First Responders' Mental Health Stigma, & Barriers to Help

 

First responders are often seen as the heroes who charge into extreme situations to save lives. But what happens when they have to face the aftermath of these traumatic events? While they may have been trained to handle the physical aspect of their job, many are not prepared for the toll it takes on their mental health. The constant exposure to trauma can lead to long-term effects, but unfortunately, resources for mental health support are not always readily available for first responders.

One coping mechanism that is common among first responders is self-medication. This refers to using drugs or alcohol as a way to cope with overwhelming emotions and feelings that they may not be ready or able to confront. According to the National Center for Injury Prevention and Control at the CDC, the high levels of mental stress in first responder jobs can contribute to substance abuse and alcoholism. In fact, studies show that first responders are more likely to engage in heavy or binge drinking compared to the general population.

The pressure to remain composed during one crisis after another can become too much to bear, leading some first responders to turn to alcohol or other substances as an easy escape at the end of a tough day. Along with alcohol, tobacco use and excessive painkiller usage are also common forms of self-medication among this group.

But these habits can quickly spiral out of control and lead to Substance Use Disorder (SUD). Many first responders may not even realize they have a problem until they try to cut back or face negative consequences from their self-medicating behavior. Asking for help with SUD can be challenging and stigmatized, especially for first responders who may feel embarrassed or ashamed about their struggle.

The culture of being a first responder is one that values strength, self-reliance, and always saving others. While this mentality can be beneficial in the line of duty, it also leads many first responders to consider stress and trauma as just part of their job, making it difficult for them to admit when they are struggling and reach out for help. Seeking help for these issues may not only go against societal expectations but also put their career at risk.

Unfortunately, this fear may of repercussion is partially legitimate. Mental health is a requirement for being a first responder. There have been cases where first responders have faced consequences for seeking treatment for mental health challenges. This can include losing access to their weapons or being assigned to desk duty, which can ultimately impact their job performance and opportunities for advancement.

The stigma surrounding mental health in the first responder community leads many individuals to under-report symptoms and avoid seeking help in order to dodge negative judgments or repercussions at work. On average, about one third of first responders experience stigma regarding mental health issues.

While shame and stigma are often the biggest obstacles preventing first responders from seeking mental health services, practical barriers also play a significant role, such as access to convenient services and compatibility with work schedules.

Surveys conducted among law enforcement officers and firefighters have revealed how widespread these practical barriers are. 525 firefighters throughout the United States were surveyed. Cost and availability were highlighted as major challenges when it came to accessing mental health services. This is especially problematic for volunteer firefighters, who may face even more difficulty in obtaining the necessary support compared to career first responders. Law enforcement officers, particularly those employed by smaller departments outside of urban areas, also encounter similar obstacles in accessing mental health services. For many, Employee Assistance Programs (EAPs) are contracted to provide mental healthcare services, effectively outsourcing the problem to people who do not understand the specific needs these first responders have.

This leads to one of the biggest problems. The lack of accessible therapists who are specifically trained to handle trauma. Often, the only option is a general mental health practitioner, who may not have the necessary expertise or understanding of the unique experiences of first responders. This can be discouraging for first responders who finally decide to seek treatment, and that negative or potentially unhelpful encounter could prevent them from seeking further help in the future.

It’s important to know that those who have mental health conditions or experience symptoms can still have positive outcomes with the right support.

The removal of the stigma associated with experiencing emotional distress, access to trauma-trained clinicians, and education about good mental health being just as important as good physical health are all important parts of the healing process. They should be easily accessible to all first responders. After all, these superheroes deserve the best care possible for all they do for our communities.

 

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Psychological Challenges of being an Emergency Medical Service Provider

 

The job of an Emergency Medical Service (EMS) provider is inherently stressful, involving constant exposure to human suffering and trauma. This can lead to psychological challenges such as depression, anxiety, and posttraumatic stress disorder (PTSD) among EMS providers. Shifts as an EMS provider can vary drastically in terms of call volume, and providers are often working outside in harsh weather conditions at all hours of the day. Emergencies can occur anywhere, from public locations like streets and shopping centers to intimate settings like private residences or nursing homes. Additionally, EMS providers may encounter violent or traumatic situations while on the job, making their work even more challenging. Repeated Exposure Trauma, the severity of the incidents that EMS providers are involved in, and the emotional skills needed to cope with Cumulative Trauma can lead to Compassion Fatigue, Secondary Traumatic Stress, Vicarious Trauma, Burnout, and PTSD. Cumulative trauma refers to the psychological, emotional, and physical distress associated with repeated exposure to traumatic events, either directly or indirectly. Every individual's experience and risk of developing PTSD is unique; some may go through years of service before displaying symptoms, while others may not have an immediate impact, just additional cumulative trauma.

A study from 2018 found that paramedics have the highest rate of PTSD. This is likely due to the top three stressors universally associated with poor mental health, include career challenges, financial struggles, and lack of sleep. Considering the long shifts, standard pay rates, and exposure to traumatic events, it's not surprising that EMS providers are considered high-risk for developing mental illness.

Shift lengths and rotations vary depending on each EMS agency's policies. Typically, shifts can last 12, 16, or 24 hours. Working irregular schedules disrupts providers' natural sleep patterns and can lead to exhaustion. Many providers also work overtime or hold multiple jobs to make ends meet, resulting in back-to-back shifts and further fatigue. While lack of sleep and financial concerns are common issues for EMS providers, the nature of their occupation is the biggest contributor to an increased risk of mental illness.

