First Responder Mental Health

The Unique Challenges of First Responders

First responders face trauma-related stress during many of their shifts. A traumatic event is very distressing and can affect their level of functioning at home and at work. According to SAMHSA’s Trauma and Justice Strategic Initiative, “trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being” (SAMHSA, 2012, p. 2). Moreover, they may experience Cumulative Career Traumatic Stress (CCTS) due to continued exposure to traumatic events. These events can bring about moral concerns at work, which stem from a first responder’s core.

First responders can suffer as they have a religious struggle with faith, are spiritually impacted, lose purpose in work, can’t make meaning out of their role and lose trust in the system and themselves. Their sense of self suffers. Furthermore, many first responders are empathetic. Empathy can move to empathic strain or empathic distress. It can occur even if they do not communicate their feelings or thoughts to anyone. Broadly speaking, empathy is how a first responder reacts when they observe another person’s emotions. We all know that they see sometimes see things that many people cannot even imagine.

On the other hand, compassion fatigue is not related to their empathy level. Rather, compassion fatigue is a cumulation of both burnout and secondary traumatic stress. Burnout is a syndrome due to prolonged occupational stress that has not been successfully managed. It is due to chronic workplace stress and is a pathological state manifested through specific symptoms such as being emotionally overwhelmed and feeling inadequate while on duty. Current stress at home and at work and the cumulative stress and trauma from their own childhood can make their job difficult, especially when they face trauma, death and tragedy on every shift.

Facing Trauma, Death and Tragedy on Every Shift

Acute trauma is the most common form of stress a first responder faces and is due to a single exposure. Comparatively, chronic trauma is due to extended exposure. A first responder’s brain, body and nervous system reacts each time a trauma occurs during their shift. Complex trauma can include a mass casualty and be so devastating that it can have a long-lasting effect. A shift can be easy, or it can be hell. As we focus on an overview of first responder mental health, we realize the horrors that can occur on each shift. When a first responder is exposed to trauma, they are put off guard and can continually be fearful that the trauma can happen again.

Trauma can have adverse effects on their emotional, mental, behavioral, physical, and spiritual wellbeing, and at the end of their shift, when they bring that trauma home, their spouse and children are impacted.  Although a person is traumatized, a first responder can vicariously experience the same symptoms as the personal primarily traumatized. For that reason, every responder agency needs to be vicarious trauma-informed.

The Impact of Secondary Trauma

An element of compassion fatigue is secondary traumatic stress (STS). It is “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other—the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995, p. 7). STS stress symptoms are like post-traumatic stress symptoms but are due to indirect exposure and not direct exposure during their shift.

A first responder may experience intrusive thoughts based on hearing a traumatic story. They may experience avoidance symptoms like PTSD, such as avoiding people, places and situations that trigger the memory of the traumatic event. Also, they may have changes in cognition and mood and find it hard to remember details of a traumatic event or feel guilt or shame when they recall the traumatic event. The mental health challenges faced by first responders are many and so are the symptoms. Although they may first experience shock or denial, reactions can linger and strain their relationships and their mental health.

Common Mental Health Issues Faced by First Responders

Anxiety, depression and post-traumatic stress disorder are issues that many first responders face on the job. A study conducted by the National Institute for Occupational Safety and Health (NIOSH) found that up to 60% of first responders have experienced symptoms of anxiety. According to the National Fire Protection Association, approximately 30% of firefighters have experienced symptoms of depression. A study conducted by the National Institute of Mental Health found that first responders are 10 times more likely to experience post-traumatic stress disorder (PTSD) than the general population. Direct trauma could result in PTSD, which manifests as symptoms like nightmares, flashbacks, anxiety, and uncontrollable thoughts about the event. PTSD is a trauma and stressor related psychiatric disorder. It occurs after experiencing or witnessing a traumatic event, series of events or set of circumstances (American Psychiatric Association, 2022).

