Getting Behind the Shield: Responding to First Responders

It would not surprise most people to learn that, among the most stressful jobs in the country are firefighter and police officer. Most people understand that those who work as first responders, including emergency medical services workers and 911 dispatchers, who come into direct contact with trauma would be directly affected by that experience. What many people may not be aware of is the extent to which this stress often leads to mental health problems in the form of depression, acute stress disorders, post-traumatic stress disorders, substance abuse, and even suicide. Additionally, most people would be shocked to learn that, very often, these workers, who dedicate their lives to protecting others, often suffer alone.

Not surprisingly, those entering this field seem preloaded with internal grounding mechanisms to deal with tragedies regularly. That being the case, the following, when added to the inherent dangers of the job, can create a perfect stress storm that lowers their resistance and drains their resilience:

• Shift work
• Sleep deprivation
• Inadequate training
• Technical problems
• Bad crews
• Malicious coworkers
• Inconsistent policies
• Family problems
• Poor leadership

Nationally, this leads to these alarming realities:

1. Police officers going through a divorce are five times more likely to commit suicide than an officer in a stable marriage.
2. More officers die by their own hand as do in the line of duty.
3. Most officers who commit suicide have no history of having sought counseling.
4. Firefighters and EMS personnel experience higher rates of lifetime suicidal ideation and attempts than the general population and other protective service professions.

These realities have drawn the attention of departments across the country and led to the creation of peer support teams offering psychological first aid (PFA). Supporting this movement is the growing awareness within the profession that the old school approach of staying silent and “sucking it up” not only no longer works, but never was a functional method for coping with the routine challenges of this service. This awareness, however, does not mean that first responders are flocking in droves to therapist offices or seeking out the assistance of trained peers who act as stress first-aid workers.

The reluctance of first responders to admit to mental health difficulties and actively seek treatment has deep roots within the public safety culture that still sees asking for help as a sign of weakness. Many in this field also worry about the negative impact of seeking help on how they are viewed by supervisors and on opportunities for promotion. Additionally, the attitude of “You can’t help us if you aren’t one of us” creates a reluctance to bestow mental health professionals with a green card into their culture and speaks to the misconceptions about counseling and psychotherapy.

The mental health community, of which I am a member, has failed to work through this resistance—to get behind the shield and make the case that, like them, we are trained to respond to crises and are equipped with the necessary tools to protect them from the ravages of stress while they protect and serve. Therapists can help alleviate the silent suffering by providing more than just diagnostic assessments and treatment for advanced stress disorders. Working in concert with the growing number of peer support programs, we can educate those who actively work to protect others from harm that their avoidance of mental health treatment puts them in harm’s way.

On a broader level, departments responsible for hiring, training, and retaining first responders need to actively engage in promoting mental health awareness, support the use of employee assistance programs and strive to actively change the culture from within. This approach requires more than just mottos and slogans or a reactive approach to high-impact events. Departments need to prioritize psychological fitness in the same manner as physical fitness. By creating, or enhancing, peer support teams those in higher levels of command can emphasize the following:

1. Providing resources during times of crisis.
2. Fostering emotional health.
3. Recognizing conflicts and using active listening skills to offer support.
4. Ensuring that requesting support will be seen as a positive not a negative.
5. Identifying signs and symptoms that may indicate the need for help.
6. Providing options and referrals for outside mental health resources when needed.

In my work bringing peer support teams online, I’ve learned that many of the peers who join often express two primary reasons for wanting to be part of a PFA team—they want to pay back the support that someone offered them, or they wish that this type of support would have been available “back in the day.” These powerful motivators are the lifeblood of these teams and can assist in breaking down the resistance to psychological first aid. The inclusion of a trained mental health professional makes it much easier for practitioners to get behind the shield and sell this much-needed service to those on the front lines of trauma response.