“It Was a Very Pleasant Surprise”: Exploring Public Safety Service Users' Experiences With Inpatient Mental Health Treatment and Recovery

ABSTRACT

Objectives

Mental health service users are responsible and autonomous individuals who can comprehend their own illness and recovery and therefore engage healthcare professionals in their care. Studies have demonstrated how service users feel more dignified, safe, and respected during mental health treatment when they are listened to by their caregivers and included in treatment decision‐making. The physical space and design of mental health facilities, as well as the approach to care and treatment, have been found to have positive implications for service users' treatment and recovery, both in contemporary and historical settings. Thus, understanding service user perspectives is necessary because these experiences may shed light on best treatment practices.

Methods

The current study engages interview data produced by public safety professionals—who are often exposed throughout the course of their service and duties to potentially psychologically traumatic events—who were receiving inpatient care for trauma and, in some circumstances, substance misuse at Edgewood Health Network's Guardians Gateway facility. Framed through the sociology of mental health literature, we qualitatively explore how these service users experienced the physical and psychological aspects of the treatment space.

Results

We found their experiences of recovery at this facility led to new conceptions of mental health treatment, including overcoming stigma, personal growth, and encouragement to try new activities and programs tailored to their individualized mental health needs.

Conclusion

We discuss how their lived experiences provide novel insights into best care practices for public safety personnel in Canada.

1. Introduction

Edgewood Health Network's Guardians Gateway (Gateway) is a trauma and addictions treatment facility created for military, veterans, and first responders (Edgewood Health Network Canada ²⁰²⁵). Located in Peterborough, Ontario, Canada, the recovery center offers clients evidence‐informed treatment services for trauma and addiction tailored specifically to meet “the unique needs of active service members, veterans, first responders, and healthcare providers in mind” in a “safe space for sharing thoughts and experiences without judgment or stigma” (Edgewood Health Network Canada ²⁰²⁵, n.p.). Gateway aims to bring first responders together in a community setting, with peer support among people who may share similar experiences. Among public safety professionals, peer support (i.e., through technology and apps) has been found to have minimal success as a vehicle for connecting peers and more success for reducing mental health stigma (Foley and Ricciardelli 2023). Beyond such informal supports that develop over time as patients progress in therapy together, Gateway offers holistic healing and treatment practices, such as: individual and group therapy sessions, cognitive behavioral therapy, dialectical behavioral therapy, skills training, detox and withdrawal management, peer support groups (e.g., Alcoholics Anonymous, SMART Recovery), and family programs. The focus is on promoting individual autonomy in treatment and providing opportunities to improve and sustain physical health (which can be difficult for public safety professionals to achieve given the competing demands of shift work, overtime, or other personal/family responsibilities; see Ricciardelli et al. ²⁰²⁴). Gateway programming focuses on meeting individual needs and understanding the mental health struggles of service users, which may vary in relation to their experiences with trauma, addiction, or concurrent mental health disorders (Edgewood Health Network Canada ²⁰²⁵). Their setting is spread across 14 acres of forest to provide service users with a serene environment and spatial permeability, as well as several indoor and outdoor activities, including a fully equipped gym, staffed kitchen, art therapy, “hot yoga, morning walks, golf, wood carving and more” (Edgewood Health Network Canada ²⁰²⁵, n.p.).

The current study, based on 30 interviews conducted with clients who received treatment at Gateway between April 2024 and August 2024, qualitatively explores how service users experienced the physical and psychological aspects of the treatment space. We also examine how their recovery led to new conceptions of mental health treatment, including overcoming stigma, personal growth, and encouragement to try new activities and programs tailored to their specific mental health needs. We frame the study through sociology of mental health literature, positioning service users as shared experts on their mental health needs and well‐being and discuss how their lived experiences provide novel insights into best care practices for public safety professionals in Canada.

