From the services they provide to the tasks they carry out to the command structures under which they operate, there is little question that first responders work in a world most other professionals rarely, if ever, experience. Indeed, it is fair to assume that many firefighters, emergency medical technicians (EMTs), and police officers join their respective fields for a chance to do and see things other career tracks simply cannot offer.

Working in a stressful field also means dealing with unique challenges, however. And widely reported struggles with PTSD, depression, substance abuse, and other psychological problems within the first responder community indicate the challenges can be quite severe. Precise figures on many aspects of first responder mental health have proven difficult to pin down, but the symptoms are still certainly visible at scale: suicides among police officers are at 1.5 times the national rate, and somewhere between 4 and 14 percent of all officers are estimated to suffer from PTSD. Meanwhile, in 2015, suicide claimed more EMT and firefighter lives than duty-related deaths.

Suicide claims more EMT and firefighter lives than duty-related deaths. Click To Tweet
Traumatic stress underscores first responder mental health issues
Symptoms of psychological problems are visible at the anecdotal level—enough so that one professional firefighter and researcher believes, “all firefighters, police officers, [and paramedics] will at some point suffer from PTSD,” according to Biomed Central. Other veteran first responders have seen or personally experienced enough of the field’s mental health challenges to open responder-specific counselling services, a testament to the trials and tribulations professionals must overcome as a matter of course.

Professionals in these fields work in some of the world’s most trying jobs—firefighting and policework were ranked as the most and fifth-most stressful jobs, respectively, in 2015. Traumatic imagery and life-or-death stress, both of which are common among first-response professions, can leave mental impressions that are difficult to erase. Because of this, the first responder community’s mental health troubles are well known by individuals and institutions alike.
Firefighting and policing are the most and 5th-most stressful jobs, study finds. Click To Tweet
Understanding traumatic stress can provide a deeper understanding of the epidemic as a whole. Research indicates that “most people will experience or witness a traumatic event over the course of their lifetime, and a significant minority will go on to develop post-traumatic stress disorder (PTSD),” because of it. Further, traumatic stress can occur when, “witnessing serious injury or threat to the physical integrity to the self or others.” While most police officers or firefighters will say their lives are not fraught with danger and trauma on a daily basis, first responders see or experience both at a rate far higher than the average citizen.

Large-scale, singular events are only one aspect of traumatic stress’s ability to impact lives, however. Just as insidious — and dangerous — are the effects that accumulate over a longer period. As a psychologist quoted in one Mic article notes, “microtraumas” that accumulate as a part of routine working life can accumulate into larger, more problematic stresses. The veteran officer who constantly checks peoples’ hands (even if he’s known them for years) or refuses to sit in a restaurant if he can’t get a seat facing the door may be suffering a traumatic stress disorder without ever knowing it, the article says.

This confluence of factors is even more important because of the noted link between traumatic stress, PTSD, and numerous other mental health disorders. The aspects of mental health problems common to first responders frequently overlap, and the disorders themselves often come in comorbid pairs. This illustrates the damage single events and long-term stress accumulation can cause. Though PTSD and chronic depression are problematic enough on their own, for instance, a combination of the two can be particularly difficult for counselors to diagnose and treat, and both can lead to complications like drug and alcohol abuse.

Work culture, desire for “toughness” may further impact mental health problems
A changing professional landscape may exacerbate these problems. Responders are asked to take more responsibility than ever on calls, resulting in a convergence of duties for medical responders, firefighters, and police. The rising number of police officers carrying naloxone, a drug used typically by EMT personnel to combat opioid overdoses, is just one reflection of this reality. As National Fire Protection Association [NFPA] Journal notes, medical aid calls have tripled in the last 25 years, and contemporary firefighters are expected to respond to many such events. Where firefighters were primarily tasked with just that in the past, they now respond to suicide calls, cover active-shooter events, and generally find themselves facing more risk than ever.
First responders are at a greater risk than ever of PTSD. Click To Tweet
Turning back to accumulated stress, internal issues can also manifest as traumatic stress problems over time. Take the policing world’s intense, often draining, scheduling practices. Long hours and pressing demands from the job can lead to fatigue, and can contribute to officer burnout, which itself can cause many negative effects: excessive taking of sick time, increased misconduct complaints, communication and focus problems, work-related depression, and numerous others. It is perhaps unsurprising that these issues have long been known to have negative organizational effects, as well.

