Navigating First Responder Mental Health

First Responders face a unique set of mental health challenges that the lay person may not be aware of. This tip explores those challenges that first responders face, how first responders tend to compensate for increased stress, how to recognize signs of distress in a loved one, and how to be receptive to other people’s concerns for you.

What is a first responder? And what kind of stress do they face?

A first responder is someone who is specifically trained to respond to an emergency, they include: law enforcement officers, paramedics, firefighters (paid or volunteer), and emergency medical technicians. First responders face a unique set of stressors “on the job.” They are regularly exposed to traumatic events, including motor vehicle accidents, violence, and natural disaster response. Many times first responders are not alloted time to decompress after a traumatic call before having to move onto the next one. First responders are at risk for developing mental health problems due to the challenging nature of the work. Some of these challenges include mitigating serious situations, the unpredictable nature of their work, and ultimately responding to challenging situations. First responders are exposed to heart wrenching situations almost daily, and often one after the other.

On top of the traumatic experiences encountered on the job, first responders are also subjected to long shift hours, frequent shifts, poor sleep hygiene, and various physical hardships, which take a toll on their mental health.

Paramedics and EMTs encounter high-pressure situations that require them to make immediate decisions that impact the lives of others. When arriving on scene of a motor vehicle accident or a medical emergency within the home, the paramedics must do a scene size-up which is a split second scan of the scene to assess for their own safety and what is going on. The paramedic not only has to manage the patient who is either injured or ill, but they also have to manage the hysterical witness or family members on scene. Blocking out the chaos around them is something that takes time and practice, but comes at a cost. Constant exposure to people who are critically ill and injured takes a toll on the psyche.

Firefighters are faced with the daunting task of running into burning buildings to save the lives of others. They put their lives on the line on every call. They block out the obvious dangers of running into a burning building or a collapsed structure, they block out the smoke, the heat, the fire, and the imminent structural failure for the sake of those who are inside. The same can be said for when they respond with paramedics to car accidents or medical calls where they are exposed to critically ill and injured individuals and have to block out the chaos around them to help the victim.

Police officers face unique stressors as well. Like paramedics and firefighters, they are often exposed to violence and dangerous situations. They are often the first to go into an unsafe situation to minimize the threat of harm to paramedics and firefighters responding with them. They face a constant threat to their personal safety when they are maintaining the law and protecting others.

Common Mental Health Concerns

A study published by SAMHSA reports that 30% of first responders will develop a behavioral health condition compared to the 20% of the general population and 85% of first responders report mental health symptoms. Some of the most common mental health challenges first responders face are:

Depression
Post Traumatic Stress Disorder (PTSD)
Substance abuse or addiction
Suicidal ideation
Anxiety

Mental Health Concerns Facts and Figures

Depression
- 11% of career firefighters report symptoms of depression.
- 22% of female firefighters report depression.
- 20% of police officers report symptoms of depression.
- 37% of paramedics report symptoms of depression.
- 28% of EMTs report symptoms of depression.
Post Traumatic Stress Disorder (PTSD)
- 21% of firefighters worldwide report PTSD symptoms.
- 15% of firefighters in the U.S. report symptoms.
- 17% of police officers in the U.S. experience PTSD.
- 11% of them meet the diagnostic criteria.
- 11% of paramedics and EMTs worldwide report PTSD symptoms.
- 15% of U.S. paramedics and EMTs have symptoms.
Substance abuse or addiction
- 50% of male firefighters reported binge drinking.
- 9% of firefighters reported driving while intoxicated.
- 39.5% of female firefighters reported binge drinking.
- 4.5% of female firefighters reported driving while intoxicated.
- 35% of police officers abuse alcohol
Suicidality/Suicidal Behavior
- 47% of firefighters had suicidal ideations.
- 19% of firefighters made a suicide plan.
- 16% of firefighters attempted suicide.
- 24% of police officers had suicidal ideations.
- 39% of EMTs and paramedics have suicidal ideations.