2. Literature Review

The sociology of mental health literature positions mental health service users as responsible and autonomous individuals who can comprehend their own illness and recovery and therefore engage healthcare professionals in their care (Cohen 2008; Johnston ²⁰¹⁹; Johnston et al. ²⁰²³; Kirmayer ²⁰⁰⁰; Kirmayer et al. ²⁰¹⁵; LeFrançois et al. ²⁰¹³; Voronka ²⁰¹⁷). Yet, some scholars do argue service users continue to be “excluded from the discursive practices, disciplinary hegemony or dominant regimes of truth within the mental health system” (Joseph 2014, p. 273). Studies have demonstrated how service users feel more dignified, safe, and respected during mental health treatment when caregivers listen to their stories and needs without judgment and work alongside them to build their autonomy and treatment decision‐making (Chambers et al. 2015; Lindwall et al. ²⁰¹²; Quirk et al. ²⁰¹²; Rashed ²⁰¹⁹), rather than render them more powerless through discursive practices of social control (Holmes et al. 2014; Johnston and Kilty ²⁰¹⁶). For example, in their study of online reviews of psychiatrists working in Canada, Johnston et al. (2023) found service users who felt less empowered during their treatment ended up creating an online ‘community of critique’ to regain the control and agency they felt they lost in unbalanced medical settings. In a similar study, Johnston (2020) found when psychiatrists were constructed by service users as kind, compassionate, non‐judgmental listeners, they were praised for their efforts in promoting service users' treatment and recovery. Thus, the care provider truly impacts interpretations of the setting and treatment.

The physical space and design of mental health facilities, as well as the approach to care and treatment, has been found to have positive implications for service users' treatment and recovery, both in contemporary and historical settings. Consider Dosse (2011) discussion of the La Borde clinic, which opened in 1953 in the town of Cour‐Chevemy in the Loire Valley of France. Founded by psychiatrist, Jean Oury, the facility still operates today, and is an example of an institution where service users actively take part in its operations. The clinic rejected the traditional approach of isolating people with psychiatric disorders and instead believed ill people should mix and communicate personably with staff and others, “without forgetting that psychotic patients need medical treatment” (Dosse 2011, p. 40). The facility had extensive gardens where service users were free to roam, providing them with spatial permeability. The design of the institution was also anti‐bureaucratic and communitarian. Nurses wore casual clothing and provided service users with more humane and less decentered care. Staff members' tasks, responsibilities, and salaries were all shared since they oscillated between manual labor, housekeeping, running workshops, preparing theatrical activities, and intellectual work, as both service users and staff are commonly encouraged to study philosophy, nurture their creativity, and develop new forms of subjectivity. Perhaps above all, delusional behavior was not fetishized; Oury believed that service users' words held truth and, while recognizing illness, La Borde still sought to seek out the creative elements that may accompany illness and be attentive to its transcendental dimensions (Dosse 2011). When disputes occurred, there was an emphasis on resolving conflicts and problems through discussion, rather than force.

Together, these studies emphasize the importance of understanding and documenting service user perspectives and how their experiences may shed light on best treatment practices for, in the context of this study, public safety professionals – who are often exposed throughout the course of their service and duties to events that can be traumatizing such as life‐threatening situations, several forms of human suffering, and assaults, rendering them at heightened risk for psychological distress, mental health disorders (i.e., Posttraumatic Stress Disorder Major Depressive Disorder, Generalized Anxiety Disorder), and suicidal behaviors (Ricciardelli et al. 2024; Ricciardelli et al. ²⁰²⁵).

3. Methods

3.1. Design

Our overarching research question is: How do public safety personnel mental health service users experience treatment and recovery at Gateway? To answer this question, we conducted semi‐structured, in‐depth qualitative interview with 30 participants who received treatment at Gateway between April 2024 and August 2024. While this study focuses on service users' experience with the treatment space, both psychologically and physically, the broader study explores participants' views of the entire inpatient experience. Ethical approval was obtained from the Research Ethics Board at Ontario Tech University (File #17761). We followed the COREQ checklist (Tong et al. 2007) to guide the reporting of this study.

