Federal Framework on Post-traumatic Stress Disorder (PTSD): Report to Parliament 2025

Table of contents

• Minister's Message
• Evolution of the Federal Framework on PTSD
  • PHAC's role
• Approach to this report
• Progress against the Framework's priority areas
  • Priority area 1: Improving the tracking of PTSD and its associated economic and social costs
  • Priority area 2: Sharing guidance and best practices related to the diagnosis, treatment and management of PTSD
  • Priority area 3: Increasing awareness by creating and distributing educational materials related to PTSD
  • Priority area 4: Improving collaboration and linkages among partners and stakeholders
• Conclusion: Lessons learned and looking forward
• Appendix A: Abbreviations
• Appendix B: End Notes

Minister's Message

Post-traumatic Stress Disorder (PTSD) can have debilitating effects on individuals, families, caregivers, and workplaces. It has a disproportionate impact on those who are exposed to trauma because of the work they do.

I am pleased to provide this report on the effectiveness of the Federal Framework on PTSD. The Framework, launched in 2020, sets out priority areas for action to strengthen collaboration and coordination across the federal government, reduce stigma, and improve recognition of the symptoms and impacts of PTSD.

The Framework recognizes that while anyone can be at risk for PTSD, workers in some professions, such as Veterans and those serving in the Canadian Armed Forces, public safety personnel, and healthcare workers, are at increased risk. Every day, these workers put in long hours and experience high stress to keep Canadians safe and healthy. In the 5 years since the Framework was developed, workers in these professions have faced unprecedented stressors as they responded to wildfires, hurricanes, acts of violence, and the COVID-19 pandemic.

On behalf of all Canadians, I extend my sincerest gratitude to Canadian military members, Veterans, public safety personnel, healthcare workers, and other frontline and essential workers for their dedication, sacrifice, and resilience.

This report provides an opportunity to reflect on progress made over the past 5 years, while continuing to work towards a Canada where anyone living with PTSD, those close to them, and those at risk of developing PTSD receive the support they need along their path to healing and recovery.

The Honourable Majorie Michel, P.C., M.P.

Evolution of the Federal Framework on PTSD

The Federal Framework on Post-Traumatic Stress Disorder Act called on the Public Health Agency of Canada (PHAC) to develop a comprehensive federal framework, informed by a national conference held in April 2019 that included 200 diverse partners and stakeholders and 15 federal departments.

Post-traumatic Stress Disorder (PTSD) is a mental disorder that may occur after a person has been exposed to potentially psychologically traumatic events (PPTEs), such as experiencing or witnessing actual or threatened death, serious injury, or sexual violence. It can result from a single specific, severe event or from a series of such events. It is important to note that not all PPTEs will result in PTSD.

The Federal Framework on PTSD (the Framework) was established in recognition that many Canadians face an increased risk of developing PTSD due to the unique demands of their occupations, while acknowledging that federal actions can also apply more broadly to other populations.

The Framework was informed by the views of experts, partners, and persons with lived experience about what is working, and what is needed, to address PTSD from a public health perspective.

The resulting Framework has informed and guided federal actions in 4 priority areas that have aimed to:

1. Improve tracking of the rate of PTSD and its associated economic and social costs;
2. Share guidance and best practices related to the diagnosis, treatment and management of PTSD;
3. Increase awareness by creating and distributing educational materials related to PTSD; and
4. Improve collaboration and linkages among partners and stakeholders.

The Framework brings together federal efforts related to PTSD and builds on existing initiatives and investments.

PHAC's role

As the Government of Canada's federal lead on public health, PHAC's role in mental health focuses on promoting mental health and preventing mental illness, and improving the overall health and wellbeing of Canadians through health promotion programs, policies, and initiatives. The Agency also plays a critical role in preparing for and responding to public health emergencies, such as natural disasters, disease outbreaks, and bioterrorism, and is responsible for monitoring trends and emerging threats on Canadian's mental health and wellness.

