Editor’s Note: Help is available if you or someone you know has a mental illness or is struggling emotionally. If you are suicidal or in emotional distress, please call or text the 988 Suicide & Crisis Lifeline.
There are not enough professional mental health resources geared to treat first responders. This includes those who work on the front lines and those who carry out the remainder of the healthcare provided to those who are sick or injured.
Since the beginning of organized healthcare and the inception of first responders, the attitude surrounding toward mental health care has been skewed and stigmatized. Mental health concerns such as anxiety, depression, post traumatic stress and burnout were seen as weakness on the part of the responder. This led to criticism, bullying and in many cases loss of job and even worse loss of life, suicide.
Suck It Up
One of the earliest attempts to offer mental health support to first responders through critical incident stress debriefing (CISD) teams was often shunned by responders and their management because of the persistent attitude that responders should “suck it up and move on” and that they “knew that this was what they signed up for so if they could not handle it, they needed to quit.” In fact, the earliest CISD teams were so underutilized they often fell apart and disappeared.
It wasn’t until 1989 when the International Critical Incident Stress Foundation (ICISF) was established that there was a formal body to train and govern CISD teams, as well as provide trainings surrounding responder stress suggesting that signs and symptoms of stress, anxiety and depression were not only expected, but were normal responses to the high levels of trauma and illness witnessed by responders on a daily basis. But, even with this education offered, the personification and expectation of responders to be tough and unbothered by trauma persisted. Meanwhile, burnout rates and responder suicide continued to rise.
Fast Forward to Today
Due to the national recognition of the toll stress and trauma take on responders, mainly fueled by the COVID-19 response, many states are finally taking measures to realize and respond to the mental health needs of their responders. There has been a national decline in the numbers of responders directly affecting the availability of quality response and care for the public. The problem of lack of quality mental health resources for responders persists.
Most mental health clinicians are not trained to deal with the unique trauma experienced by responders. They very often do not know how to respond to or understand the complexity of the trauma responders witness on a daily basis and are then expected to go home and interact with their families as if nothing major has happened.
Conversely, responders have a fear of seeking out mental health services because they feel as if the clinicians will not understand and won’t know how to respond. They feel that if the clinician does not have a background in, or at least specialized training in the trauma and lingo of responders, they won’t be able to help.
So, where do the helpers go for help? Very often responders attempt to rely on negative coping strategies such as alcohol or use of other substances to self-medicate in hopes of numbing or forgetting the trauma they experience. This only leads to loss of job, career, friends, family and ultimately in some cases loss if life. Response has be reactive instead of proactive with a history of negative outcomes and a lingering stigma surrounding mental health.
Help from the Government
How can states facilitate positive strategies to assist their responders? Let’s look at one state that is making positive strides toward addressing the mental health needs of, and resources for their responders.
In 2019, the Tennessee Department of Health partnered with the Tennessee Federation of Fire Chaplains to create and new broad scope statewide Disaster Mental Health/Crisis Response Team capable of providing Critical Incident Stress Management (CISM) response incorporated with mental health first aid for adults and youth, Psychological Triage and Suicide Intervention.
This team uses the CISM response model and training sanctioned by ICISF, along with additional trainings to be able to respond to any person or group in need of assistance including first responders, healthcare workers, schools, industry and the community at large. Members come from a cadre of professional backgrounds to be able to provide teams to respond to assist those with the same or similar backgrounds.
The team can provide one on one consultation or intervention, group interventions and whole community responses providing CISM diffusing’s, debriefings, mental health first aid, suicide intervention and referral to higher levels of mental health care if indicated. Team request and response is free and available around the clock.
Called to Respond
From April 1, 2019, through December 31, 2023, this team has responded to 11 major disaster deployments, 377 CISM debriefings, 67 CISM diffusing situations, 3,463 individual crisis interventions with at total of 14,262 persons served and 16,645 total team training hours recorded.
Additionally in 2023, the Tennessee Department of Health approved utilization of workforce development funds to partner with The National Council for Mental Wellbeing to train staff and community partners as mental health first aid (MHFA) Instructors who would then train all public health staff and any other requesting entities in MHFA.
A community concentration was placed on training first responders and other healthcare staff as well. The intention is to give responders and the general public the education to recognize someone may be experiencing a mental health issue or crisis and the tools to approach, assess, intervene and refer if needed.
To date this initiative has trained adult MHFA and youth MHFA instructors, resulting in staff members, responders and community members being trained to recognize and respond to mental health issues or crisis situations within their families, co-workers and the community served.
More Help
Other initiatives in Tennessee include the creation of peer support teams and curriculum for clinicians to better understand and provide a safe and comfortable environment for responders to seek professional assistance for their unique trauma experiences.
The overarching goal is to provide education and resources proactively for responders to assist one another and the public in order to implement positive coping strategies and peer support to avert crisis from occurring.
This will decrease the burden on mental health providers, decrease anxiety, depression and stress and normalize mental health care. Tennessee is eliminating the stigma around seeking care for mental health issues and is providing strategies to build resilient and career lasting responders.
