OUT OF THE DARKNESS: FIRST RESPONDER MENTAL HEALTH

by Angela Outhouse, RN, EMT

An ordinary person may not think of first responders as a special group or population, but aren’t we? First responders are a group of people tasked with protecting and keeping people safe in many ways. We respond to emergencies, leave our dinner tables, our children’s games, our beds, our favorite shows… and rush toward potential danger to help total strangers. Oftentimes the people whose aid we come to could not imagine the extent of the sacrifices we make. It takes courage and a special mindset to rush toward danger when others run from it.

If you’re reading this article, you are probably a first responder too. Did you know that repeated exposure to traumatic events can cause post-traumatic stress disorder? Even though we are trained specifically for extreme circumstances, we were not prepared for such things as horrific crime scenes, the death of a colleague, public insurrections, aggressive social discord, mass shootings, and pandemics such as COVID-19.

What happens if someone endures more than they are psychologically capable of? What is being done to assist first responders with mental health issues? How prevalent is PTSD and other pathologies that arise from being a first responder? Questions like these are the tip of the proverbial iceberg. Statistics from the US Department of Health and Substance Abuse and Mental Health Administration Help for Heroes Program revealed 30% of first responders suffer from mental health issues, and firefighters have a higher attempt and ideation rate of suicide than the general population. The nature of the work, including repeated exposures to emotional and provocative experiences, altered sleep schedules, and burnout can pose significant risks to their mental health. While firefighters are at increased risks for mental health issues, according to other research, more than 50% of firefighter deaths are due to stress and extreme exhaustion.

Here are some other first responder statistics: 18-24% of dispatchers suffer from PTSD; 15-24% of firefighters suffer from PTSD; 37% of fire and EMS professionals have contemplated suicide; and a startling revelation that firefighters are more likely to commit suicide than die in the line of duty. How does repeated exposure to graphic and traumatic scenes affect people? How do first responders cope? Regular people don’t see firsthand what horrible things people do to each other and themselves, but first responders do. 911 dispatchers take panicked calls with people screaming or even taking their last breath. How do they deal with that?

There is a documentary called PTSD911. In the trailer of this documentary, the story of a police officer who was suffering from PTSD and trying to figure out how to get help without losing her job is showcased. Another officer recounted that a police officer went in to ask for help and was fired. A dispatcher stated she was forced to resign because her superiors didn’t understand how a call affected her when she wasn’t even there. A firefighter voiced fear that if he asked for help, losing his job would be a very real threat. And if he can’t do this job, what can he do? He put all his eggs in this basket… who is he if he’s not a firefighter? These are very real fears!
What has been done to address these revelations? As a result of researching first responder suicides, the Helping Emergency Responders Overcome Act was passed, which among other things directs the Centers for Disease Control and Prevention to initiate a public safety officer reporting system and gather additional statistics. Also highlighted were peer-to-peer programs to promote communication, dialogue, and trauma processing. Ideally, marketing the right approach for those who might be hesitant to seek help for a variety of reasons is key. The challenges faced by first responders have grown exponentially. While some strategies are taking shape to combat mental health issues in first responders, more needs to be done.

Research has shown that fear associated with seeking help and treatment often prevents first responders from doing so for fear of personal and professional repercussions. Peer support programs have sparked interest and support, and receive positive firsthand feedback. These programs are unique to first responders. Peer support team members are trained to identify risk factors for behavioral, mental health, and substance abuse problems. They are taught active listening, being present in conversations, and validating techniques. They offer compassionate, low-level psychological interventions. They serve as resources during times of mental health crisis, and are taught to recognize distress, use active listening skills, offer support and encouragement, and provide advanced mental health resources.

The effectiveness of one peer support program revealed 48.3% participated in peer support, and of that, over half reported the support either helped them directly or indirectly. Other studies also indicated that peer support programs had higher rates of participation than Employee Assistance Program and other mental health resources. This is consistent with the belief that peer support programs reduce a person’s resistance to seeking help and the stigma associated with seeking help. Peer support works because it is based on the idea that those who have overcome stressful and traumatic events are in a unique position to help others because they have “walked in their shoes.” Peers can personally relate and help others deal with similar experiences. Each step of peer support training is touched upon, such as symptom recognition, how to approach someone you think is in crisis, active listening, tone of voice, paraphrasing, reflecting, and normalizing. They are taught to role-play with different scenarios. They stress that learning should be ongoing and refresher courses should be available to maintain skill levels and effectiveness.

As first responders, what can we do for each other? Host a mental health first aid class. Go out and find mental health first aid training. Join a peer support team. You could be the one to recognize warning signs in one of your peers. With welcoming body language, good listening skills, and being attentive, you can have a powerful impact on someone who may be teetering on distress. As the first line of support in recognizing the signs of mental health and substance abuse challenges, you can offer assistance and resources to your peers. You could be the vital link between your peer experiencing a new or worsening crisis, and assisting them to seek appropriate professional support. This and other similar programs help reduce the stigma surrounding getting help for mental distress.
If we, first responders, do not get the help we need, who will answer the call? Lives depend on us. Isn’t it important that we look out for each other? The bottom line is first responders should not have to worry about asking for help for fear of being benched or let go. Peer support and mental health first aid programs teach peers to recognize signs and symptoms of distress, recognize that someone may be having a mental health issue, and intervene before it becomes a critical incident. Be safe out there and remember, we are all in this together and it’s okay to ask for help.

Resources
• National Suicide Prevention Lifeline: 1–800–273–TALK (1-800-273-8255)
• Crisis Text Line: Text “MHFA” to 741741
• Lifeline Crisis Chat: crisischat.org
• Substance Abuse and Mental Health Services Administration: samhsa.gov/find-help
• Mental Health First Aid USA: mentalhealthfirstaid.org/mental-health-resources/

Angela Outhouse, RN, EMT is a member of FASNY’s EMS Committee; president of the Westchester County Volunteer Firefighter’s Association, trustee of Buchanan Engine Company, chairman of the board of Croton EMS, sergeant-at-arms of the Hudson Valley Volunteer Firefighter’s Association; and, director of SNYVFA.

References
• leb.fbi.gov/articles/featured-articles/first-responder-peer-support-programs
• mdpi.com/1660-4601/18/21/11097
• psychiatrictimes.com/view/first-responders-and-mental-health-when-heroes-need-rescuing
• rcmp-grc.gc.ca/en/gazette/mental-health-service-offers-anonymity-first-responders-rcmp
• nami.org/Blogs/NAMI-Frontline-Wellness/2021/Documenting-the-Traumas-of-First-Responders
• mentalhealthfirstaid.org/mental-health-resources