Organizational culture and individual desire to fit in with a perceived notion of toughness, in turn, have negative effects on overall mental health. Trish Buchanan, who lost her police officer husband to suicide and subsequently started a charity event to help fallen first responders’ families, shared in a Hartford Courant feature that displaying emotions in many first response organizations is implicitly shunned and considered a “sign of weakness.” Combining this with the common requirement for employees to self-report a need for counselling, can result in officers, firefighters, and EMTs not asking for — and thus not receiving — the help they need to combat their issues.

Cultural issues like these can have an even worse effect when traumatic memories are involved. First responders who fail to discuss a particularly traumatic event are likely to try to suppress the memory as a means of mental self-defense; this can lead to a “rebound in trauma-related thoughts.” This in turn causes added “anxiety [and] diminished perceptions of controllability over thoughts,” creating a cycle of negative thoughts and traumatic memory that is highly difficult for the individual to overcome without help.

How can organizations help their professionals overcome mental health issues?
Despite all of this, some degree of mental discomfort and a need for coping strategies are unavoidable when someone chooses a career in the first response arena. The world needs people to respond to horrific car accidents and enforce the law when active shooters take innocent lives. Nevertheless, there is a significant difference between simply suffering the effects of traumatic stress, and proactively attempting to resolve the pain that may accompany it.

Organizations can be of great service to their employees when it comes to the emotional pain. They can also serve themselves by making resources available and taking time to transform any cultural woes. Failure to keep response to traumatic incidents in check can have a severe impact on the organization’s ability to operate efficiently and effectively.

Counseling, where possible, is a positive step for organizations with the autonomy and budget to afford it. However, larger departments are generally best equipped to staff in-house psychiatric professionals — and while confidentiality can rightfully be a concern for employees when the right protections are not provided — others may be able to work affordable third-party services into an insurance or separate mental health coverage plan. North Platte, Nebraska, for example, offers free counseling to all city employees; moreover, their first response organizations require a sit-down debriefing following traumatic incidents, such as officer-involved shootings and child deaths/autopsies.

A mandatory debriefing may be as therapeutic as the city’s counseling offer. The National Alliance on Mental Illness (NAMI) offers many tips on assisting officers following a traumatic event, with the same basic idea underscoring most of their advice: when you give responders a forum in which they can safely express their feelings, you give them a chance to get better. Simply showing the organization wishes to avoid the stigma surrounding emotional expression can be empowering for officers struggling with traumatic memories and other counterproductive stress. NAMI also encourages appointing a mental health manager among existing staff and revising policy surrounding traumatic events.
Simply creating policies and a forum for mental health issues can save lives. Click To Tweet
Combatting accumulated stress will likely be more situation-dependent. The organization with staffing issues could consider hiring more staff, changing policy to mandate certain amounts of time off following long stretches of work, or incentivize performance with mental health-friendly benefits such as paid time off or tickets to recreational events. In a stressful job, reminding staff that management is concerned about their wellbeing through both word and action can go a long way.

Mental health in first response remains challenging—but not unbeatable
Although many factors may be the same at high level, make no mistake about it, the ultimate path to recovery from any mental health problem is a personal affair, and largely a self-directed one. In the first response field, where traumatic memories and intense stress can be de rigeur, the challenge is even greater. What triggers one person may not affect another, and a struggling employee may shrug off offers of free counseling and mandates to share their problems despite the organization’s good faith attempts to help.

That said, any action taken to correct a life- and profession-impacting problem is better than nothing. If you are struggling with intrusive thoughts, recurring memories, depression, suicidal thoughts, or any of the other endless challenges first responders may face, do not assume it is unfixable or permanent. Help that is specifically tailored to your profession and needs is available and, quite often, affordable. The first step is to seek help, and the second is finding a willingness to talk about what bothers you — establish these and you may be surprised at the progress you make.

If you are struggling with work-related depression, PTSD, substance abuse, or other issues, the following resources may be of assistance:

The Code Green Campaign
EMS Mental Health Resources
Firefighter Behavioral Health Alliance
Share the Load Program (Firefighters)
Helping Heroes: Resources
Initiative 13

Additional Links
Badge of Life Police Suicide Myths
Do negative emotions cause coronary heart disease?
As police gain awareness of PTSD, Mounties see diagnoses doubling
Police Suicide in Small Departments: A Comparative Analysis
PTSD: The Hidden Toll of Policing
Police Suicide: Recent studies and prevention suggestions
Developing a wellness program
Predictors of suicide ideation
Alcohol in the workplace factsheet
Cop’s documentary aims to shed light on after-effects of an OIS
First Responders and Traumatic Events
Suicide Among Law Enforcement Personnel

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