First Responder Mental Health and Wellness

There is a certain glamor ascribed to the work of a first responder: saving people, running into danger, leading a heroic lifestyle. While these perceptions have merit, there is a reality behind the media glow that cannot be ignored.

Stress Triggers and Influences

Even when cases are closed, patients are dropped off at the hospital, and fires are put out, the toll they take on first responders can remain.

Law enforcement officers face an average of 188 critical incidents during their careers5, and 70% of EMS workers don’t have enough time to recover from a traumatic event before encountering another.4 While not every case is dire, there is always the potential the next call could be.

Exposure to traumatic situations, chronic stress, physical strain, and demanding schedules all hold the potential for a first responder to develop mental illnesses like PTSD and depression that may lead to high stress, risk-taking, and suicidal behaviors.1

While we often focus on the impact of direct trauma on mental health, there are several factors that come from other areas of the job. The long, odd hours some first responders have may disrupt their daily lives and impact their sleep schedule, which may already be impeded by psychological stressors.2 Things like financial problems, poor relationships, and long-term injuries can also add to mental strain.6

The Link Between Mental and Physical Health

We often speak about mental and physical health as two separate things, but they are deeply interwoven, as seen in cases of PTSD. Left untreated, the body gets stuck in “fight or flight” mode, which triggers the release of stress hormones. This makes the heart beat faster and causes the mind to pause tasks like the filing of short-term memories.7 If the brain gets stuck in this mode, it can cause physical changes like shrinking of the memory center.7

There are three lenses we want to focus on regarding mental and physical health: sleep, strength, and stigma.

SLEEP

Sleep is a major component to both mental and physical health. As previously established, first responders are prone to poor sleep schedules for a variety of reasons.

Sleep is tied to overall wellness, disease prevention, and mental health maintenance. The lack of quality sleep increases poor decision making and limits cognitive capacity, both of which can be critical as a first responder.5

There is already pressure on first responders to make quick, informed decisions. Adding in fatigue lowers the chance of positive outcomes, which may already be tenuous. While the solution is not as easy as saying ‘just sleep more,’ it is vital to take whatever steps are possible to ensure maximum restfulness.

STRENGTH

Strength is not just physical, though it is a good place to start. There are a lot of expectations laid on the shoulders of first responders. Good physical fitness is often considered a given, but that is not always the case. Depending on his/her specific role and the resources offered by the organization, a first responder might find it challenging to maintain a physically active lifestyle.

There are a variety of reasons physical health might be impacted. Desk or driving-based jobs are more sedentary; on-call work makes healthy eating difficult; injuries on the job may make exercise a challenge (and can take a toll on mental wellbeing).

The impact of poor physical health can affect mental health just as mental can impact physical. According to the CDC, physical activity can improve brain health by keeping judgment skills sharp, reducing risk of depression and anxiety, and aiding in sleep9—all things that would benefit first responders.

STIGMA

Throughout history, there has been an expectation that individuals signing up for first responder work are mentally prepared for what the job entails and do not need support.8 This persistent culture of strength within first responder spaces can lead to difficulties seeking help, which only adds to mental strain that compounds over time.5

While first responders are often resilient—can problem solve under pressure, can recognize a need for support, can apply humor, can harness feelings of hope for the future—they face so many mental burdens that even these safety nets can break.8 Without these protections, burnout and other mental illnesses can develop and cause things job dissatisfaction and depersonalization from events connected to trauma on top of the other known symptoms.8

Mental health struggles overall can impact decision making, jeopardize safety, and strain relationships, and 70% of first responders have said they do not believe their mental health needs are being met.6 When there is no mental health management, maladaptive coping behaviors like social withdrawal, avoidance, and passive-aggression may form.6 Substance abuse and aggression can follow if let unchecked.

Because of the toll taken on first responders throughout their careers, once mentally and physically healthy people are more likely to have heart attacks, more often face mental health challenges, and have lower life expectancy compared to the general populace.

Actionable Steps

There are preventative measures against PTSD and other stress-related illnesses. These include but are not limited to: creating a support network in and outside of work, taking stock of your own feelings to prevent burnout, and going to therapy even before you think you need to.

While it is wise to take precautionary steps, there are strategies you can apply to help cope after you have realized a need.

Maintain a schedule outside of work: this doesn’t have to be rigorous, but routines can help keep you manage stress, get better sleep, eat better, and stay active.3

Try daily activities like walks, yoga, journaling, knitting, crosswords, or whatever makes you feel at ease.1

Create and reinforce boundaries: take time for yourself and don’t be afraid to say no to plans or to take time off work if you need to.

Make social-media boundaries, too. There is a lot of negativity online and spending too long doom-scrolling doesn’t help your state of mind.
This includes separation from work. As much as is possible, don’t take work home with you. Sometimes, the memories follow you, but that is when you must try to implement some of these other tools.

Open dialogue with someone you trust: whether it is a therapist, a family member, a friend or, ideally, all of the above, find someone to talk to who has your best interests in mind.

Time with family can already be sparse as a first responder. Let them in. If you worry about overloading them with your feelings or trauma, find a professional.

Take nutrition seriously: we have already mentioned the difficulties there are in maintaining a regular, healthy meal schedule when on the job. Remember to drink water, eat well when you can, and limit things like alcohol.

When you have time, try meal and snack planning. Even food on-the-go can be good for you.

Don’t be too hard on yourself about the days you can’t eat well. You do yourself no favors by letting guilt take over.

Conclusion

In order for a first responder to be at their best in their professional and in personal life, it is essential to take care of both physical and mental health needs. Physical activity, healthy eating, and open communication are all positive steps to aid in mitigating some of the more damaging risks.

Changing the cultural mindset on mental health may be a challenge, but if done on a smaller scale, it may help first responders tackle other challenges that could aid in mental and physical strength.

Mental Health Resources for First Responders

First Responder Crisis Text Line: 24/7 support for first responders in a mental health crisis. Text “BADGE” to 741741.
Frontline Helpline: Support for first responders and their family members affected by traumatic experiences, staffed by former first responders. Call 866-676-7500.
National Crisis & Suicide Prevention Lifeline: A network of crisis centers that provide emotional 24/7 support to anyone experiencing emotional distress or in a suicidal crisis. Text or call 988.
Code Green Campaign: Mental health resource and advocacy organization for first responders. Visit codegreencampain.org.
Responder Strong: Online source for first responders and loved ones offering educational resources, professional help, and self-help tools. Visit responderstrong.org.
First H.E.L.P.: Online community connecting families and loved ones of a first responder lost to suicide. Visit 1sthelp.org.
First Responders Foundation: Supports the emotional well-being of first responders and their spouses by providing online support through groups and workshops. Visit firstrespondersfoundation.org.
First Responders Children’s Foundation: Provides financial support to both children who have lost a parent in the line of duty and families enduring significant financial hardships due to tragic circumstances. Visit 1strcf.org.
Puppies Behind Bars: Trains inmates to raise service dogs for wounded war Veterans and first responders, and detection canines for law enforcement. Visit puppiesbehindbars.com.
Disaster Responder Assets Network (DRAN): Free resources and access to peer support group meetings via Zoom for first responders and health care professionals. Call 707-200-3765.
CopLine: 24/7 support for police officers and their family members, and is answered by retired police officers who are trained in crisis intervention. Call 800-267-5463 or visit copline.org.
SafeCall: 24/7 crisis line for first responders. Call 206-459-3020 or visit safecallnow.org.