By Megan Poff, NRP
You are at the station completing your morning duties when the tones for the first call of the day echo through the halls. Your department is paged to a familiar address for a suicidal subject. It doesn’t make any sense: Your crew was just there last night for a shift BBQ.
Your mind racing, you arrive on scene and enter the front door. This isn’t some stranger facing a crisis—this is one of your own. It is the person you conquered paramedic school with, the one who plays with your kids at the company picnics, your best friend and partner.
“This Is What You Signed Up For”
Over the past few years, first responder mental health has become a hot topic. With the struggles faced during COVID-19, there is a new focus on first-responder mental health and the overall well-being of those on the front lines.
There is a new generation of providers entering the workforce who bring new perspectives and a different understanding regarding the importance of mental health. The “newbies” are often met with a stigma that has been prevalent for generations.
You may think “this is what you signed up for.” It isn’t. As first responders, we are often the last to admit that we are worn down, burned out, and quite frankly, exhausted.
Every department, large or small, would benefit from a mental health program that would enable its members to have longer, healthier careers.
“The average career span for a paramedic in the United States is 6.5 years with an average suicide contemplation and attempt rate at 10 times the national average.”1 Overall, first responder suicidal ideations are increasing with “50% having suicidal thoughts and 16% having at least one attempt.”2, 3
Rural departments often rely on minimal staff or a volunteer force to fill their rosters. For these departments, much of the call volume is friends, family, or neighbors.
This alone can create heightened levels of stress and the likelihood of sustaining long-lasting effects of traumatic exposure, leading to post-traumatic stress disorder (PTSD).
Trauma, stress and burnout can erode the very foundation of these organizations, jeopardizing the safety of both responders and the communities they serve. When your department depends on 10 members, every person counts.
Losing anyone is detrimental and to attempt to hire a replacement can be nearly impossible. With lower wages in rural areas, qualified applicants flock to bigger cities, leaving the rural departments struggling to find help. They must rely heavily on local talent.
The stigma surrounding mental health in EMS continues to persist. Most people are concerned participation in mental health programs will bring ridicule, unwanted attention, or make them seem unfit for duty even if the concern is baseless.
This must change. And that change can start at any level in the organization. Negative talk about mental health—at any level within an organization—perpetuates a toxic culture. Sometimes, breaking the stigma proves more challenging than keeping it going.
“That’s Why We Cope with Dark Humor and Whiskey.”
Sound familiar? Depending on the organization, you may face attitudes 30 years in the making. Education and open dialogue are the cornerstones of this endeavor.
By fostering an environment where departments encourage and support discussions about mental well-being, rural agencies can begin to dismantle the barriers that prevent individuals from seeking help.
A mental health program tailored to the unique challenges faced by first responder agencies is not only essential but feasible, even on a tight budget. It takes only one person who is passionate about their career field, their department, and who cares about the people around them to start a movement.
When thinking about why most of us choose this as a career, it comes down to all of us wanting to help others. Here is how we help ourselves.
Your Department’s Needs
No one knows your department as well as you do. Rural first-responder agencies often operate with limited resources, in terms of both personnel and finances.
Despite the challenging terrain, addressing mental health needs is not a luxury. It’s a necessity.
If what you’re doing now is not meeting your department’s needs, it’s time to have some hard conversations. To establish any type of new program or develop an existing one, talk with your colleagues, your supervisors, and your bosses to learn what your department truly needs.
Do you already have something in place that people aren’t using? Why not? And if you don’t have a program in place, is there a reason why?
When you’re building a new program, you must do some planning first. Establish a blueprint of what you would like to see from your new program.
Ask for feedback. Approach leadership with your plan for how to build a team, rather than simply sharing the idea of starting one.
Steps for Getting Started
- Decide the type of program you want. What would benefit your organization the most? A peer support team? A critical incident stress debrief team? A resiliency advocate? Some combination of all of these?
- Talk to your crew members and get their buy-in.
- Do your research. You can find several free trainings for first responders who want to start peer support teams. For example, in the state of Missouri, Warriors Rest offers free critical incident stress management and peer support training to first responders. Your state may have something similar.
- Map it out. Like a blueprint for a house, your presentation to the leadership team must include not only the idea, but a plan for how to make it work.
- Create a policy. General policies and guidelines for peer support and resilience programs already exist. A quick Google search or AI-assisted platform can come in handy. Create them to fit your department. You don’t have to reinvent the wheel to make it your own! Consider the following categories:
- Mission and purpose.
- Team description.
- Program goals.
- Program limitations.
- Confidentiality statement.
- Social media.
- Team composition.
- Team recruitment and retention.
- How to access the team.
- Training requirements.
- Application for the team.
- Criteria for dismissal.
Confidentiality Is Key
Your department isn’t going to access peer support if they don’t think they have confidentiality. The only reason confidentiality should be broken is if there is a direct threat or reason to believe that the employee is a risk to themselves or others.
