A. Conceptual considerations

1. United Nations Standard Minimum Rules for the Treatment of Prisoners

The human rights and dignity pre-requisites outlined in the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) were felt to be applicable and beneficial for improving CSE health and wellness. Some of these concepts and principles may help organizations develop a mutually agreed-upon set of standards that could be used to assist in the development of accreditation pathways for correctional services if not already in place. These principles include:

  • The inherent dignity and value of human beings and their safety and security.
  • There should be no impartiality or discrimination between any CSE, justice-involved persons, or others.
  • Ensure correctional settings reflect societal standards and ensure all involved have equitable access to physical, mental and other health-related resources.
  • Safety and security of information to ensure privacy and confidentiality in all CSE-related processes.
  • Disciplinary processes that are well defined, respectful, supervised and reviewable.
  • Rules related to institutional personnel (Rule 74-82) as applicable.

2. Grid Group Cultural Theory

Grid Group Cultural Theory (GGCT), a sociological framework was discussed during the review. This theory categorizes work cultures based on high or low dimensions of “grid” (formal rules/structural constraints) and “group” (collective identity/shared purpose). Nakamura (2016) applied this theory to correctional workplace cultures internationally and found, of the four possible outcomes, the “fatalist” cultures, that includes CSE is characterized by high-grid, low-group condition and this group was associated with elevated suicidality. In fatalist environments, staff navigate extensive formal controls (high grid status) while often lacking a shared sense of community or purpose (low group status), creating organizational uncertainty and diminished accountability. This framework provides an important context for program and policy development by providing an explanation why some past interventions may have been unsuccessful. When directives or protocols strengthen formal controls without fostering a collective sense of belonging, they may contribute to or reinforce conditions associated with suicidality risk among CSE. Auditing risk factors through a cultural lens, particularly when evaluating workplace stressors according to the experiences of CSE themselves (Ricciardelli et al., 2024), offers a possible structured diagnostic framework for intervention. This approach unifies some of the thematic commentary from our review by identifying both dimensions of at-risk workplace culture and providing a lens to interpret all findings and recommendations from our review.

B. Themes of recommendations

In the context of the risks faced by the CSE subset of PSP, the findings of the 34 individuals who died by suicide, and discussions with over 90 participants, 28 recommendations were developed during this review. The recommendations were also informed by relevant research findings, numerous discussions with CSE staff, families, researchers, service providers and other PSP-related specialists.

The system-based approach followed during this review was intended to inform prevention of further deaths without focusing on the specific pathology of each death. Thematic considerations presented in the recommendations are summarized as:

  1. External independence: The provision of effective supports, evaluation and analysis of and for CSE requires the involvement of entities that are independent of the employer while ensuring transparency and accountability to and for CSE. This could help address the concerns raised by staff and others regarding the surveillance effect of expressing vulnerabilities and aid in striving for a workplace with improved psychological safety.
  2. Engagement of CSE: How staff are engaged and encouraged to provide input and insights; the necessity for trust; the importance of collecting information that leads to observable outcomes by staff (not just data gathering and storage); and the credibility of the support being provided.
  3. CSE recognition: Recognition of CSE staff as individuals and as PSP, with the associated rights and expectations grounded in human rights principles and protections. A recurring theme in the recommendations was the need to prevent isolation and marginalization of CSE staff while they perform the challenging work of protecting and rehabilitating members of society. The review highlighted the necessity of institutionalizing this recognition to ensure it is consistently reflected in policies, practices, and organizational culture. Targeted training, resilience-building initiatives, and structured mentorship were identified as key mechanisms to strengthen and support CSE staff within the specific contexts of their roles.