Approach to this report

This report was prepared by PHAC and was informed by the findings of a review conducted by the Office of Audit and Evaluation (OAE) at the Public Health Agency of Canada.

This report also provides an overview of activities undertaken across the Government of Canada related to PTSD.

Progress against the Framework's priority areas

Priority area 1: Improving the tracking of PTSD and its associated economic and social costs

Federal Framework commitment

• Explore strategies to support national surveillance activities and examine the feasibility of using health administrative data and enhanced data linkages to capture and report on PTSD.
• Continue supporting data collection on PTSD.

Since the Framework's publication, there have been significant strides in improving the tracking of rates of PTSD through collaboration with Statistics Canada. The subsequent economic and social costs of PTSD have been explored with other partners and stakeholders.

In 2021, PHAC published the results of a systematic review of the prevalence of PTSD as reported in Canadian studies, which pointed to the need for more up-to-date Canadian data.^{Footnote 1} Since then, PHAC has worked with Statistics Canada to gather data and information on the mental health of the general Canadian population by developing the Survey on Mental Health and Stressful Events (SMHSE), and incorporating specific questions about PTSD in the Survey on COVID-19 and Mental Health (SCMH).

This collaboration has resulted in a clearer picture of how stressful events affect mental health, and how recent events, such as the COVID-19 pandemic and other national and international crises, have intensified stress and demands on many Canadians.^{Footnote 2}

Results to date from the SMHSE indicate that almost two-thirds of adults living in Canada have experienced at least 1 PPTE in their lives, and about 8% report moderate to severe symptoms of PTSD (i.e., screen positive) within the past month.^{Footnote 3}

When asked to identify the worst event they had experienced, the following types of events were the most commonly identified among individuals screening positive for PTSD: sexual assault (14%), life-threatening illness or injury (10%), situations involving sudden accidental death (6%), and physical assault (6%).^{Footnote 4}

Within Canadians 18 years and over, the SCMH found that the prevalence of symptoms of PTSD was:

• higher among women (9%) than men (6%);
• highest among those aged 18-34 (16% of women and 7% of men);
• lowest among those 65 and over (2%); and
• higher among frontline workers (11%) than other Canadians (7%).^{Footnote 5}

PHAC's monitoring of mental health throughout the COVID-19 pandemic highlights the ongoing need for support related to trauma and PTSD.

It also underscores the prevalence of burnout, moral injury, and moral distress among public safety personnel, healthcare workers, and other frontline workers who have been heavily relied upon throughout the response to the pandemic.

While the social and economic costs of PTSD remain to be fully understood, current data indicates that many individuals, families, workplaces, and the healthcare system in Canada are bearing a significant burden.

To address some of these costs, PHAC continues to collaborate with partners, such as the Institute for Clinical Evaluation Sciences, and the Association of Workers' Compensation Boards of Canada. These collaborations aim to explore how administrative data, such as electronic medical records and workers' compensation claims, can offer a more comprehensive understanding of the impacts of PTSD and help inform future federal actions.

Data and tracking findings:

PHAC has made progress towards improving tracking of the rate of PTSD and its associated economic and social costs by developing new data collection and examining the use of existing data sources.

PHAC's surveillance activities in response to the Framework improved the availability and timeliness of PTSD data. Before the SCMH and SMHSE, the most recent national data on the prevalence of PTSD was collected in 2012.

OAE's review noted that future efforts could focus on continuing to examine available data sources to track PTSD and disaggregate or break down by key health dimensions or sub-populations where feasible; and continuing to explore the social and economic costs of PTSD.

Related links

• A Systematic Review of the Prevalence of Post-traumatic Stress Disorder Reported in Canadian Studies
• Survey on COVID-19 and Mental Health (SCMH)
• Mental Illness during the Pandemic (Cycles 1 and 2) – Health Infobase
• Interactive dashboard: Map of Canadian mental health during the COVID-19 pandemic (SCMH) – Health Infobase
• Survey on Mental Health and Stressful Events (SMHSE)
• Post-traumatic Stress Disorder among adults in Canada – Health Infobase

Priority area 2: Sharing guidance and best practices related to the diagnosis, treatment and management of PTSD

Federal framework commitment

• Work with partners and engage experts to compile existing guidance on PTSD and identify where gaps may exist.
• Continue to support research to bridge PTSD-related information gaps, inform effective guidance for healthcare providers, and advance evidence-based decision making.

Evidence-based guidelines and best practices are essential to ensure the best care and support for those affected by PTSD. Guidelines can also help individuals, family members and support networks recognize symptoms of PTSD, and help reduce stigma and other barriers to care. Promoting best practices and improving access to knowledge and information can help improve standards of care, allow service providers to intervene more quickly, and offer hope to those in need.

While key sources of evidence-based clinical approaches for the treatment of PTSD were identified in the Framework, the need to tailor standards of care for diverse population groups was also raised by stakeholders.

In response, PHAC funded McMaster University's Trauma and Recovery Lab to create an inventory of evidence-based guidelines, guidance, and effective interventions for PTSD and trauma. McMaster conducted a scan of evidence and guidelines about mental health interventions for diverse population groups, and identified the strengths and gaps in the available evidence about mental health supports for PTSD and trauma. Building on well-established partnership networks, McMaster will be implementing a comprehensive knowledge mobilization plan to make this information accessible for all Canadians, including healthcare professionals, public safety personnel, military and Veterans, and other service providers, by 2025.

PTSD diagnosis, treatment, and management is complex and there are no one-size-fits-all approaches. These efforts are critical to informing the delivery of culturally safe, trauma-informed care practices, and inclusive approaches.

Guidance findings:

Through funding to McMaster University, PHAC has advanced work to complete commitments for this priority area.

Opportunities for future work highlighted by the OAE review include establishing a single Canadian repository of information where healthcare providers can access guidance on PTSD diagnosis, treatment and management.

Additional good practices to support dissemination, such as leveraging professional associations, collaborating with people with lived experience of PTSD, and leveraging implementation science, could be considered.

Priority area 3: Increasing awareness by creating and distributing educational materials related to PTSD

Federal Framework commitment

• Work with partners and engage healthcare providers to identify current PTSD educational materials, understand the educational gaps, and seek advice on best practices for the dissemination, adaptation, and uptake of educational materials.

Stigma and fear associated with disclosing mental health challenges can impede many individuals from seeking early intervention for their symptoms. Increasing awareness and understanding of PTSD among Canadians and healthcare professionals empowers individuals, organizations and leaders to seek support early and overcome barriers to help-seeking. Actions taken to advance this commitment under the Framework include a glossary of terms, and funding for projects that contributed to education and awareness related to PTSD and trauma.

The glossary of terms aims to promote a shared language and understanding of psychological trauma and PTSD. The initial iteration of the glossary was intended to facilitate open discussions among the many partners and stakeholders at the National Conference on PTSD held in 2019 and assist in developing the Federal Framework on PTSD.

The recent release of the Glossary of Terms Version 3.0 reflects a major milestone in establishing a common understanding of trauma and its impacts. This work continues to reflect the ever-evolving language regarding psychological trauma and helps bridge the gaps among people living and working in different contexts.

The Canadian Institute for Pandemic Health Education and Response (CIPHER) at the University of Regina promoted awareness of these terms through its Words Matter campaign. Words Matter aims to share and promote a collective understanding of many well-known and used mental health terms that describe various occupationally related challenges many public safety personnel, healthcare workers, Veterans, and their families face every day.