3.2. Participants

The average age of participants was 45.7 years (SD = 9.8) and most service users identified as male (n = 24). Approximately half of the participants were first responders (e.g., law enforcement, paramedicine, correctional workers), while the remaining participants had a military background with the Canadian Armed Forces. Most participants in the current study were undergoing treatment for both trauma and substance use disorders. We refrain from sharing further demographics of participants to maintain confidentiality.

3.3. Procedure

In the final weeks of their treatment, all eligible participants were approached by one of the project's researchers (EV), who was not involved in their direct clinical care. During participants' free time and in private, the researcher informed them about the study and invited them to participate. Interested individuals received a detailed explanation of the study and had an opportunity to ask questions before providing informed consent. Those who consented were assigned a participant number (e.g., P01) to maintain confidentiality and integrity of the data. We continued recruitment until the target number (N = 30) of participants were consented and interviewed. We note one participant declined without providing a reason and none withdrew.

Interviews were scheduled collaboratively and were completed by the Principal Investigator (PI; KM). The PI is a female clinical psychologist (PhD) with over 22 years of experience conducting research, including qualitative interviews. She had no relationship or any contact of any sort with the participants prior to the study. Participants were told by the PI that she was affiliated with the treatment facility as a consultant and was interested in learning about their experience during their inpatient stay. No other information about the PI was shared with the participants. Interviews were conducted either in‐person or virtually via the secure healthcare version of Zoom, in a private office at the facility. The PI began each session by reviewing the consent process before proceeding with the interview. The PI used a semi‐structured guide that included ten questions. To seek clarification or elaboration, additional questions or prompts were used. Interviews lasted approximately 20–75 min, were audio‐recorded for accuracy and documentation and then destroyed once transcription was complete. The PI also took notes as a backup to the audio files (memoing) and to ensure details were recorded to contextualize audio files—these memos were destroyed once transcription was completed. No repeat interviews were conducted. Participants were not able to review the transcripts of their interviews, nor the results; an unfeasible suggestion given transcription was completed after participants were discharged from the facility. Interviews were intentionally conducted one to 2 weeks before participants' discharge.

3.4. Data Analysis

We analyzed the data using a qualitative content analysis approach to interpret participant responses through a process of coding and identifying patterns or themes (Hsieh and Shannon 2005). This analytical method explores explicit or implicit meanings, themes, and patterns within the data, allowing researchers to investigate social phenomena in an interpretive yet systematic way (Shava et al. 2021). The analysis followed an inductive reasoning framework, meaning data were meticulously reviewed, coded, and categorized, with themes emerging directly from the content. The analysis began with verbatim transcription of the audio recordings to ensure a complete dataset. Thematic units, representing expressed ideas, served as the primary analytical focus, with even single words qualifying as thematic units (Zhang and Wildemuth 2005). Initial coding categories were created as the PI analyzed the first three transcripts. Another researcher (EV) then reviewed these transcripts independently to validate the coding scheme and propose additional categories, which were refined collaboratively with the PI to create a final coding manual. Subsequently, the remaining transcripts were coded using this manual by EV, and adjustments were made as needed through regular discussions with the PI. Once all transcripts were coded, EV and KM worked together to analyze the categories, identify relationships, and discern patterns. Insights were reviewed with the remaining authors (MJ & RR) to refine the conclusions and deepen the analysis. The analysis was managed using Microsoft Excel. We present a summary of the themes in Table 1.

Table 1.

Summary of Themes, Descriptions, and Illustrative Quotes.