In these rare instances, this information shall only be shared with those who intimately need to know, such as the shift leader or supervisor. Information divulged in any mental health support capacity should never be shared on any online platform, or between peers, family members or friends.
Breaking Ground
Leadership buy-in is a crucial element of any mental health initiative’s success. And this is about more than just buy-in. It’s about a real belief that a mental health support team will benefit the organization.
Highlighting the benefits of such programs, including improved morale, retention rates, and overall performance, can sway even the most skeptical leaders. And demonstrating the cost effectiveness of preventive measures compared to the long-term costs of untreated mental health issues can further bolster support from decision makers.
If your department is still on the fence, you can market peer support teams, mental health, and resiliency support as an added benefit to applicants. This may set your department apart from competitors.
You may meet resistance. In these cases, it’s worth gently reinforcing the point that taking better care of current employees is more cost effective than finding new ones. (And that’s IF you can even find someone to replace them!)
Stress the importance of keeping your crew mates healthy; the higher the morale and employee satisfaction, the more qualified applicants your department will receive.
Picking Budget-Friendly Finishes
Now comes the heart of the program—implementing budget-friendly options that promote peer support, fitness and overall wellness:
1. Peer Support Programs
Establish peer support networks within the agency, where responders can confide in and support each other. This training can be found online through the National Association of Emergency Medical Technicians, or through outside agencies.
Most states have resources, grants and funds available to support mental health training. If you truly can’t find something within your state, there is no reason that someone passionate—you, perhaps—couldn’t put together a training to present to your peers.
If you can find or provide training in active listening, empathy and de-escalation techniques to enhance peer support capabilities, you’ll be well on your way to building a successful program.
2. Health and Fitness
Exercise and diet are the two most effective preventative measures to manage stress, minimize chronic health issues and build resilience. Within your department, how can you help boost this? Could you start a running or hiking group? Could you encourage healthier snacks at meetings?
While you may experience resistance, keep in mind that education is your best resource. We have all had the experience of running on Red Bull and a prayer at 2 a.m. while we’re four charts down and the pager continues buzzing. Learning how to prioritize our own health to serve our communities and extend our careers is essential.
3. Overall Wellness
In addition to fitness and health, taking care of your mind is vital. How many nights have you stared at the clock, unable to sleep? If this is you or maybe someone in your department, try some of the common and effective mindfulness techniques in your trainings.
These can often help with intermittent sleep deficiencies. And while they will also help build resilience and allow for a better recovery from traumatic events, they will not serve as a substitute cure for chronic symptoms of PTSD.
Incorporate holistic practices such as mindfulness, meditation and relaxation techniques into your daily routine.
4. Know Your Resources
Most employers offer the assistance of an Employee Assistance Program but often it isn’t tailored to first responders. The National Volunteer Fire Council has compiled a list of mental health providers nationwide that work specifically with first responders and their mental health.4
Reach out to the providers in your area so you can consider whether they would be a good fit, should you need to refer someone to an outside counselor, therapist or psychiatrist.
5. Department Size and Budget
The beauty of these initiatives lies in their adaptability to departments of any size and budget. Whether it’s a small volunteer fire department or a larger sheriff’s office, the principles don’t change.
Leveraging existing resources, tapping into community partnerships, and prioritizing creativity over extravagance ar critical elements of making mental health programs sustainable and scalable.
You can build a peer support program at virtually no cost. Or perhaps you have a budget to accommodate a more in-depth program.
Stronger for the Future
The house that trauma built can become a sanctuary of resilience and well-being with the right tools and mindset.
By prioritizing mental health, rural first responder agencies can strengthen their foundations, ensuring the safety and security of responders as well as the communities they serve.
With peer support, fitness, and overall wellness at its core, this blueprint offers a path forward—one that is inclusive, sustainable, and, above all, compassionate.
About the Author
Megan Poff is a Wyoming-born paramedic practicing in Belton and Harrisonville, Missouri. She is passionate about advocating first responder wellbeing, mental health and resilience.
References
1. American Military University. (2024, May 8). 5 tips for starting and sustaining a career in Ems. EMS1. https://www.ems1.com/ems-products/education/articles/5-tips-for-starting-and-sustaining-a-career-in-ems-DeHbYBWdgEv35skq/
2. First Responders – The Columbia Lighthouse Project. Home of the Columbia-Suicide Severity Rating Scale (C-SSRS). (2024, April 5). https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/first-responders/#:~:text=A%20national%20Florida%20State%20University,and%206.6%25%20had%20attempted%20it
3. Psychologically Healthy Fire Departments: Directory of Behavioral Health Professionals. https://www.nvfc.org/provider-directory/
4. Glenn, PsyD, LCSW, CCTP, T. (2021). Two: Establish. In I’ve Got Your 6 (pp. 9–9). essay, Rising Phoenix Press.