The Government has also advanced knowledge and education products through program funding. The COVID-19 pandemic created challenges for mental health throughout the population, including for those delivering front-line and essential services. Budget 2021 provided $50 million to support projects that addressed PTSD and trauma in those most affected by the COVID-19 pandemic, including healthcare providers, long-term care workers, personal support workers, teachers, Veterans, public safety personnel, and other frontline and essential service providers.

Through this investment PHAC supported 14 projects, including a knowledge hub, that have collectively improved the availability of evidence-based information and resources related to trauma and PTSD.

These projects have:

• Adapted, scaled-up, and delivered mental health and resiliency training for healthcare workers, public safety personnel, and other frontline workers, who are regularly exposed to PPTEs;
• Adapted evidence-based tools, training and guidance to assist organizations, leaders, supporters and communities to recognize those affected by trauma and PTSD;
• Adapted and delivered Resilient Minds for Indigenous and Francophone Firefighters;
• Developed ecosystems of peer support programming through the Beyond Silence and PeerOncall apps, including guidance and best practices, and free access to available mental health supports through PSP Mental Health;
• Developed ecosystems to support healthcare workers related to PTSD, stress, moral injury, among other topics through Healthcare Salute as well as tools to help organizations respond safely and effectively through REVEL;
• Supported families of public safety personnel through PSPNET Families, a virtual wellbeing hub.

Collectively, these projects involved over 70 collaborators in over 200 virtual and in-person sites across Canada, and have provided mental health and resiliency training, information, and support to approximately 150,000 frontline and other essential workers. Through these projects, trauma-informed resources have been created, while accounting for diverse backgrounds, disciplines and sectors, urban and rural settings, and official languages. New and existing resources have also been adapted and expanded to reach populations of concern, including healthcare workers, and families of public safety personnel.

There is a continued need to recognize and respond safely to trauma and provide communities with mental health supports in the aftermath of emergencies or traumatic events.

Recognizing these ongoing needs, PHAC provided funding to McMaster University's Trauma and Recovery Lab to develop the Canadian Emergency Response Psychosocial Support Network or canemerg-urgencecan.com.

This project developed and disseminated tools, resources, and guidance to support communities across Canada with the psychosocial response to emergencies and PPTEs. These resources enhance awareness of trauma, resilience and mental health.

Educational materials findings:

While progress was made to improve the dissemination of educational material, facilitated by the COVID-19 and mental health investment addressing PTSD and trauma, there were no specific activities to identify current PTSD educational materials, and understand the current information and educational gaps.

The OAE review found that there are opportunities for future work to enhance dissemination of educational resources, for example through a national repository, or via targeted promotion through a coordination knowledge translation strategy.

Related links:

• Those most affected by COVID-19: Addressing post-traumatic stress disorder (PTSD) and trauma – Funded Projects
• June 27, 2024: Message from the Minister of Mental Health and Addictions and Associate Minister of Health – National Post-traumatic Stress Disorder (PTSD) Awareness Day - Canada.ca
• August 9, 2024: Help is within reach: Canadian Emergency Response Psychosocial Support Network

Priority area 4: Improving collaboration and linkages among partners and stakeholders

Federal Framework commitment

• Work with partners and stakeholders to identify the best mechanism(s) for increased collaboration among key federal departments, partners, and stakeholders, as well as for ongoing sharing of information, including uptake of common and culturally appropriate terminology, definitions, and safe language related to PTSD and trauma.

The success of the Federal Framework on PTSD relies on strong collaboration among federal partners, healthcare professionals, researchers, community organizations and those impacted by PTSD. Working together helps ensure a coordinated and comprehensive approach to addressing PTSD, leaving no one behind.

The Government recognized the need for connection and collaboration when it developed the Federal Framework on PTSD. Since its launch in February 2020, the Framework has guided federal actions addressing PTSD, bringing them under one umbrella.

In its role as coordinator for the Framework, PHAC has facilitated collaboration across federal departments and agencies, through mechanisms including governance tables, online platforms, and shared web content. PHAC co-leads an interdepartmental, Federal Coordinating Committee (FCC) on PTSD, which has resulted in enhanced information sharing and reduced overlap between PHAC and Public Safety Canada, and 15 other federal departments leading PTSD efforts.