Common Coping Strategies

As stated above substance abuse is unfortunately common in the first responder community. Substance use is a type of emotion-focused coping strategy. Emotion-focused coping includes techniques that reduce or remove feelings of fear, anxiety, depression, and frustration among others. At times it can be viewed as an escape technique. Excessive substance use can lead to substance abuse. Some other not so healthy coping strategies include using food as a coping mechanism. A study conducted by the CDC reported that 70% of firefighters and EMS personnel are overweight or obese (based on BMI) and 80% of police officers are overweight, with 40% of police officers being obese. Excess weight can cause additional physical and mental stress on the individual.

An additional coping strategy that many first responders employ is nicotine use, whether through cigarettes, cigars, vapes, or smokeless tobacco (chewing tobacco). A recent study reported that 31% of first responders currently vape, 22% are current smokers (cigarette and cigars), and 11% of first responders are dual users, meaning they vape and smoke. First responders are more likely to use chewing tobacco than the general population with 53% of firefighters endorsing use of chewing tobacco. Within the study the author includes that the higher reported stress the first responder endorses the more likely they are to use a nicotine based substance to cope.

Apart from those statistics, one of the most sobering facts is that firefighters and police officers are more likely to die by suicide than on duty.

Signs of Mental Health Concerns

Many first responders work with the same crew or the same partner every shift so it is pretty easy to notice when something is bothering a coworker. Some signs pointing to mental health concerns to be on the look out for include…

Someone who is usually quite talkative is more quiet than normal
Someone is easily agitated
Excessive tiredness in someone
Depressed mood or other mood changes
Eating changes, including overeating, undereating, or changes in diets
Someone who is usually very put together start appearing more disheveled
Loss of interest in activities
Changes in tobacco habits or caffeine habits
Someone who is getting excessive complaints from patients and families, or someone who is usually very pleasant on calls becoming less pleasant and more irritable
Changes in alcohol habits off duty
Showing up to work intoxicated or under the influence of drugs

If you start noticing signs like those in your coworkers or your partner it can feel intimidating to discuss those changes with them. It can be especially scary noticing those changes in your spouse who is a first responder. If someone comes to you with concerns about your mental health, know they are doing it out of concern for you, they are not trying to hurt your feelings, and often they are doing it because they are worried about you, or even scared for you. Hearing their concerns for you can be difficult but it can also help to save your life.

How to ask for help

Many first responders are hesitant to ask for help when they are feeling symptoms of burnout or experiencing other mental health concerns. It is common to experience feelings of shame and guilt surrounding asking for help. Being a first responder is a big responsibility and many think “who is going to trust me to take care of them if I have my own problems” so many times those problems get ignored. Many view it as a weakness to ask for help or bring up troublesome feelings. First responder culture is resistant to mental health treatment because “everyone else has these problems too.” They tend to normalize experiences rather than qualify it as traumatic or painful. The motivation to seek help is statistically lower in the first responder population than any other professional population, a study by the CDC reported that 70% of EMS workers never or almost never use mental health services or resources. Also many first responders fear the stigma attached to seeking mental health treatment. The same study reported that 57% of EMS workers worry about negative repercussions of asking for help so they do not do it and 40% of EMS workers specifically fear being demoted or fired for asking for help. Decreasing the stigma of mental health care and prioritizing a culture of resilience within agencies provides big steps towards feeling comfortable reaching out for help.

First responders are the primary line of defense in an emergency and are the first to step up to render aid, but are the last ones to help themselves. By bringing awareness to the realities of the stressors of the job and the repercussions of years of abuse by the system, first responders can get the help they deserve and feel like they are in a safe space.

If you are a first responder and you feel like you need additional support in your mental wellness journey from a trained therapist please reach out to 215-922-5683 x 100 or schedule directly online. For your convenience, we have five in-person offices and can also provide counseling and therapy virtual

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Navigating First Responder Mental Health

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