Beyond the 13 factors: When the ‘protect’ mission fails inside an organization

First responders and healthcare professionals begin each day with a clear and unwavering mission: to protect public safety. This commitment is foundational as society relies on these teams to reduce risk and prevent harm.

But what if the organization fails to protect its own people with the same conviction as it protects the public? What happens when the workplace dedicated to delivering safety and care to others fails to protect those within?

Like any psychosocial factor, in this context, the sanctuary can be a powerful psychosocial protective force when well managed. However, when the internal environment fails to align with the external mission, the sanctuary itself can become an unwelcome psychosocial hazard. When workers feel unsafe, unsupported or unable to speak up, the sanctuary transforms from a protective factor into a hazard, increasing the risk of mental harm and, if unaddressed, potentially leading to psychological injury or illness.

Some refer to this experience as “sanctuary trauma,” but through the lens of occupational health and safety, it is more accurately described as sanctuary harm: a psychosocial hazard that arises when an organization’s internal environment does not align with its external mission to protect its team members with the same rigour and conviction it protects the public.

In professions involving police officers, firefighters, paramedics, 911 operators, military personnel and healthcare workers, where the expectation is to project a mission to protect with confidence, an internal failure to uphold that standard can leave individuals feeling isolated, ashamed and sometimes believing they are the problem. When the workplace sanctuary fails to protect, the resulting psychosocial hazard undermines individual well-being and the integrity of the organization’s mission.

A psychologically healthy and safe workplace is defined by standards that work to prevent mental harm and promote mental health. The expectation to protect should be applied to workers and the workplace as it is to the public these organizations serve.

When sanctuary protection is absent, workers feel unsafe reporting concerns, leaders minimize issues, or peer dynamics tolerate disrespect, the psychosocial factor of protect has failed within. Employees think the sanctuary has failed to protect them, and this incongruency becomes lived to the point it is a psychosocial hazard.

If not detected early, this sanctuary harm can drive silence. Confidence in the employer’s ability to protect erodes, performance suffers, the risk of mental harm increases, and the external mission is compromised because the internal mission has failed.

Assessment methods: System-level and early detection

Workplace assessments that typically focus on system policies, practices, culture and leadership are beneficial for evaluating psychosocial factors that influence how work is organized. They also examine interpersonal interactions, equipment, and working conditions to identify potential hazards.

In this series, we have provided ideas for measuring beyond the 13 PHS system factors. However, in vocations exposed to significant traumatic events, it is also beneficial to detect the risk of mental harm at an individual level, which is critical to prevent psychological injuries. Because perception plays a big role in psychological health and safety, it is prudent to be mindful that no two employees may have the same experience.

System-level assessments should be complemented by tools and approaches that surface early warning signs, such as evaluating psychosocial risk factors and hazards — the kinds discussed in this series. However, to help understand individual impact, the persons responsible for first responders and health care should also consider individuals’ experience as a secondary validation of harm and risk.

The tools used should guide help-seeking behaviour promotion, and employers should receive aggregated data on their workforces’ risk profiles to anchor not only perceptions of workers but also what they are experiencing.

The following two tools, which we have helped design, are recommended for organizations seeking to identify and address psychosocial risks.

Occupational Stress Injury Resiliency (OSIR) tool: Developed by the Public Services Health & Safety Association in partnership with The Conference Board of Canada, OSIR is an evidence-based, purpose-built tool designed to help employers understand and identify risks of occupational stress injuries within their organizations. The OSIR provides an organizational-level assessment of risk factors related to occupational stress injuries (OSI).

The OSIR surveys employees anonymously on four key areas:

• Support programs
• Supportive environment
• Supportive leadership
• Resiliency behaviours

Aggregate results are used to generate a vulnerability profile for the organization, ranging from high to minimal risk of occupational stress injuries (challenge, concern, thriving). The results are linked to critical outcomes for mental and physical health, as well as workplace factors such as absenteeism. OSIR provides actionable recommendations for programs and strategies to promote psychological health and safety, build resilience and prevent occupational stress injuries. Employers can use the OSIR to evaluate existing support, benchmark progress and inform targeted action plans for workplace well-being.