Federal collaborative actions are supplemented through engagement with external experts and partners including regular presentations to the National Collaborative on PTSD and external meetings and briefings with federal partners such as the Atlas Institute for Veterans and Families.

Other federal departments and agencies have also led key initiatives to address PTSD, with input and support from federal partners and other experts and stakeholders.

Examples of federal collaboration addressing PTSD

The Minister of Public Safety is leading Canada's first-ever National Action Plan on Post-Traumatic Stress Injuries. Notably, Budgets 2018 and 2023 provided $31.7 million to Public Safety Canada to advance this Action Plan. This included supporting the development of a Knowledge Exchange Hub with the Canadian Institute for Public Safety Research and Treatment (CIPSRT) to provide a trusted space to learn and share information about post-traumatic stress injuries (PTSI). This funding is also supporting the renewal of the Action Plan for an additional 5 years. A sub-committee of the FCC is informing its approach, along with other partners and stakeholders. Funding has also supported the continuation of PSPNET, a program specifically designed for public safety personnel to manage PTSI through self-guided, internet-delivered cognitive behavioral therapy.

Budget 2018 also provided the Canadian Institutes of Health Research (CIHR) with dedicated funding for research to better understand post-traumatic stress in public safety personnel in Canada. This was supported through a partnership between CIHR and CIPSRT. A total of 54 research projects were funded that focused on:

• causes and determinants of PTSD;
• diagnosis, awareness, and prevention;
• mental health tools and resiliency training; and
• support models for public safety personnel suffering from post-traumatic stress injuries.

In 2020 to 2021, CIHR hosted a webinar series called PTSI Among PSP Research Highlights, which featured learnings from this research to mobilize knowledge around policies, practices and programs that can support public safety personnel with post-traumatic stress injuries. The research direction around PTSI/PTSD was informed by diverse stakeholders, including federal partners, and has been shared more broadly in published reports such as a What We Heard report released in January 2020 (Post-Traumatic Stress Knowledge Gaps Consensus Workshop: What We Heard - CIHR).

Defence Research Development Canada (DRDC) provides national leadership on science, technology and innovation enhancing Canada's defence and security. In 2021, DRDC collaborated with McMaster University, the Canadian Institute for Public Safety Research and Treatment (CISPRT) at the University of Regina, among other partners, to develop OnCall and OnCall Support. These are twinned smartphone apps designed to facilitate peer support within the public safety community. OnCall is designed to promote high quality, accessible information and confidential links to real-time peer support, while OnCall Support is designed for peer support providers and includes a list of resources and tools to help manage peer support connections. The project received initial funding through a grant from CIHR that was exploring post-traumatic stress injuries in public safety personnel in Canada. In 2022, CIPSRT received PHAC funding under the Addressing PTSD and trauma in those most affected by the COVID-19 pandemic investment to further develop and leverage the existing OnCall platform. Similarly, PHAC funded a peer support project with McMaster University, which has designed and built similar offerings for healthcare workers. Teams from both universities have shared their technical expertise between the 2 projects.

A 12-year, longitudinal study funded by the RCMP at the University of Regina is generating knowledge about the effects of policing on the mental health of RCMP officers. Findings are helping to identify tools to help manage stress, and better identify post-traumatic stress injuries through early detection. Knowledge emerging from this project is being shared to reduce risks; enhance early treatment of PTSD and operational stress injuries; and support faster recovery for the RCMP and other emergency response organizations. Knowledge events including annual conferences hosted by Canadian Institute for Military and Veteran Health Research (CMVHR) are helping to mobilize learnings out of this project and share them amongst federal and other organizations.