With the increase in disasters around the world, the demand for EMS providers is higher than ever as they play a crucial role in disaster management systems. However, an estimated 69% of EMS providers report not having enough recovery time between traumatic incidents. Most EMS providers are expected to be on duty for strenuous amounts of time—up to and beyond 24 hours. The duration and intensity of being on call, engaging in extremely stressful situations, and having little opportunity for rest in between incidents can lead to burnout.

Although EMTs and paramedics are often the first responders, they are not the only ones in the EMS chain suffering from burnout. Reports show that other EMS personnel are also experiencing increasing levels of burnout within the industry. Nurses who face moral distress have reported feelings of emotional exhaustion and depersonalization - two key components of burnout. The job of an emergency dispatcher may not require them to physically enter a scene, but they still face daily challenges and trauma that can take a toll on their mental health. Emergency Dispatchers, who act as the vital link between individuals in crisis and first responders, are responsible for dispatching assistance to both emergency and non-emergency situations. They must remain levelheaded and composed while handling multiple tasks and finding solutions on the spot amidst dangerous and heartbreaking situations such as home invasions, domestic violence incidents, fires, car accidents, and even murders.

According to recent findings from the Pulse of 9-1-1 State of the Industry Survey, 74% of respondents reported staff burnout at their 9-1-1 centers, with many displaying symptoms of anxiety, fatigue, and low energy levels.

Moral distress is a major issue within the medical community and it comes as no surprise that it contributes to mental health problems among EMS providers. Despite the patient's decision, EMS providers must respect their choice, even if it may result in their death. One common ethical challenge arises when competent patients refuse assistance that could benefit them. In fact, a study revealed that 27% of ethical conflicts during paramedic responses were due to issues with informed consent. EMS providers may feel a sense of duty to respond and may struggle with moral responsibility to provide care, even if the patient denies treatment or transport- regardless of medical advice. This can lead to moral distress for EMS providers who have good intentions but cannot act upon them. The consequences of moral distress can be significant, such as burnout, job dissatisfaction, high turnover rates, and emotional detachment from patients - all of which ultimately impact patient care.

The effects of burnout, moral distress, and cumulative trauma are not limited to EMS providers; they also affect Emergency Department (ED) nurses and physicians.

Unfortunately, EMS personnel, like other first responders we’ve discussed, are often the last to admit they need help, as it goes against their role as providers of support rather than recipients. Seeking help is often stigmatized or seen as a weakness in this community, where toughness is essential. However, it is crucial for first responders to know how and where to find help.

Support mechanisms, the removal of the stigma associated with experiencing emotional distress, and education about good mental health being just as important as good physical health need to be available and easily accessible to all first responders.

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

The Mental Health Risks of Search and Rescue Workers

 

Search and rescue (SAR) is one of the most crucial and challenging jobs in the world. It involves looking for and providing aid to individuals in dangerous or desperate situations. From treacherous mountain terrain to rough waters, SAR teams are routinely exposed to difficult situations as they put their own lives at risk to help others.

In the United States, there are multiple organizations responsible for SAR at national, state, and local levels. Most daily SAR operations in the US are led by County Sheriffs, although some states such as Alaska have State Highway Patrol overseeing SAR efforts. In certain areas, local fire departments, EMS services, or non-profit agencies may also provide SAR assistance. Members of SAR teams typically receive training in the Incident Command System (ICS), first aid, and necessary outdoor skills for their designated terrain and climate.

Though search and rescue teams receive important training to help them perform their duties, there are very few full-time SAR roles or opportunities for individuals to pursue. Most often, aspiring SAR professionals work other, relevant full-time jobs on the side and stay on call for any potential search and rescue situations. The most common career fields that offer search and rescue opportunities include:

• Law enforcement

• National parks employees

• Firefighters

• Emergency organizations

• United States military

Like other first responders, SAR personnel are frequently exposed to traumatic incidents in their line of duty. This includes life-threatening situations, severe injuries, and the loss of colleagues and civilians. As a result, they face a higher risk of developing Compassion Fatigue, Acute Stress Disorder (ASD), and Post-Traumatic Stress Disorder (PTSD).

As with firefighters, SAR volunteers have higher rates of depression, suicidal thoughts, and attempted suicide than paid career first responders. This could be due to the heightened work-family conflict caused by the demands of their volunteer role, limited training on mental health and critical incidents, and potential challenges in accessing mental health care. Over the years, the demands placed on SAR volunteers have become more challenging as outdoor recreation grows in popularity without an equivalent increase in volunteer-based rescue services available.

While it may seem glamorous, SAR work is far from it; there are no set hours and teams must be prepared to spend the night in the field if necessary. SAR teams undergo rigorous training and live their lives on-call, ready to help others at a moment's notice.

SAR personnel are often faced with the reality that it will take hours and sometimes days to reach those who need help. Some will be beyond help when they are found. Those who are still treatable will have the added insult of prolonged suffering and exposure to the elements as they are transported to a car facility. SAR personnel are required to handle themselves and the operation in a professional manner while dealing directly with people’s suffering.

Unfortunately, burnout and high levels of stress among SAR personnel are common and comparable to other first responder groups.

Research has shown that the risk of developing PTSD increases with each traumatic event experienced by SAR personnel.

Unfortunately, SAR personnel, like other first responders we’ve discussed, are often the last to admit they need help, as it goes against their role as providers of support rather than recipients. Seeking help is often stigmatized or seen as a weakness in this community, where toughness is essential. However, it is crucial for first responders to know how and where to find help in order to build resilience.

Support mechanisms, the removal of the stigma associated with experiencing emotional distress, and education about good mental health being just as important as good physical health need to be available and easily accessible to all first responders.

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD