluctant to seek support within their small, close-knit community for fear of privacy violations. Small community or volunteer organizations may not have the resources or expertise to provide help. For PSP in very remote areas, structured supports may not be available, necessitating travel over long distances to receive help. When faced with these barriers, rural and remote PSP may abandon efforts to seek formalized help. However, distress lines, video and telephone counselling, and online support groups exist, in part, to provide help and support when traditional face-to-face services are not immediately available. Indeed, one positive outcome of the pandemic is that many clinicians have transitioned to offering treatment online, thereby increasing options for rural and remote PSP to access clinicians across their province. These resources can be effective and valuable sources of support for rural and remote PSP during this pandemic.


References

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., Hozempa, K., Brunet, A., Weekes, J. R., Griffiths, C. T., Abrams, K. J., Jones, N. A., Beshai, S., Cramm, H. A., Dobson, K. S., … Asmundson, G. J. G. (2018). Mental Disorder Symptoms among Public Safety Personnel in Canada. Canadian Journal of Psychiatry. 63(1), 54–64. https://doi.org/10.1177/0706743717723825

Regambal, M. J., Alden, L. E., Wagner, S. L., Harder, H. G., Koch, W. J., Fung, K., & Parsons, C. (2015). Characteristics of the traumatic stressors experienced by rural first responders. Journal of Anxiety Disorders, 34, 86–93. https://doi.org/10.1016/j.janxdis.2015.06.006