Theme	Brief description	Illustrative quotes
Breaking through stigma in a live‐in residence	Gateway was seen not as a clinical institution, but as a supportive community where participants reconnected with others and themselves, reducing stigma and encouraging openness.	“I was terrified of having a roommate…[but] we're like two teenage girls who have found being silly again.” – P07 “It's getting me out of my shell a bit and getting me out there again.” – P09 “The big thing being here is that I'm away from work… I'm more like my own self here.” – P19
Safe psychological environment	The treatment space was consistently described as psychologically safe. Shared experiences with other service users helped build trust and reduced hypervigilance.	“It's a safe environment…especially when it comes to the PTSD symptoms and the sharing.” – P07 “I literally don't have to be on guard every minute…the people here also are very, very calm.” – P12 “It was very quick to gain trust…whereas in the real world, I don't trust anybody.” – P18 “From day one, when I got here, people were so quick to open up about the problems.” – P17
Safe physical environment	The esthetic, layout, and amenities (e.g., gym, nature, games) created a sense of physical safety, freedom, and comfort. Participants described this space as healing and liberating.	“It doesn't feel like you're trapped…the access to the gym… I'm 100% better.” – P11 “It makes it easier for us to not feel like we're locked up in some kind of institution.” – P27 “The sport court is absolutely amazing…I've used the gym a ton…access to the YMCA…incredible.” – P23 “There are some really earthy tones…activities for painting, puzzles, toys…you can go back in the woods and walk.” – P12
Feeling at home versus an institution	The facility contradicted expectations of a cold, clinical environment. Instead described as warm, welcoming, and more like a home, surprising many and increasing engagement in treatment.	“I expected very clinical, cold, impersonal…It was a very pleasant surprise.” – P01 “I thought it was gonna be very hospitalized and white gowns…when I got here…I was like, holy smokes.” – P02 “My expectation was really low…[but] the rooms are great.” – P06 “It was warm…not clinical.” – P04
Trying new things	Gateway's space and culture encouraged participants to explore new activities, interests, and self‐care practices they had not before tried before, leading to personal growth.	“I started reading…playing darts…I became a Leafs’ fan.” – P06 “Try it all…What resonates with you, stick with it, but open your mind.” – P11 “I never would have done sound therapy…gave it a shot…picked up smudging.” – P13 “The pickleball courts have been huge for me…I never played before.” – P29 “I even attended an AA meeting, just to try it.” – P19

4. Results

We structure the results by first exploring how the Gateway treatment facility helped service users while in treatment overcome mental health stigma, especially through their relationships with peers and staff. We then describe how service users generally felt both psychologically and physically safe in the treatment space, and how the sense of safety affected their sense of self and interpretations of their recovery period. Next, we report on participants' preconceived conceptions of mental health treatment facilities and how Gateway produced rather instantaneously different and renewed conceptions of mental health treatment, which led to positive feelings of ontological comfort and security. We close the analysis by shedding light on how the approach and physical landscape of Gateway allowed service users to ‘try new things’ and explore new opportunities for personal growth.

4.1. Breaking through Stigma in a Live in Residence

At Gateway, service users described not feeling so much like an “inpatient” receiving treatment at a typical psychiatric hospital. Rather, for example, P01 framed the space as a “live in residence” where service users felt more included in their recovery process, while also experiencing the comfort of residing in a space much different than their current living realities. To elaborate, P19 stated: “the big thing being here is that I'm away from work. When I'm away from work, I'm a lot better and I find that I'm more like my own self here because I don't have that exterior pressure.” Beyond being away from any potential factors at home or work shaping their mental health, for some service users, living with people (i.e., sharing a room) or being present among other public safety people (i.e., peer support) were key components driving their preparation for reentry back into their homes and communities, as well as their ability to recover. The human connections Gateway facilitated among service users, which participants often reported as being optimized through careful attention to the physical layout and social atmosphere of the treatment spaces, was evidenced by P07 who learned she really appreciated having a roommate:

I was terrified of having a roommate. I was like, ‘oh my God, this is not gonna be good.’ And we're so silly. We're like two teenage girls who like have found being silly again. And, you find your inner child again, almost. And you do silly things and you bug the boys at your table and just finding joy and humor and making fun of yourselves again. Not taking life so seriously.

