Emergency medical services personnel, firefighters, and police officers (“first responders”) are usually the first on the scene to face challenging, dangerous, and draining situations. They are also the first to reach out to disaster survivors and provide emotional and physical support to them. These duties are strenuous to first responders and with time put them at an increased risk of trauma. Research shows that repeated exposure to such situations, the fast-paced nature of these jobs, and institutional factors can take a toll on first responders’ health. The Substance Abuse and Mental Health Services Administration (SAMHSA) has put together a research bulletin that reviews existing literature and provides insight into behavioral health issues experienced by first responders.
It is estimated that 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population (Abbot et al., 2015).
Emergency Medical Services Personnel At Increased Risk
One of the core risk factors for first responders is the pace of their work. First responders are always on the front line facing highly stressful and risky calls. This tempo can lead to an inability to integrate work experiences. For instance, according to a study, 69 percent of EMS professionals have never had enough time to recover between traumatic events (Bentley et al., 2013). As a result, depression, stress and post-traumatic stress symptoms, suicidal ideation, and a host of other functional and relational conditions have been reported.
Police Officers At Increased Risk
Police officers are at increased risk of negative mental health consequences due to the dangerous nature of their jobs as well as the greater likelihood that they experience critical incidents, environmental hazards, and traumatic events (Heavey et al., 2015). In a study, about three-fourths of the surveyed officers reported having experienced a traumatic event, but less than half of them had told their agency about it. Additionally, about half of the officers reported personally knowing one or more law enforcement officers who changed after experiencing a traumatic event, and about half reported knowing an officer in their agency or another agency who had committed suicide (Fleischmann et al., 2016).
In law enforcement, the estimates suggest between 125 and 300 police officers die by suicide every year (Badge of Life, 2016). Another study linked strain on the job to suicidal ideation, as well as depression and anger. Officers with burnout showed significantly greater suicide risk, with a 117 percent greater likelihood of suicidal thoughts for officers who reported burnout at work (Bishopp & Boots, 2014).
Firefighters At Increased Risk
The nature of the work of firefighters, including repeated exposure to painful and provocative experiences and erratic sleep schedules, can pose significant risk to firefighters’ mental health (Stanley, Boffa, Hom, Kimbrel, & Joiner, 2017). To add to that risk, firefighters face many barriers to seeking help, including stigma and the cost of treatment. For instance, according to a study by Stanley et al., volunteer firefighters have greater structural barriers to use of mental health services (including cost, inadequate transportation, difficulty getting time off from work, and availability of resources) than career firefighters and the general population (2017).
In a study about suicidality, firefighters were reported to have higher attempt and ideation rates than the general population (Stanley et al., 2016).
Risk and Protective Factors for Behavioral Health in First Responders
The SAMHSA report lists many studies that have assessed the risk and protective factors for behavioral health issues among first responders. In general, these factors can be categorized based on time relative to the disaster—before, during, or after the event occurs.
Collateral behavioral health damage in first responders may owe to being unfit mentally or physically prior to a disaster to perform relief work, as well as inadequate training, unrealistic expectations from leadership, and arbitrary decisions or shows of favoritism (Mitchell, 2011). Another team of investigators found that life events, including personal trauma and loss prior to the disaster, were associated with increased risk of post-disaster mental health issues (Brooks et al., 2016).
To read the full report, go to https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf or download it here.
More trauma resources available on our Trauma Topic Page.
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If you live in Indiana and need help finding a behavioral health provider, visit Find Help or call (800) 284-8439.