C. Specific considerations informing the recommendations

  • The importance of a workforce understanding its operational environment, the specific functions required and the risks to wellbeing are key components for workplace health and wellness. External experts, working collaboratively with CSE and employers could help achieve improved workplace health and wellness.
  • Understanding and developing the language and pathway to ensuring mental health, in the context of harms, is a requirement for prevention as well as for the early identification and reduction/removal of any conditions that may develop. The recommendations address language acquisition, risk reduction and prevention of harms as CSE move through the stages of their occupational life cycles.
  • Prevention or early management of issues is preferable to interventions required after serious mental health symptoms develop or the person experiences suicidal ideation. Staff training will help ensure CSE are healthy as well as being committed to helping justice-involved persons be motivated for change.
  • Families described the presence of the high stress work environment, the often-challenging workplace culture of limited support and “toxic masculinity”, as well as limited access to resources and treatment options throughout their employment.
  • The importance of staff training to help ensure CSE are healthy as well as being committed to helping justice-involved persons be motivated for change.
  • Shifting from virtual training to more in-person, onsite, live training (when possible) was deemed to be important for all new staff as well as those requiring refresher courses. Exposure to in-person training to personally experience the “sights, sounds and smell of the environment” was considered an important requirement and may help prevent moral injuries. The importance of enhanced situational awareness of a particular work location and environment was felt to be significant.
  • Different inherent risks were recognized within the specific life cycles of CSE employment.
  • The impact of moral injury and resultant risks of PTSD, mood, anxiety and other psychiatric disorders, substance and other addiction-related conditions, as well as sociocultural complications were important concepts within the recommendations.
  • Debriefing after significant incidents was recognized as valuable given the opportunity for supportive conversations and meetings to discuss and learn from these incidents. The benefit of supportive, voluntary, and safe communications at these times was highlighted.
  • Response systems such as peer support, incident response systems, and other methods of managing and debriefing after traumatic events/outcomes would benefit from the availability of clinical, academic as well as appropriate supports/resources.
  • Learning and improvement occurring from incident analysis could be improved if it was modelled after the medical systems’ approach to adverse outcomes. As a result, there was a recommendation that responses to significant incidents and post-event analysis be grounded in principles in place in the health care field, such as quality-of-care reviews. “Shame and blame” should be replaced by a “name and frame” approach. This approach would highlight the need for identifying all the factors (name) and the environment (frame) that are predisposed to a particular occurrence or event and, in turn, inform their prevention.
  • Specific resources, grounded in known treatment principles with effective research supported outcomes are necessary.
  • A well-established set of treatment options and resources should be available for CSE. Shifting away from broader-based resource provision that is not tailored to the needs of PSP, particularly CSE, such as counsellors and clinicians who are not knowledgeable and sensitive to the specific CSE-related work environments and harms is required.
  • There is need for cultural competence with respect to CSE by all service providers engaged to support this workforce. This requires the incorporation of wellbeing to include all aspects of physical, social, emotional, occupational and financial wellness. The Psychological Health and Safety in the Workplace standard (CSA Z1003) could assist employers to provide a recognized framework ensuring a psychologically healthy workplace for CSE.
  • Recognizing the occurrence and analysis of staff surveys and the importance of this information informing ongoing program analysis and improvement. Surveying staff at all stages of their life cycles of employment was viewed as important in understanding the day-to-day risks. The Province of Ontario completed a staff survey in 2017/18 and is currently working on completing another survey.
  • Caseload, workload, and justice-involved persons’ population numbers are dynamic and challenging to define and predict. Providing the information in a dashboard, which has a component of information that is publicly accessible, was recognized as potentially helpful to illustrate current case numbers, workplace related needs and challenges as well to increase public awareness and/or limit morbidity.
  • Inherent susceptibility and resilience of CSE was related to work location, workplace prerequisites (such as degree requirements), and mental health literacy of the workforce.
  • Peer support was occasionally described as challenging and not trusted by staff and they often relied on their own “people who they trust.” It would be beneficial for there to be specific input of the CSE in program development and implementation regarding peer support programs.
  • Policies and an organizational culture that further encourage wellness could include incentives for the CSE to maintain health and wellness in its many forms. This could help with the significant numbers of “sick calls” that occur by many that also impacts on the ability to hire the correct number of staff.
  • Concern relating to protecting CSE and their families, from threats as well as emotional and physical abuse, was highlighted during the review. In addition, concern was raised regarding perceived lack of consequences for those responsible for these threats/actions further impacting the wellbeing of those involved.
  • The importance of recognition that a death by suicide for any CSE should not be considered a normal or expected outcome because of their jobs. Recommendations to develop the language and awareness of the risks and mental health-related injuries are intended to ensure wellbeing while preventing imitation or clustering of suicide-related outcomes. The public health-related approach to suicide prevention was not within the scope of this review although it was mentioned and should be considered for all those working with CSE.

It was clear throughout the review that there are many sources of stress amongst CSE, varying from internal dynamics of their specific teams, the dynamic that exists between CSE and justice-involved persons, the dynamic of being supervised and the dynamic between CSE and the public which includes friends and family. These areas require training, monitoring and interventions to ensure health and wellness.

The questions for CSE have often been “how many traumatic exposures you have had?”, “how many deaths have you witnessed?”, and “how often have you witnessed or experienced violence?” The questions that should be asked more often are “how many lives you have helped?”, “how many lives saved?”, and “how many positive interactions have occurred today?”

Finally, to broaden our approach the importance of evidence-based methodologies/research along with traditional approaches such as learning through direct knowledge transfer/experience sharing that the direct link between all recommendations and definitive lines of evidence cannot and should not always be made. The merging of the “truisms” from scientific study to conversational and experiential knowledge translation is imbedded throughout this report and its recommendations and it is hoped that this clarifies their inclusion and encourages equal consideration and acceptance. Recommendations do not need to be specifically informed and developed from “definitive scientific/research-based evidence”. Human experience and concepts including equality, dignity and overall human rights require inclusion.