In this excerpt, P07 identifies a social gain from shared living insofar as she discovered more “joy and humour” in her life by taking life less “seriously”—a relational theme not always described by service users in research reporting on experiences with stigma or difficult social hierarchies (i.e., between staff and patients; between patients themselves) in mental health spaces in Canada (Johnston 2019) and beyond (Sercu and Bracke 2017). P09 describes the “peer support program” as “great” and helping him to come “out of my shell”, as he explained: “It's also hard for me because I have been isolating for so long and…So it's been good. It's getting me out of my shell a bit and getting me out there again. It's also been very hard.” Thus, his experience of the peer support program within the residence reveals the treatment program's many purposes, including relationship building among service users who may otherwise have been fearful of receiving treatment at Gateway due to previous perceptions of mental health environments or self‐stigma (i.e., believing themselves as weak or less than for their illness). The idea that mental health is an individual level problem to be resolved by the person suffering is a recognized phenomenon among many public safety professionals who have qualitatively reported a need to be over reliant on resilience to overcome mental health challenges (Coulling et al. 2024; Johnston et al. ²⁰²⁴).

4.2. Safe Psychological Environment

The social environment and design of the facility were considered safe by participants, as clearly reflected upon by seven participants. For example, P07 felt the “safe environment” served to “make it a better environment.” They explained why they felt psychologically safe at Gateway:

It's a safe environment, especially when it comes to the PTSD symptoms and the sharing, the sharing of and the experiences of the tragedies that we've had to go through. I don't, not to negate the trauma that other civilians and stuff like that have experienced, but it's not the same.

In this excerpt, P07 distinguishes traumatic experiences encountered on the job from trauma civilians may encounter, and points to how the nature of public safety work means their treatment and social needs will be different. In this case, being able to connect with peers with similar life and work experiences resulted in comfort for the participant, and the ability to ‘open up’ in a non‐judgmental space, which for this participant, was conducive to treatment.

For P12, their safety was not only physiological, but psychological, as they learned to be less hypervigilant and calm: “I literally don't have to be on guard every minute…the people here also are very, very calm in their voices.” What is described here is a more relaxed atmosphere driven by both service user and staff's “calm” demeanors, that may starkly be different from the realities of public safety environments where one must ‘keep their guard up’ and be ready to respond, at all times, often resulting in experiences with hypervigilance and social isolation at work and, additionally, spilling over into their lives at home (McKendy and Ricciardelli ²⁰²³). Similarly, P29 felt safe enough to “admit” their occupational work, that is, what they do for a living and for service, which is the first step in building the trust necessary to grow and heal—especially when the very nature of the work is highly confidential and sensitive. P26 described the space as “the safest place you're going to be the next seven or 9 weeks (means you can try new things easier),” and P18 explained how feeling safe while trying to build personal relationships that encourage trust and sharing was indicative of both a socially and psychologically safe space:

A super comfortable place for people to get better and feel safe, safety being the biggest thing. It was very quick to gain trust, and give trust, whereas in the real world, I don't trust anybody, and I don't care if people don't trust me, I just don't give anybody the time.

Public safety personnel such as correctional workers have described the pitfalls and isolating mental health stigma that materialize when work cultures “suffer in silence”, that is, work against sharing and openness about mental health (Johnston et al. 2024), stigmas that are still reflected (and resisted) in broader society (Thoits 2011; Thoits and Link ²⁰¹⁶). In this case, P18 recognized the symbiosis between feeling safe and being able to share, and how “quick” this could materialize in a unique mental health setting distinct from everyday living.

P17 called the facility “kind of a bubble”, explaining how “The atmosphere around here, the people around here, not just the staff, but the clients, I guess, people like myself that are here. From day 1, when I got here, people were so quick to open up about the problems.” Thus, across data, participants, such as P16, “find it really safe.”

4.3. Safe Physical Environment

Discussion of the physical environment included both interpretations of the space (i.e., the facility), how the space is used (i.e., the function), looks (i.e., esthetic), and what the space lends too (i.e., provides opportunities for). The interpretation of the physical space was described in ways that had unique values for participants. For example, P11 interpretated the gym facilities as a way to stop feeling “trapped”:

First of all, this place, it doesn't feel like you're trapped…the access to the gym. If I feel down and everything, obviously I know I'm feeling it. I go to the gym. As soon as I go to the gym, work out, I'm 100% better, just about.