Organizational Mental Health Assessment (OMHA): The OMHA is a comprehensive organizational-level assessment tool designed to detect early warning signs of psychosocial risk and mental harm in the workplace. It evaluates multiple dimensions, including comfort in reporting issues, perceptions of leadership support, team dynamics and psychological safety.

By gathering behavioural and perceptual data from employees, the OMHA enables organizations to identify risk signals before harm escalates, pinpoint areas for targeted intervention and track progress over time. It supports a proactive approach to psychological health and safety, helping leaders foster environments where employees feel safe, supported and empowered to speak up, reducing the risk of mental harm and injury.

Practical controls and implementation strategy

Managing to the internal standard to protect employees with the same mission and rigour as most first responders and health care organizations do for the public requires systematic controls anchored in a psychological health and safety management system that is consistent with recognized standards. Key steps include:

1. Leadership acknowledgment and visible commitment: Leaders must recognize and address gaps between the external protect mission and the internal experience of workers. This includes public commitment to correcting sanctuary failures and responding to concerns without retaliation.
2. Safe reporting mechanisms: Establish confidential, anonymous channels for reporting concerns; reinforce the principles of psychological safety; and demonstrate early wins by acting on feedback.
3. Rapid, non-punitive incident learning: Treat psychosocial incidents as opportunities to understand system contributors rather than to assign blame.
4. Routine measurement and continual improvement: Integrate regular assessments of psychological safety and sanctuary health into organizational processes. Use findings to inform action plans and monitor progress.
5. Leader training and modelling: Build capability for supportive supervision, psychologically safe conversations and fair responses to errors.
6. Job design and staffing controls: Address high-risk job demands, enhance autonomy and support and reduce exposure to interpersonal risks.
7. Transparent communication and feedback loops: Maintain open, two-way communication about psychological health and safety initiatives, progress and challenges. Ensure employees receive updates on actions taken in response to their concerns, closing the feedback loop and building trust.
8. Peer support and connection programs: Implement peer support networks and structure opportunities for team members to connect, share experiences and support one another. These programs help reduce isolation and foster a sense of belonging. We promote the Crisis-Ready Interventionist program to help employers have employees who can support peers struggling to defuse, de-escalate and encourage help-seeking behaviours to break down stigma barriers.
9. Access to mental health resources and early intervention: Provide accessible, confidential mental health resources, including counselling, employee assistance programs and crisis support. Promote early intervention by encouraging employees to seek help before issues escalate.

10. Regular review of policies and practices: Periodically review and update organizational policies, procedures and practices to ensure they align with best practices in psychological health and safety. Involve employees in the review process to ensure the policies remain relevant and effective.

Why this matters: Confidence, charge and mission alignment

When employers fail to protect workers, workers are more likely to disengage, absenteeism rises, the risk of mental harm increases, and service quality suffers. Conversely, when people feel protected and believe that the internal mission aligns with the external mission, sanctuary becomes a source of energy, engagement, and resilience. This alignment is both a moral imperative and a performance necessity for first responders and healthcare workers.

Impact on the original 13 factors

Strengthening a commitment to protect the workplace (i.e., sanctuary) can positively influence several psychosocial factors. When the following are reported as perceived drains, they can have a negative impact and contribute to the risk of the psychosocial hazard we are calling sanctuary harm, which increases the risk of mental harm at the individual level.

• Organizational culture, civility and respect: Clear norms against incivility and bullying reduce psychosocial risk.
• Psychological protection and growth: Safe reporting and supportive supervision enable learning and reduce fear.
• Workload and control: Addressing job design, staffing and autonomy lowers sustained stress exposures.
• Leadership and involvement: Visible commitment and participatory measurement foster trust and shared responsibility.

Bottom line

First responders and healthcare providers are mandated to protect the public and reduce harm. When sanctuary protection fails inside the organization, a psychosocial hazard emerges that can lead to mental harm and, if unaddressed, to injury or illness. Aligning internal protection with the external mission by early detection through workplace assessments of the environment, as well as individual assessments of mental harm risk and injury, psychologically safe leadership, and continual improvement protects the protectors and strengthens the system’s ability to serve the public.