Mental health problems affecting first responders: an overview

By Cristiano Antonino On Jun 22, 2022

Mental Health Issues Affecting First Responders: Examining The Uniques Challenges Faced By Police Officers, Firefighters, Paramedics, EMTs, And Other First Responders

We take it for granted that if we ever find ourselves in a dire emergency, we can pick up the phone, dial 911, and be rescued from whatever our crisis may be.

And it’s true – whether faced with a fire, a car accident, a medical emergency, or fear of a violent attack, someone will be on that phone asking us for information and offering us guidance within moments, if not seconds.

Very shortly after that, one or more first responders will appear in order to assess the situation and facilitate whatever action is necessary to make us safe again.

First responders are the first people to assist at the scenes of emergencies.

They include police officers, firefighters, EMTs, rescuers, deputy sheriffs, volunteer first responders, and, yes, 911 operators as well.

They are the first to arrive at what is quite often the absolute worst day of someone’s life.

And they do this day in and day out, year after year.

Naturally, this is going to take a toll on one’s mental health. How could it not?

Facts And Statistics

Depression, substance use disorder (SUD), post-traumatic stress disorder (PTSD), and suicidal ideation are more common amongst first responders than in the general population.

Police Officers And Firefighters Are More Likely To Die Of Suicide Than In The Line Of Duty
85% Of First Responders Have Experienced Mental Health Issues
Depression And PTSD Are 5 Times More Common In First Responders
35% Of Police Officers Experience PTSD
18-24% Of 911 Operators And Dispatchers Experience PTSD

All of this, and yet there is still stigma attached to those who may be in need of help or support:

7 In 10 Say Mental Health Services Are Seldom, If Ever, Utilized
57% Fear Negative Repercussions For Seeking Help
40% Fear Being Demoted Or Fired

First responders repeatedly face unthinkable tragedy, yet since it is their chosen profession, there is an inherent culture of not asking for help when a person is struggling to come to grips with it all.

Each of their peers is experiencing the same things, and the mentality is that since it is their job, they should be able to just “get on with it.”

Mental health is a topic that has steadily gained traction and awareness over the past few decades, and the stigma of asking for help is declining for much of the general population.

We still have a long way to go, however, especially for people (such as veterans) with careers in which the expectation is to maintain a certain stoicism and tolerance for tragedy and pain.

Understanding, compassion, and awareness are all necessary for continuing that forward progress.

If you are a first responder yourself or feel concerned for one, here are some things to be looking out for.

Asking for help may be difficult, but doing so may save a life.

Mental Health: First Responders and Depression

The most important thing to understand about depression is that it’s not temporary sadness or moodiness, which we all experience sometimes.

Depression is a serious condition that impacts both your mental and physical health and may require treatment.

Depression affects how you think, feel, and act. It can interfere with work, relationships, and day-to-day living.

A depressed person will often lose interest in activities that used to give them pleasure.

Some symptoms of depression include:

Withdrawal From Close Family And Friends
Disruptions In Sleep Patterns; Sleeping Excessively Or Not Enough
Lack Of Energy; Even Basic Tasks Seem Overwhelming
Difficulty Concentrating, Making Decisions, Or Completing Tasks
Unexplained Physical Problems, Such As Headaches Or Back Pain
Reduced Appetite And Weight Loss, Or Increased Food Cravings And Weight Gain
Excessive Or Increasing Consumption Of Alcohol Or Other Substances
Recurring Thoughts Of Death Or Suicide

This is not an exhaustive list, nor does everyone with depression experience all these symptoms.

If you or someone you care for have been living with 3 or more of these symptoms daily for two weeks or more, it may be time to reach out for help.

First responders are in the unique position of always being the ones people reach out to in times of crisis.

They repeatedly witness terrible tragedies but may feel that their own feelings of grief or loss aren’t “justified” since they chose to be in the helping field.

This is simply not true. Just because something terrible isn’t happening directly to you doesn’t mean you won’t be affected by it.

And when a person faces crisis after crisis and doesn’t have access to the proper means of processing those crises, it is only natural that emotional distress and eventually depression (or other mental health issues) may eventually set in.

A significant number of the mental health challenges we face result from unrecognized or unprocessed emotions – including depression.

First Responders and Substance Use Disorder

“Self-medicating” is a term used for people who turn to alcohol or other drugs in order to cope with feelings and emotions that are too confusing, intense, or painful to come to face head-on.

