Proactive mental health training that works — and the evidence behind it.
A research-backed overview of the BOS program, its outcomes across three delivery formats, and what it means for public safety personnel and first responders.
44.5%
of Canadian public safety personnel screen positive for at least one mental health disorder. [7]
ABOUT THIS REPORT
Why this report exists, and where its evidence comes from
Why This Report Exists
Public safety personnel (PSP) and first responders face mental health risks beyond those of the general population, yet many remain unaware of proactive programs designed to address those risks before harm occurs.
This report gathers and presents independent, peer-reviewed evidence on the Before Operational Stress (BOS) program — so organizations can make informed decisions about bringing proactive mental health training to their teams.
Who It’s For
Fire, police, paramedic, corrections, military, and healthcare leaders evaluating proactive mental health training
Wellness and peer-support coordinators
Frontline professionals considering training for themselves
Where the Data Comes From
Every statistic is drawn from peer-reviewed research published between 2021 and 2025 — including four independent evaluations of BOS led by researchers at CIPSRT, University of Regina, plus two foundational framework papers.
Background figures on the scale of the problem come from large national studies of Canadian PSP and nurses. Sources are numbered throughout and listed in full at the end.
Why It Matters
Most resilience programs are delivered once, after a crisis, and are never measured.
BOS was built to do the opposite: to prepare people proactively, early in their careers, and to be held to the standard of independent evidence. What follows is that evidence.
01 - The problem
02 - The gap
03 - The solution
04 - The evidence
05 - Accessibility
06 - Lived experience
07 - Durability
08 - Broader impact
09 - Scale & reach
SECTION 01 · THE PROBLEM
The crisis facing public safety and healthcare workers
PSP, first responders, and healthcare workers face repeated exposure to traumatic events. They also screen positive for mental health disorders at roughly four to five times the rate of the general population.
Evidence suggests that exposure to trauma is a contributing risk factor. PSP and nurses report experiencing a potentially traumatic event an average of 11 or more times over a career, while most people in the general population encounter fewer than five such events in an entire lifetime.
11+
potentially traumatic events over a career — PSP & nurses, on average. [9]
<5
such events in an entire lifetime — general population, typically. [13,14]
The human toll: trauma and suicide risk
Among Canadian public safety personnel, lifetime rates of suicidality are sobering:
Canadian healthcare providers reported worsening mental health since the onset of the COVID-19 pandemic. [12]
27.8%
Suicidal ideation [8]
4.6%
Attempted [8]
13.3%
Made a plan [8]
7 in 10
SECTION 01 · THE GAP
Existing approaches aren’t enough
The problem is that most mental health support for people in these professions arrives too late and too thin. BOS was designed to fill this specific, well-documented gap.
11+
potentially traumatic events over a career — PSP & nurses, on average. [9]
<5
such events in an entire lifetime — general population, typically. [13,14]
The human toll: trauma and suicide risk
Among Canadian public safety personnel, lifetime rates of suicidality are sobering:
Canadian healthcare providers reported worsening mental health since the onset of the COVID-19 pandemic. [12]
27.8%
Suicidal ideation [8]
4.6%
Attempted [8]
13.3%
Made a plan [8]
7 in 10
Why This Report Exists
Public safety personnel (PSP) and first responders face mental health risks beyond those of the general population, yet many remain unaware of proactive programs designed to address those risks before harm occurs.
This report gathers and presents independent, peer-reviewed evidence on the Before Operational Stress (BOS) program — so organizations can make informed decisions about bringing proactive mental health training to their teams.
Who It’s For
Fire, police, paramedic, corrections, military, and healthcare leaders evaluating proactive mental health training
Wellness and peer-support coordinators
Frontline professionals considering training for themselves
Where the Data Comes From
Every statistic is drawn from peer-reviewed research published between 2021 and 2025 — including four independent evaluations of BOS led by researchers at CIPSRT, University of Regina, plus two foundational framework papers.
Background figures on the scale of the problem come from large national studies of Canadian PSP and nurses. Sources are numbered throughout and listed in full at the end.
Why It Matters
Most resilience programs are delivered once, after a crisis, and are never measured.
BOS was built to do the opposite: to prepare people proactively, early in their careers, and to be held to the standard of independent evidence. What follows is that evidence.