The benefits of the interpretation of the gym as liberating is also complemented by the research finding exercise is good for mental, physical, and social health and complimentary to medical treatment (Cisler et al. 2024). The notion of ‘escape spaces’ was also echoed by P27, who said:

… makes it easier for us to not feel like we're locked up in some kind of institution…It's good for the, it's good. There's places where we can just go and enjoy sometime in front of a TV or there's a games room where we can play games or sit on a computer. We can go outside anytime we want.

Here, what is described is a space of liberation rather than incarceration, where service users can enjoy much needed spatial permeability and thus feel ‘free’; even though they require treatment, they have spare time to enjoy activities and hobbies and deflate (Dosse 2011). Also evidenced in P27's words is the value placed on the facilities—the many ways available to pass time. P23 described how “The sport court is absolutely amazing. I'm a sporty person. I like to be up and doing stuff. The games room offers lots of gym, I've used the gym a ton. And access to the YMCA, I don't want to downplay that. That's incredible…. I haven't even got into the food yet. That's a whole other story.” P23 was not the only participant to remark on the quality of the food, such as P24, who stated, regarding being in treatment, “Food helps. The food here is fantastic. I haven't had, we're in week six and I think I've had one salad I didn't like in 6 weeks.”

Describing how the facilities or space is used and its esthetic, P12 provided their interpretations:

… the different rooms they have where you meet is nice. There are some as really earthy tones. For me, I'm an earthy person. I like gardens, but so the colors are nice. They have activities for painting or just puzzles or and just little toys that help keep your hands busy…That sounds crooked, but it works, and they've got a pool room if you want. You've got an exercise room if you want to, if you're pissed off, if you're angry and you want to exert energy, go to the weight room or you can throw darts, or if you just want to be by yourself and watch the TV you can, because your moods are changing all the time… Umm see, they've got a place you can go back in the woods and walk, which that's nice for me because I like the outside. So being able to do that has been nice.

The diversity of available activities was beneficial for service users. P12 describes how their changing moods and emotional needs could be accommodated and met through the physical space, which contrasts some critical literature framing mental health spaces as highly emotionally controlling and regulating (Thoits 2012; Johnston et al. ²⁰²³). P12 also described caution with color to create warmth and centralize nature but also attended to their physical and social needs too, not just psychological. There are different activities intended in each space to align with mood and need variations, which may provide some avenues for passing time as one experiences the diverse feelings that arise through treatment.

Moreover, what the space lends itself too, regarding the opportunities provided for, were diverse and satisfying for participants. P22, like others reflecting on the social relations developed, explained how “we have the board in the dining room that showed us everybody's name with their mission too.” As such, “it really gave us the opportunity to like know people by name, like get to know them if we chose to which I thought was me so I totally did. But yeah, like I like the sense of community.” Thus, for P22, the space and how it was used provided opportunities for social relationships to develop. Rather conversely, but evidencing the diversity of the space, P21 explained how they found time for solitude without isolation in the space:

I'm the type of person who doesn't like being alone or lonely, but I also appreciate my solitude. And there's always a place here that you can find, you know, a place that you need to find your little niche somewhere to do that.

Overall, Gateway, according to participants, seems to facilitate the diverse needs of service users, whether introverted or extroverted, or both, producing a healing atmosphere that is conducive, above all else, to feelings of safety and comfort during treatment.

4.4. Feeling at Home Versus an Institution

The atmosphere at the facility continued to be described by participants as different than whatever was the participants' preconceived idea of a treatment center or mental health institution. Two participants described the difference as follows:

Yes, I expected very clinical, cold impersonal, just going to therapy. I did not expect the outings, the activities that we have on site, the AA, the Smart Recovery, the exposure therapy, none of it. I didn't expect, I just thought it was going to be almost like prison style, hit your muds, go sit down with your tray, but yes, it was a very pleasant surprise (P1).