First Responders Believe Treatment Is Effective but Professionally Risky

First responder resiliency, safety and wellness are now a priority with leadership across the country. Command staff and supervisors need to take action to identify the impact of empathic strain, burnout, secondary traumatic stress moral injury on police officers and identify ways to do something about it. Several studies have shown that mindfulness-based intervention (MBI) is a popular method to reduce stress related to one’s job. Being mindful, having gratitude, prayer, making meaning of their role, having life’s purpose and self -compassion are ways to mitigate the impact of moral injury. In essence, mindfulness can be done with a meditative practice. Think about what it would be like to be prepared in advance to deal with moral injury.

The emotional residue of moral injury can present itself weeks, if not years after a traumatic event.  Although many first responder departments across the country are focusing on PTSD, they also need to focus on trauma-related stress, insomnia, depression and hopelessness. Supervisors can adopt a non-punitive response to members who ask for help, encourage new recruits as well as seasoned professionals to continually utilize their information seeking skills to empower themselves and reinforce that stress is part of the job but stress managed well can create growth.

Difficulty Seeking Help

There are barriers such as stigma and confidentiality to first responders getting mental health treatment. Many feel hopeless and fear coming forward. So, they wind up drinking too much or dying by suicide instead of seeking help. Hopelessness can be caused by financial issues, health problems and negative incidents that have impacted one’s self-esteem. Hopelessness can feel like different things to different people – no hope, despair, pain, desperate. Maladaptive coping behaviors such as withdrawal, being passive-aggressive or avoidant seem harmless at first. Sure, a few drinks with peers can temporarily ease anxiety– racing thoughts, chest pain, or feeling jittery. A drink temporarily numbs the anxiety. However, in the long run, this maladaptive coping behavior can make problem solving an issue and make anxiety, if that’s what they are feeling, much worse.

How Employers Can Support First Responders

There are things that departments can do to support the mental health care of their first responders. First, recognize the stigma, which is a negative social attitude linked to an attribute that implies social disapproval that may lead to being discriminated against. If first responders have a negative belief about confidentiality, that will keep them from getting help. They may fear that their supervisors and those who they work with will find out about their mental health issues. Confidentiality is key to getting the help that they need.

Employers can support first responders by recognizing the organizational stressors that they face and do something about them. They need support to manage constant exposure to violence, abuse, neglect, death, personal injury, inadequate resources, time constraints, interpersonal disagreements, perceived inequality and long hours. The question administrators need to ask themselves is how badly or for that matter, how well, is their department helping first responder handle these stressors?

The Strength of Seeking Help

The best way for first responders to get help for mental health issues is to focus on their character strengths. It takes strength to seek help when experiencing acute stress as a first responder. Acute stress is the most common type of stress that puts their body into the fight-or-flight-response. Acute stress is a fleeting emotional or physical response immediately felt after a stressful event. It’s basically short-term stress. Acute stressors such as responding to a fire, medical emergency or car crash, can occur one after the other throughout the day. Although acute stress goes away quickly, that is not the case with chronic stress.

Acute stress symptoms can include anxiety symptoms of elevated heart rate, irritability, anger, anxiety symptoms such as difficulty breathing, sweating, chest pain, headache, neck pain, stomach pain, jaw pain, nausea, and feeling numb. Overarousal wreaks havoc on their body and mind and can result in anxiety where they worry excessively and feel tired, shaky, have palpitations and feel constantly on edge. First responders need to identify their character strengths and put them into practice to manage stress.

The Power of Prevention for First Responder Mental Health

Prevention begins with inoculation. If a first responder is taught ways to manage the stressors of their job before they start their job, they can be prepared for the worse case scenarios that might happen during their shift. By being prepared, they become inoculated from vicarious trauma when it does occur, ensuring that they act in a healthy way. If training is given to them as a recruit, their mind can fight off the negativity that vicarious trauma causes. Just like a vaccine fights off disease, they can be inoculated against vicarious trauma, so that they have a plan and are ready to handle stress and trauma on their shift before it happens.

