Silent Clients: Trauma’s Effects on First Responders

First responders, including paramedics, police officers and firefighters, are on the front line of tragedy and chaos. They come to save lives and help out when others cannot. But they also experience significant trauma, witness acts of violence and otherwise put themselves in danger. The impact of this stressful work is significant on both physical and mental well-being. First responders can benefit from mental health care, and addiction treatment services, but they aren’t always willing to ask for help.

First Responders and Mental Health

The work that first responders do is so important, but they often suffer poor mental health as a result. According to a University of Phoenix survey¹ of 2,000 workers, 85 percent of people working as police officers, firefighters, paramedics or nurses experienced symptoms of mental health conditions. Eighty-four percent of these workers had a traumatic experience while on the job, and 34 percent were diagnosed with a mental health condition.

A study² conducted with 200 first responders working with refugees in Europe found that 17 percent were later diagnosed with post-traumatic stress disorder (PTSD) and that 22 percent were diagnosed with depression. Additionally, 73 percent of the workers reported poor overall well-being, and 57 percent reported feeling burned out.

The consequences of mental health issues related to first responder work can be very serious. Studies have found that firefighters, for example, have very high rates of suicidal thoughts and behaviors. One study³ found that the rate of suicidal thoughts and plans among a group of firefighters was 46.8 percent and 19.2 percent. More than 15 percent of these firefighters actually attempted suicide.

The Stigma of Asking for Help

Asking for help for mental health issues and substance use disorders is challenging for many people. There is a stigma attached to addiction and a perception of weakness that makes it difficult for many first responders to ask for the help they need. According to a University of Phoenix survey¹, 39 percent of workers said that they would face negative repercussions for asking for help for mental health issues on the job. A significant proportion of first responders reported that reasons for not asking for help included:

• A fear that their supervisors would treat them differently
• Feeling that their co-workers would perceive them as weak
• Being passed over for promotions

First responders work in a culture that promotes bravery, strength and selflessness and that creates an image that workers are invincible. Admitting to having a drug or alcohol problem runs counter to this accepted culture making it difficult to reach out for help.

Trauma-Centered Care

At the heart of mental health issues for first responders is trauma. First responders see and experience traumatic events nearly every day on the job. Trauma-centered or trauma-informed care is mental health care that recognizes the prevalence and the impact of trauma on people. It focuses on the symptoms of trauma and provides care based on best practices and research-based knowledge about the experience of trauma.

According to the Substance Abuse and Mental Health Services Administration⁴, a trauma-centered approach to mental health care includes important principles: trust, safety, support from peers, collaboration, empowerment, and respect for gender and cultural issues.

Anyone, including first responders, who has experienced trauma, can benefit from a treatment program that place an emphasis on traumatic experiences and their repercussions. There are many such programs available through public health and community centers along with mental health and addiction treatment centers. Treatment strategies used in trauma-centered care include:

• Individual cognitive behavioral therapy, a one-one-one type of counseling that helps change negative thoughts and behaviors
• Eye movement desensitization and reprocessing, which uses eye movements to help clients reframe and desensitize trauma
• Exposure therapy, a PTSD treatment that forces clients to face, and therefore desensitize traumatic memories
• Dual diagnosis treatment, addressing all mental health and substance use issues and needs
• Biofeedback to help manage stress and anxiety

Peer-Centered First Responder Programs

First Responders can benefit from trauma-centered treatment, but they can further benefit from programs that are designed specifically for people in this line of work and that involve peer-to-peer support. Many treatment programs, such as the First Responder program at Transformations, offer peer-based recovery support, including group therapy with other first responder clients and treatment led by therapists who themselves are former or current first responders.

One example of a peer program is the Omaha Fire Department’s peer support program.⁵ It offers confidential counseling to help first responders overcome the fears of stigma and being treated differently. The counseling is provided by police officers and firefighters who have spent 40 or more hours in training for behavioral counseling.

Peer programs like the one in Omaha are becoming more common, as are other types of trauma-focused care especially designed to help first responders. Many treatment centers for mental health and substance use disorders now offer care that is tailored to these workers.

First responders provide invaluable services to their communities, and as a result they suffer. Tailored treatment is essential, as is breaking down the stigma that prevents them from getting it.