The Canadian Centre for Occupational Health and Safety (CCOHS), a federal agency responsible for the advancement of safe and healthy workplaces, has developed workplace products promoting the reduction of public health-related risks on a variety of topics including mental health, PTSD, burnout, and workplace trauma. PHAC has supported the CCOHS to further develop resources to improve mental health and prevent psychological harm in the workplace. The suite of products, including a Tipsheet, Infographic, Risk Assessment Checklist, and Video, provide employers with tangible action items they can implement in the workplace to support employee mental health and enhance psychological health and safety.

Federal investments like these have facilitated knowledge sharing, resources, expertise, and best practices to enhance the overall effectiveness of the Framework. As we move forward, collaboration will continue to be a critical element for success in addressing PTSD.

Collaboration findings:

Even though PHAC did not identify the best mechanisms for increased collaboration and information sharing, PHAC has made progress in working with federal partners to improve collaboration and information exchange, which has resulted in enhanced sharing and reduced overlap among federal departments who are leading PTSD efforts. This collaboration has established relationships which have facilitated further work beyond the Federal Framework commitments.

OAE found that while relationships among federal partners was enhanced under the Framework, there is an opportunity to enhance collaboration and leadership on PTSD outside of federal partners at a national level.

Related links:

• Public Safety: National Action Plan on Post-Traumatic Stress Injuries
• CIHR: PTSI Among PSP Research Highlights
• OnCall: Peer Support project
• CIPSRT/RCMP: RCMP Longitudinal PTSD Study
• CCOHS: Healthy Minds @Work

Conclusion: Lessons learned and looking forward

This report provides an opportunity to reflect on the important progress that has been made under each of the Framework's priority areas over the past 5 years.

Important actions have been taken, despite a number of challenges. While the Framework set out key priorities to guide federal efforts, it did not provide dedicated resources to advance those activities. In addition, the COVID-19 pandemic caused delays and disruptions to some activities.

On the other hand, the response to the pandemic created opportunities for action and learning, including a $50 million investment in projects addressing pandemic-related PTSD and trauma. The Framework guided this and other federal initiatives related to the experiences of frontline and other essential workers, their families, and others whose mental health was particularly impacted by the pandemic.

The experience of the past 5 years has demonstrated many strengths of the Government of Canada's collective activities, including:

• Collaboration with external researchers, clinical experts, community groups and other stakeholders to address PTSD;
• Commitment to evidence-based policies and programs, informed by advances in research and data on PTSD; and
• Collaboration and cooperation across federal departments serving various sectors.

Moving forward, the Government of Canada will continue to work collaboratively to advance the goals of the Framework by continuing to:

• Build and share knowledge and evidence about rates and impacts of PTSD, and about effective treatments and protocols for addressing it;
• Mobilize resources, educational materials and knowledge products related to PTSD to appropriate and relevant audiences; and
• Foster cross-sectoral collaboration and exchange, to address and respond to PTSD. Collaborative efforts will be expanded to include organizations and experts external to the Government of Canada.

The Government of Canada remains committed to supporting the wellbeing of those with PTSD and those at risk. Together we will work to eliminate stigma, advance knowledge, support evidence-based treatment and management, and learn from each other.

Appendix A: Abbreviations

CIHR

Canadian Institutes of Health Research

CIMVHR

Canadian Institute for Military and Veteran Health Research

CIPSRT

Canadian Institute for Public Safety Research and Treatment

CIPHER

Canadian Institute for Pandemic Health Education and Research

DRDC

Defence Research and Development Canada

FCC

Federal Coordinating Committee on PTSD

HCW

Healthcare workers

PHAC

Public Health Agency of Canada

PSC

Public Safety Canada

PSP

Public Safety Personnel

PPTE

Potentially Psychologically Traumatic Event

PTSD

Post-traumatic Stress Disorder

PTSI

Post-traumatic Stress Injuries

RCMP

Royal Canadian Mounted Police

VAC

Veterans Affairs Canada

Appendix B: End Notes