Many people don’t even realize they’re doing this until they unsuccessfully attempt to cut down or they face some sort of negative consequence as a result of their self-medicating.

First-responders are more likely to self-medicate than the rest of the population.

They’re consistently faced with high-stress situations, and it is their job to remain calm, compassionate, and productive, even in the midst of the most challenging and heart-wrenching situations.

The expectation to remain calm and collected in the face of one disaster after another can become a heavy burden, and a cold beer (or two or three) at the end of a particularly difficult day can easily become a habit.

Habits can lead to dependence, and dependence can lead to substance use disorder (SUD).

People who drink for the purpose of self-medicating are much more likely to develop a dependence on their substance of choice.

Facts And Statistics

2 In 5 EMTs Engage In High-Risk Use Of Alcohol Or Drugs
25% Of Police Officers Report Drinking To “Feel Like Part Of The Team”
The Rate Of Alcohol Use Disorder In The Police Force After 4 Years Of Service Is 36%
25% Of Police Officers Have Been Negatively Affected By Co-Workers Drinking
An Estimated 10% Of All Firefighters Abuse Drugs
An Estimated 29% Of All Firefighters Abuse Alcohol
Substance Use Disorders Among First Responders With PTSD Is 20%

Alcohol is the most commonly abused substance by first responders, but marijuana has become legalized in many states and is gaining traction as a recreational drug of choice.

Many first responders become injured on the job and require pain medication for recovery, and this can become a slippery slope. People unintentionally become addicted to prescription pain medications all the time – especially people who are suffering emotional distress in their daily lives.

If you believe that you or someone you care for may be self-medicating, some things to look out for include:

Changes In Appetite And Sleep Patterns
Deterioration Of Physical Appearance And Grooming Habits
Difficulties In Relationships
Difficulty Concentrating, Making Decisions, Or Completing Tasks
Abandonment Of Enjoyable Activities In Order To Drink Or Use Drugs
Sudden Mood Swings, Increased Irritability, Angry Outbursts
Appearing Fearful, Anxious, Or Paranoid For No Apparent Reason

Asking for help with a substance use disorder may feel difficult, embarrassing, or shameful, even more so for first-responders.

Keep in mind that many people report feeling a huge sense of relief after admitting to needing help, and it may surprise you how much support and compassion you receive upon doing so.

With the right intervention and care, it is possible not only to recover from a SUD but to thrive higher than you ever believed possible.

First Responders and Post-Traumatic Stress Disorder

More than 80% of first responders are exposed to traumatic events on the job.

They are regularly involved in incredibly high-stress situations, including life-threatening injuries and death.

Approximately 1 in 3 first-responders develops post-traumatic stress disorder (PTSD) in the course of their career, as opposed to 1 in 5 in the general population.

It is natural to feel fearful and troubled after a traumatic event. Fear is part of the body’s “fight-or-flight” response, and it is a safeguard from putting ourselves in further danger.

This feeling of fear will eventually pass as time goes by after the traumatizing event.

For some people, however, that fight-or-flight response lasts longer and may even worsen, and this can potentially lead to a diagnosis of PTSD.

Anyone can develop PTSD, but the more tragedy and trauma someone faces, the more likely they are to do so.

This is why first-responders have such a higher risk of eventually developing PTSD.

Symptoms of PTSD may include but are not limited to:

Flashbacks, Or Reliving The Event Over And Over, Which May Be Accompanied By Physical Symptoms Such As A Racing Heart.
Recurring Nightmares Or Memories Of The Event
Avoiding Places, Events, Or Objects That Trigger Memories Of The Event
Difficulty Concentrating, Making Decisions, Or Completing Tasks
Being Easily Startled Or Jumpy
Difficulty Falling Asleep Or Staying Asleep
Feeling Irritable Or Angry; Having Aggressive Outbursts
Taking On A Negative View Of Oneself And/Or The World
Distorted Thoughts About The Event; Taking On Guilt Or Blame Or Shame That Is Not Appropriately Yours To Take On
Becoming Socially Isolated
Finding It Difficult Or Impossible To Feel Positive Emotions, Such As Joy Or Satisfaction

Treatment for PTSD may involve talk therapy, medication, or both.

Many people who have PTSD also struggle with other issues, such as substance abuse or depression and anxiety.

It is important to seek out professional care in order to get the best treatment possible.

For a person exposed to multiple traumas, such as a first-responder, it is really important to develop a consistent self-care routine in order to keep track of feelings and emotions as they come up.