Although there are treatment options for first responders in a mental health crisis, these issues need to be addressed at the beginning of their careers. According to a survey conducted by the Ruderman Family Foundation, up to 98% of first responders have experienced mental health distress in their lifetime. Departments should help first responders understand Adverse Childhood Experiences (ACEs) as a high ACEs score will have a mental health impact. If, as a child, prior to the age of 18, they were made to feel unsafe on a chronic basis. It is well documented that addiction and suicide are two of the main health issues associated with high ACE scores. Perhaps they witnessed violence, lived in an unsafe neighborhood, experienced racism, bullying, or lived in foster care. The categories in the ACES study are broken down into abuse, neglect and household dysfunction. These categories follow them into their career as a first responder.

Recognize The Role of Resilience

A survey conducted by the Ruderman Family Foundation found that up to 70% of first responders feel that their mental health needs are not being met. The impact of mental health distress on first responders can range from moderate to severe depending upon their level of resilience. The term resilience refers to the process of adapting, bouncing back and overcoming quickly in the face of difficult challenges and sources of stress. Resiliency, considered a distinct group of eight personal characteristics: 1. being a flexible thinker; 2; keeping a positive attitude; 3. maintaining boundaries; 4. staying connected with others; 5. having as sense of humor; 6. being a realistic optimist; 7. remaining satisfied with their job; and 8. practicing self-compassion.

Promote The Practice of Self-Care

Occupational stress, shift work, and exposure to traumatic events at work increase the probability of experiencing traumatic stress, which impacts the sleep quality and mental health. Insomnia is a major problem and self-care is critical in managing it. Here are 10 actionable take-aways to promote self-care and manage insomnia:

1. Take advantage of health screenings.
2. Seek out online mental health services.
3. Filter out negative social media.
4. Remind themself of the value of policing.
5. Set a positive intention for the day.
6. Express their feelings to someone who they trust.
7. Rather than enabling their friends, get them help.
8. Create a ritual at the end of their shift to facilitate transition to personal life.
9. Balance basic self-care into their day with good nutrition and regular exercise.
10. To calm the nervous system when stressed, say a short phrase such as, “I am calm.”

Mental Health Resources for First Responders

A survey conducted by the National Alliance on Mental Illness (NAMI) found that nearly 40% of first responders have considered suicide. These individuals need resources before they are suicidal and mental health care way before the point where they want to end their pain. Whether they need to talk to trained peer or a professional counselor, they must first realize that they have a problem.  Whether sleep deprivation, depression, anxiety, spousal issues, excessive overtime, working night shift or dealing with bureaucracy, there are resources available.

As first responders start their journey on wellness and holistic proactive approaches, they can focus on eight wellness dimensions that impact their mental health. Once they identify their emotional, physical, sexual, social, spiritual, community, career and financial wellness, they will be able to focus on the mental health resources that they need.

1. Emotional wellness: thoughts and emotions bring about positive behaviors, learn new skills, open-minded, leisure pursuits, healthy self-esteem, achieve goals, adapt to change.
2. Physical wellness: health and fitness, have the energy to get things done, regular exercise, get enough sleep, proper nutrition.
3. Sexual wellness: sexual pleasure, absence of disease, self-determination in one’s sexual life, sexual safety and respect.
4. Social wellness: meaningful friendships, intimate partner, share positive experiences, provide emotional support, receive emotional support.
5. Spiritual wellness: meaning in life, religious beliefs, sense of purpose.
6. Community wellness: like where they live, feel safe, sense of belonging, live in a fair society.
7. Career wellness: like what they do every day, fulfilled by their first responder role, reinforce job skills.
8. Financial wellness: manage their money well, have enough money to do things that they enjoy.

Wellness is defined as “the quality or state of being in good health especially as an actively sought goal” (Merriam Webster, n.d.). When seeking out mental health resources, a first responder recognizes the importance of the eight pillars of wellness as they reach out to their EAP, HR, a mental health provider or a trained peer support program.

The impact of workplace stress on first responders’ health needs to be better understood. All first responders must be aware of the health dangers associated with their work and be able to ask for assistance when necessary. Leaders and supervisors need to create work environments that will give them proper training, safeguard against work overload, and encourage public safety officials to ask for assistance when it’s needed.