First responders—including police officers, firefighters, and emergency medical service workers—face mental health struggles at disproportionately high rates. Repeated exposure to death and disaster in their fields causes emotional trauma that can lead to anxiety, depression, posttraumatic stress disorder (PTSD), and suicide.
In fact, a report commissioned by the Ruderman Family Foundation found police and firefighters are more likely to die by suicide than in the line of duty, despite the media in large part only covering the latter type of tragedy.
Threats to the well-being of first responders emerge from an interwoven set of structural and cultural barriers that include overwork, exposure to crisis conditions, lack of provided counseling, and stigma surrounding mental illness in both first responder and greater American communities. Proactive intervention is necessary to ensure greater safety for those working in emergency fields.
Though more studies are necessary to gather accurate data, the few investigations into the mental health of first responders point to a pattern of higher-than-typical rates of mental illness and suicide.
In the Ruderman Family Foundation report, researchers found firefighters and police officers die by suicide at a rate of 18 and 17 per 100,000, respectively—compare that to the rate of 13 per 100,000 for the general population. PTSD is also common among police officers, with one team of researchers estimating the prevalence at 35 percent.
According to a 2018 report by the Substance Abuse and Mental Health Services Administration (SAMHSA), 37% of fire and emergency medical service workers have thought about suicide, which is almost 10 times the rate typical of American adults.
The same report cited research indicating an estimated prevalence of suicidal ideation among a group of 1,027 current and former U.S. firefighters at 46.8 percent, compared to a lifetime rate of 13.5 percent for other American adults.
The mental health crisis among first responders emerges from a broken system. Structural obstacles come in pragmatic, cultural, and educational forms, as illustrated in an infographic from Northwestern University’s online Master of Arts in Counseling program.
First responders face high exposure to critical incidents, or high-stress experiences that traumatize involved individuals. Though life-threatening disasters and emotionally horrifying situations are integral components of first responder work, many departments don’t provide sufficient education about mental health, time off to recover after exposure to disaster, access to mental health services, or suicide prevention programs.
These pragmatic obstacles are interwoven with cultural stigma—departmentally and in greater American culture—about mental illness. First responder work environments especially prize strength, bravery, and selflessness, as is stated in many of the referenced reports on mental health among these populations.
Ruderman Family Foundation report co-author Miriam Heyman says that this atmosphere can lead those experiencing mental health struggles to stay silent about their suffering, as speaking out is considered explicitly against the values of their jobs; this silence can then perpetuate feelings of isolation.
Refusing to speak out about mental health struggles often also comes from a practical and realistic fear of threat to employment, as many first responder departments require passing mental health tests to gain positions.
Experts recommend a variety of workplace interventions to improve first responder mental health. Possibilities mentioned in the SAMHSA report include development of plans in advance of crises to give employees greater feelings of preparedness and the collection of as much information as possible about disasters at hand to diminish danger levels and thus mitigate anxiety.
Creating systems of peer-to-peer support, providing mental health training and services, and offering adequate recovery time after stressful incidents can likewise go a long way for helping first responders. Dr. Nate Perron, professor at Northwestern, similarly recommends peer support programs and mental health services. He stresses the importance of openness within departments, encouraging police and fire chiefs to talk honestly and openly with their teams about mental health struggles and seeking professional care.
“Some of the best supports for first responders lie within the agencies themselves,” Dr. Perron said. “Supporting mental health can be encouraged from the top down, which fits the hierarchical models used in these settings. Agencies, including law enforcement, fire departments, and EMS, can encourage debriefings after especially difficult events, and first responders can be regularly exposed to the potential side effects of the profession (so they can be observant of those effects with one another) with routine training.”
As advocates rally for change on a structural level, friends and family of first responders may be wondering how best to support loved ones in need. Northwestern suggests keeping an eye out for disengagement among first responders in their lives outside of work, as this can be a sign of distress.
They recommend loved ones help first responders connect with professional mental health providers and support them through fears that seeking treatment will threaten their employment status.
Experts say friends and family of anyone going through hardship can also offer key support by truly listening and being there for their loved ones. They may also provide assistance with basic daily practices that can support mental health like helping loved ones eat regularly and maintain routines.
Current organizational systems fail first responders by threatening their mental health and survival through the very nature of their day-to day-work. Large-scale adjustments must be made surrounding exposure to trauma, recovery time, and mental health training and resources to protect Americans serving in emergency fields.
About the author
Colleen O’Day is a senior digital PR manager and supports community outreach for 2U Inc.’s social work, mental health and speech pathology programs. Find her on Twitter @ColleenMODay