Self-care often includes therapy or other mental health treatment modalities.

First Responders and Suicidal Ideation

Both law enforcement officers and firefighters are more likely to die by suicide than in the line of duty.

EMS providers are 1.39 times more likely to die by suicide than the general public.

Many first-responders consider stress to be “part of the job,” which likely contributes to these high numbers since these workers don’t feel comfortable (or safe) reaching out for the help that they need when they’re struggling with their mental health.

Suicide is not a stand-alone event; it is usually preceded by a mental disorder such as depression or PTSD.

Because first-responders experience these disorders at such a disproportionate rate to the general public, it makes sense that their suicide rates would be higher as well.

Facts And Statistics

25% Of First Responders Are At High Risk For Suicide
37% Of EMS Providers Have Contemplated Suicide
6.6% Of EMS Providers Have Made A Suicide Attempt
Between 125-300 Police Officers Commit Suicide Each Year (These Numbers Are Underreported)
46% Of Firefighters Have Contemplated Suicide
15.5% Of Firefighters Have Attempted Suicide

Fear of repercussion prevents many first responders from seeking out treatment for their mental health

The longer they go without the proper prevention and support, the higher the likelihood that suicide will start to feel like a viable option.

Sadly, fear of repercussion may be perfectly legitimate.

Mental health is a requirement for being a first responder, and people have, in fact, lost their weapons status or been remanded to “desk duty” after seeking out help for mental health challenges.

If you or someone you care for are a first responder and you feel concerned about your own or their mental health, some signs to be on the lookout for include:

Ongoing Feelings Of Anxiety Or Depression
Feelings Of Despair About Life
Inability To Concentrate Or Make Decisions
Increased Alcohol Or Other Substance Consumption
Incidents Or Thoughts Of Self-Harm

Fortunately, the increasing awareness of mental health struggles is starting to make its way to our first-responders.

There is more compassion and understanding than there used to be. If you or a loved one are struggling, please reach out for help as soon as possible.

Your struggles are not a sign of weakness or failure.

They are a sign of being human.

There is help and support out there for you, and you deserve to feel strong and healthy (mentally, emotionally, and physically) no matter what your chosen career may be.

Just because you chose a helping profession doesn’t mean you aren’t deserving of a bit of help yourself.

Asking for Help as a First Responder

When you’re in a high-stress job, it is easy to minimize or even disregard the toll that stress is taking on you, especially when you’re expected to take on those high levels of stress without batting an eye.

Keep in mind that you aren’t going to keep performing your job at peak efficiency if your mental health begins to slide, especially if you’re unaware of it and not doing anything to keep yourself healthy and safe.

Here are some things to look for that may be signs that it’s time to reach out:

Irritability and Anger. Things may start getting under your skin that you never used to, or you may find yourself snapping at friends or loved ones more often.
Anxiety, Depression, or Constant Sadness. If the bad days outweigh the good days, or you’re finding it difficult to feel joy or pleasure, it may be time to reach out.
Reliving Traumatic Events. Re-experiencing trauma and replaying traumatic events in your mind over and over again is a sign of PTSD. If you are ruminating or having sudden flashes of troubling memories, please reach out for help.
New or Increased Substance Use. Starting or scaling up alcohol or drug use is often a sign that you are trying to cope with unpleasant feelings by stifling them. The sooner you get help with this, the less likely you are to face negative consequences due to your increasing usage.

Our minds and bodies are connected, and many people, especially those who must remain calm and somewhat disconnected from the stressful situations they find themselves in, will manifest emotional troubles in their physical bodies.

This can look like this:

Problems With Appetite Or Digestion
Increased And Unexplained Aches And Pains; Headaches, Stomachaches, Back Pain
Problems Performing Sexually Or Conceiving
Difficulty Remembering Things, Or A “Fuzzy Head”

There is absolutely no shame in experiencing any of these symptoms or any other symptoms that are not listed here.

It is not a sign of weakness or failure to feel the effects of an incredibly difficult job that few people could handle.

In fact, asking for help is a sign of strength, not weakness.

It means that you have the courage to make yourself a little bit vulnerable in order to fortify yourself so that you can perform your job even better, not to mention your personal and private life will become easier and more enjoyable as well.

If you do feel that your job or position may be put in jeopardy if you admit to needing help, you can do so anonymously.

The more support you have, the better off you’ll be, so do try and let your family and other loved ones help and support you if you can.

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