When first responders arrive on the scene of an incident, their first job is to remain calm and in control of the situation, putting their emotions aside to focus on saving lives. But what happens afterwards? This stress of handling critical incidents — sometimes more than one in a single day — and the cumulative effect of working in emergency services can have a profound effect on one’s mental health.
In fact, according to one survey of EMS providers, mental health is a significant concern — but not one that’s always talked about. The survey indicated that 37 percent of the respondents had considered suicide, a rate that’s about 33 percent higher than the average population. Suicide attempts were also more common, at 6.6 percent of first responders as opposed to .05 percent of the general public. Rates of anxiety and depression were also considerably higher.
Some of the issue stems from the fact that working in EMS is inherently stressful. While all responders can point to specific incidents that had a profound effect on their mental state, the job itself is considerably more stressful on an average day than most. EMS personnel learn to expect the unexpected, but the long hours, concerns about personal safety, compassion fatigue, and other factors can lead to higher levels of stress and other mental health issues. However, the culture of EMS has also been an issue when it comes to mental health. Until recently, the prevailing culture has been one that accepts stress as part of the job. This has meant not only a lack of mental health resources for responders, but also a reluctance to take advantage of them. Many first responders feel that asking for help and seeking mental health services is a sign of weakness, and that they shouldn’t be working in the field.
The tide is shifting though. As society’s view of mental illnesses like anxiety and depression is progressing, and understanding of the role of mental health in every aspect of life increases, EMS agencies and leadership are putting a greater priority on protecting and supporting the mental health of their teams.
Creating a New Culture
Research shows that first responders working in a culture that encourages individuals to seek help — and makes help available — are significantly less likely to consider suicide than those who work in a less supportive culture. But how can EMS managers create a culture that is supportive of mental health?
EMS administration education and training has begun incorporating more aspects of mental health management. Among the strategies that agencies are incorporating include:
- Improved training. Both individuals and teams are receiving additional training in the identification and management of stress and related issues. First responders are learning more strategies for self-care and stress reduction, and signs to watch for that indicate a need for additional help.
- Increased debriefing sessions. Debriefing sessions after critical incidents have long been a part of EMS protocol. However, research indicates that mandatory debriefings, or sessions held too soon after incidents, can actually exacerbate stress. Many agencies are changing procedures, and incorporating more information about the availability of mental health services into these debriefings.
- Increased teamwork. A culture of mental health is one in which all of the team members are committed to each other, and willing to reach out when someone else needs help. Some agencies are offering training for responders to help them understand when to reach out to others and how to go about doing so. This culture change also means removing the stigma associated with asking for help.
- Encouraging accountability partners. Accountability partners are used in many fields to give individuals a sounding board and a place to get help and support when needed. Partnering with someone else who is going through similar experiences gives first responders someone to lean on and talk about their feelings — and who will feel comfortable recommending help when necessary.
- Increased availability of resources. EMS agencies are steadily increasing the availability of resources. Although only about half of agencies offer some type of mental health services, the number of agencies developing programs is increasing. And while Employee Assistance Programs (EAP) are by far the most common type of mental health services, many agencies are expanding the types of services offered, including critical incident counseling, peer support programs, mental health awareness training, crisis hotlines, resiliency training and more.
Despite these changes, there is still work to do. For instance, some EMS providers report that simply seeking help from EAP will trigger a competency review, which could lead to dismissal. Others note that they fear that seeking services will be reflected in their personnel record, and affect their eligibility for future opportunities. Privacy regulations and changes in the perception of mental health can help prevent these problems, along with a greater understanding of the fact that when first responders experience stress, it’s simply a matter of being human — and the better equipped responders are emotionally, the better prepared they will be for handling incidents.
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