Yeah, I thought it was gonna be very hospitalized and white gowns and kind of place. So, when I got here and they gave me the tour and the lay down, like I was like, holy smokes (P2).

In the first excerpt, P1 feared the treatment space would resemble an “asylum” or total institution, consistent with early and recent critical literature on mental health spaces in Canada and beyond that marked mental health institutions as being driven by surveillance, strict routinization, stigmatizing, and even dehumanizing (Goffman 1961; Johnston ²⁰¹⁹). P2, likewise, was pleasantly surprised that the reality of Gateway was different than their preconceptions. These participants' words echoed those of other participants who, like P03, “expect it to be kind of more in a secure, hospitalized, everywhere, watched all the time situation.” P4 described the facilities as “warm” and not “clinical” while P06, recognizing “my expectation was really low” said “the rooms are great.” The collective idea was that the facility was far from what such facilities are preconceived as by citizens, which seemed to empower service users to become highly engaged in their treatment regimen while also allowing them to deflate and connect with peers and staff.

4.5. Trying New Things

Participants spoke to being introduced to many different activities by the people they met within the shared living space, some having lasting effects (at least to date). P06, for example, stated:

I started reading. Which, I never, I never read in my life besides newspapers and social media stuff. But yeah, I got into that. I got into playing darts with a cohort here. Yeah, and then I became a Leafs fan because everybody watched the Leafs here.

P06 viewed the inpatient treatment as a time to try new activities, thought processes, and thus discover new ways of being. They felt they came ready to try new things – yet none felt the space was a barrier to trying. In this context, P11 said:

I'm really open to trying anything here and everything that I buy into and really give it my all…I tell the people, we arrive here, the new guys and all that. I'm like, ‘try it all. You don't have to like it, just try it all. What resonates with you stick with it, but open your mind.’

Similarly, P13 also reported how “I never would have done, sound therapy…Never would have done that, gave it a shot. Wow. I picked up smudging” to explain how she opened up and tried new activities. The more open attitude extended to trying “meditation and stuff” (P14), being “willing to experience different sensations” (P26), or to learning new skills (i.e., “the pickleball courts have been huge for me. I've been very active playing pickleball on a regular basis, which I never played before coming here” (P29)). P19 even attended an AA meeting, which they decided was not for them—but the point being they had the time to try new a new model of recovery. Overall, these excerpts reveal how Gateway facilitated methods of self‐discovery for many participants, which some described as being life‐changing and leading to new interests.

5. Discussion

Guardians Gateway provides treatment support for military members, veterans, and public safety personnel suffering from trauma and addiction‐related mental health challenges i.e. evidence‐informed in a closed environment—a residential space resembling a home within a community. In essence, Gateway is interpreted by participants as empowering their service users in their own recovery while engaging with healthcare—a practice most recommended in scholarships (i.e., Cohen ²⁰⁰⁸; Johnston ²⁰²⁰; Kirmayer ²⁰⁰⁰, 2015). At Gateway, the space, at least while within the grounds, eliminates the stigma of mental health by equalizing why everyone is there. By offering exclusivity, that is, only serving public safety personnel and active/retired military members, the service users share in their need for mental health support and provide peer support to each other, thus eliminating the stigma because they are all the same. This acknowledgment and reflection are fundamental to owning their treatment and taking interventions to heart—actioning what is learned and feeling safe to do so. Moreover, to manage recovery, the facilities provide a release from work and the demands of regular life, a temporary space of refuge, where they can all heal.

