First Responder Mental Health
Communities spend thousands of dollars on first responders to protect them physically: body armor for law enforcement officers, heat resistant gear for firefighters, gloves and reflective clothing for Emergency Medical Services (EMS) personnel. Supporting and investing in programs related to first responders’ mental health is equally important in keeping their minds safe. First responders train long hours each year to stay prepared for almost any situation. In the past, training has centered around physical safety and job efficiency. In recent years, efforts have been made to include mental health training and reduce the stigma associated with mental health for first responders (Rose, et al., 2015).
It’s easy to realize that first responders endure hazardous conditions, traumatic events, and long hours on the job, but much of the stress comes from the everyday job requirements. Burnout and compassion fatigue can be the most difficult aspects for first responders to manage. Burnout was recognized by the World Health Organization (WHO) in 2019 as a health concern and has been described as “physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment” (Cocker & Joss, 2016).
Effects of Burnout
Almost 70% of first responders report not having enough time to recover in between the traumatic events they experience, and 7% develop clinical depression (Bentley, et al., 2013). As many as 37% of fire and EMS first responders have considered suicide, a rate 10 times higher than the national average (Abbot, et al., 2015). Other consequences for individuals experi
encing burnout may include increased risk for alcohol and substance misuse (Grayson, 2010).
Compassion fatigue can also manifest in first responders. Compassion fatigue is another symptom of the stress resulting from exposure to a traumatized individual (Cocker & Joss, 2016). Compassion fatigue can be particularly challenging, as the job stress begins to impact relationships at home (Grayson, 2019). Signs of compassion fatigue include sadness and grief, avoidance, reduced empathy towards others, negativity towards others, and detachment.
First Responder Exposure to Stressors
| Death | Grief | Injury |
| Loss | Threats to Personal Safety | Long Hours |
| Poor Sleep | Physical Hardship | Trauma |
Signs and Symptoms of Stress and Burnout
| Fatigue | Anger/Frustration | Poor Concentration |
| Withdrawal | Easily Frustrated | Irritability |
| Poor self-care | Addiction | Nightmares |
| Headaches | Digestive Problems | Muscle Tension |
(SAMHSA, 2018)
Protective Factors
The Substance Abuse and Mental Health Services Administration (SAMHSA) created a guide listing potential protective factors. These include job satisfaction, social support, camaraderie among coworkers, and receiving specialized training. The SAMHSA report also denoted risk factors which included longer hours on the site of the disaster, dealing with serious injuries or bodies of the dead, identifying with the victims, and experiencing recent personal stressors.
Resilience is “the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity” (Haglund et al., 2007). Resilience provides a protective factor against the stressors first responders face that result in burnout, compassion fatigue, and other mental or behavioral health effects. While some individuals have higher resilience and respond better to the stressful demands of the job, resilience is a skill that can be learned. Resilience training and peer support programs have shown a positive impact in 80% of studies, though the training must be refreshed to maintain the benefits. (Awa, et al., 2010).
Possible incentives for departments and organizations in supporting mental health
include increased productivity, fewer sick days, improved engagement at work, improved recruiting and retention rates, fewer disability claims, less conflict, and higher morale (BC FirstResponderMentalHealth, n.d).
Reducing Stigma
One of the most important barriers to address in providing mental health supports is reducing stigma among first responders themselves. Ensuring senior leaders are onboard and clearly support mental health efforts in the workplace is critical (BC FirstResponderMentalHealth, n.d). Without support from leaders, mental health within the department or organization will suffer (Carpenter, et al., 2015). First responders must feel safe in their work environment, whether that means job security or someone to talk to about concerns (Backberg, 2019).
Peer support provides a great way to promote mental health efforts and reduce stigma; also offer these services to family members and retired first responders (JEMS Staff, 2018). Great benefit comes from including families of first responders in mental health efforts. When spouses, parents, and siblings, etc., understand the importance of keeping their loved ones safe mentally as well as physically, the support system grows (Lamplugh, 2017).
Self-care Strategies
- Maintain core components: adequate sleep, good nutrition, regular physical activity, and active relaxation
- Stay hydrated
- Practice basic hygiene
- Find things to look forward to
- Communicate with family and friends
Resources for First Responders
- Employee Assistance Programs (EAPs)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- PTSD Foundation of America
- Alcoholics Anonymous (AA)
- National Suicide Prevention Lifeline
- Safe Call Now
- Code Green Campaign
- MindShield for First Responders
- BCfirstrespondersmentalhealth.com
Authors
Maren Voss, Timothy Keady, Kira Swensen, B.S.
Timothy Keady
Professional Practice Extension Assistant Professor | Health and Wellness | HEART Initiative
Home and Community Department
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