Facilitators and obstacles to help


Improving access to support

  • A proactive offer of support and care is likely to have positive effects on the actual use of help by crew members
  • We know from interviews and from research on men’s relationships with health services, that when a man tries and fails once to obtain the help he needs, he is less likely to try again. Therefore, improving first time access to services is very important.

Promoting use of resources

  • Railway companies (at all levels: top management, Claims Department, Human Resources Department, operation managers, Safety and Police Department, local management, team leaders, employees), as well as the union, the Railway Association of Canada and Operation Lifesaver should promote help seeking, be aware of existing stereotypes and advertise resources (by presenting, describing and explaining them).
  • Some authors suggest systematic screening and individualized education after an incident occurs, to improve awareness of symptoms in crew members and increase treatment seeking.

Involvement of peers


  • Peers play a key role in changing values and behaviours. Peer support programmes are an important medium to promote existing resources and their use in a time of crisis.
  • Peers who successfully used available help become good advocates for help seeking.

Training, support and care protocols

  • Accurate and unbiased information is important. The use of resources will depend upon the trust people place in these resources, their usefulness and the absence of negative consequences at work. When people are well informed about the various resources and their impact, they can make the right decisions for themselves.
  • In times of intense crisis, reducing uncertainties by clearly describing resources and available support helps people regain a sense of control, feeling supported by their employer and reduces tension.
  • When an incident occurs, involving the affected crew member in decisionmaking post incident, including decisions concerning return to work and length of absence, can help them regain some control over the situation and his own well-being.

Limits and Obstacles

Fear of lost income

  • Some crew members do not “book on trauma” because they fear the 3-month delay it automatically induces before they can return to work (see medical rules). They feel forced off work and feel victimized twice, first with the incident, and again with the loss of income that comes with time off work.

Masculine stereotypes

  • Even if it is changing, there is still a strong masculine culture within the railway industry. Men who strongly adhere to strong masculine values and stereotypes tend to “bottle it up”, repress their feelings and deny their difficulties.
  • These men tend not to use available resources to help them cope with critical events. Proactive offers of help, support, care and treatment at several key moments after the incident is a key factor in promoting the use of resources in crew members. This proactive offer of interventions should be imbedded in company protocols.
  • In a long-term perspective, the railway industry can play a role in promoting help seeking in its values and codes of conduct, encouraging employees’ perspectives to evolve.

Fear of negative consequences at work

  • Some people fear that if they take time off work, use medication, consult with a therapist or express emotional difficulties, they will be judged by their peers, by their managers and that this will have a negative impact on their work relationships.
  • Protocols that focus on blaming the individual and establishing who is responsible for the incident can have important negative consequences on recovery.

Pre-existing work relations difficulties

  • Seeking help implies that people admit to experiencing difficulties. This can only be done in a context of trust. Difficult relations with colleagues or especially lack of trust in managers may prevent crew members from expressing a need for support and care.

Misunderstanding who can help

  • People do not always understand the role of the professionals they meet. There are misunderstandings leading to frustrations, unexpected consequences and grievances.
  • The role of the company medical officer appears to be particularly ambiguous to employees.
  • People do not always understand the difference between a doctor, a psychiatrist, a psychologist, a social worker and a therapist. They do not always contact the right professional and may feel frustrated by the response.
  • These misunderstandings may lead to multiple referrals and an increased risk of discontinuing care seeking.

Prior unmet expectations

  • The desire to seek support depends largely upon previous experiences. Negative experiences in the past will discourage people to seek help again.
  • Past arguments with the employer about a previous sick leave increases pressure when a second incident occurs. This pressure can be enough to discourage affected crew to take time off work.
  • Having a poor experience with a mental health professional can lead people to think that these resources are useless.


On-train duties are regulated by the Safety Critical Position rules within the Railway Safety Act.




A safety critical position involves mandatory mental and physical fitness requirements in order to guarantee proper alertness, judgment, sensory and motor functions. In order to make certain that safety critical position holders have the required fitness, the Railway Medical Rules Handbook has prescribed specific guidelines. These guidelines address some of the mental health issues that may arise from experiencing critical incidents. They indicate that it is impossible for a train driver to work if he experiences symptoms associated with a mental health problem and that he must be free of any symptom for a period of time before returning to work.

  • Acute stress disorder – no symptoms for one month before return to work;
  • Post-traumatic stress disorder – no symptoms for three months;
  • Panic disorder – No symptoms for six months;
  • Depressive disorder – No delay, the person has to be asymptomatic before returning to work.

These rules have a strong impact on the willingness of some crew members to seek help after they had a critical incident, because they may feel that they will be trapped in long procedures before they can come back to working normally. They may also fear the loss of income associated with the time off. Finally, most of the time, train crew feel they do not need so long to get better. They feel that either they do not ask for help and must go back to work too soon, or they do seek help and must therefore stay off too long from work. In sum, the medical rules based upon diagnostic manuals and the practices of Workers Compensation Boards seem to dichotomise the possibilities; either:

  • The worker is fit to work within 72 hours after incident, or
  • The worker is diagnosed with a traumatic reaction and is off work for at least one month, with the responsibility to prove themselves fit in order to return to work.

Most crew members find themselves in situations that are “in-between”. Taking these variations into account within the medical rules would increase the use of support and decrease recovery delays and difficulties.