Indeed, the treatment space was described as psychologically safe by participants. The actual design helps to create the essence of safety, but also the sense of safety that comes from being around likeminded peers. From how Gateway is described, there are elements of Dosse (2011) description of the La Borde clinic. For example, people mix and communicate, and mental health is celebrated and provides outlets for growth. In the staff and service users creating a safe environment collectively, service users could lower their guard and live without hypervigilance, which is an area requiring further investigation in future research. For example, how does reducing hypervigilance lead to effective treatment seeking and treatment reception? Second, do service users become more trusting, thus more receptive to interventions? However, answering and evidencing these questions requires further systematic examination – beyond public safety professional groups and also to the broader application of treatment and recovery services for the general population. Many of the concerns and successes raised by our participants may extend to other groups of mental health service users (i.e., civilians, racialized service users, women), who have also been found in Canada to benefit from inpatient treatment and recovery services that promote autonomy, spatial permeability, individualized treatment, positive relational dynamics with staff, and focus less on security practices and more on making the treatment space feel like a home for healing (Johnston 2019, ²⁰²⁰).

Moreover, treatment at Gateway appears to provide a space for public safety professionals to end the enforced isolation often tied to public safety cultures, where practitioners are to “suffer in silence” rather than disclose and seek help—a culture that is slowly changing (Johnston et al. 2024). As noted, the physical environment at Gateway was described as functionable but inviting in esthetic, while providing ample opportunities for reflection, meditation, and growth. Participants did not feel incarcerated or trapped; instead they felt they could escape within the space—they still felt free which further could help their readiness for treatment. The diversity of activities available to engage in and the gym were ways in which service users could escape. For most, they described the space as having an unexpectedly “homey” feeling rather than feeling like a typical mental health institution. The safety of feeling at ‘home’ also encouraged many participants to try new activities and try new ways of existing, thus supporting processes of self‐discovery and recovery. We recommend this model and design of care and treatment for other public safety professional treatment facilities, while being attentive to the need for further research.

Our study is not without limitations. For example, 80% of the sample were men. While most public safety occupations are dominated by men, we possibly did not accurately capture the experience of women service users. Public safety organizations have been found to suffer from stoic work environments, often built through rigid gendered relations and structures, that may suppress the expression of emotions and view mental health concerns as a “weakness” (Coulling et al. 2024; Johnston and Ricciardelli ²⁰²⁵). Thus, future research must consider how inpatient treatment facilities can provide public safety professionals who are service users with the comfort to express gender in ways that otherwise may be suppressed in their working cultures. Additionally, the interviews were conducted in the last 1 to 2 weeks of a typically 9‐week program. Future research would benefit from capturing service users' perceptions of their treatment environments at other time points in their care or upon completion of the program in its entirety.

6. Conclusion

We aimed to qualitatively explore how Gateway service users experienced the physical and psychological aspects of the treatment space. Through in‐depth, semi‐structured interviews, we discovered service users found living in a home‐like residence, while unexpected, facilitated peer support that helped to lower their experiences of self‐stigma. They described the facility as offering both psychological and physical safety through the actual architecture, diversity of activities and spaces, as well as through the demeanors of the staff. Together this helped them feel safe, which allowed them to open up and take advantage of the interventions offered. They could actively participate in the program and have their needs addressed; the sense of openness also supported them to try new things and enhanced their self‐discovery. Overall, our results provide critical information about how services users can benefit from carefully designed treatment environments and should be valued as expert testimony on service user mental health needs for public safety professionals in Canada.

Author Contributions

All authors were involved in the development of the research idea and conceptualization of the project. Krystle Martin and Emma Vester were responsible for data collection, input, and analysis. All authors contributed to data interpretation. Matthew S. Johnston and Rosemary Ricciardelli worked to produce the first draft of the manuscript and Krystle Martin and Emma Vester were involved in reviewing and editing subsequent drafts.

Funding

The authors received no specific funding for this work.

Ethics Statement

This study was approved by Ontario Tech University Research Ethics Board (#17761).

Consent

All participants in this study provided written and verbal consent to participate.

Conflicts of Interest

Krystle Martin is a consultant for Guardians Gateway and received part‐time salary for this work. Emma Vester is employed by Guardians Gateway. We have no other potential conflicts of interest to declare.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The qualitative data used in this study are not available for public distribution due to ethical considerations regarding participant confidentiality.