Workers in helping professions often care for people who are in crisis and have to deal with the secondary trauma resulting from addressing those situations. Their work can put their own mental health at risk.
“I do advocate for emotional wellbeing for anyone and everyone, but really focus on people who do have careers working on the frontline, especially first responders. They almost need it at a completely different level,” said Melissa Nytko, MSW, LCSW, who is a Certified First Responder Counselor and owns Calm Connections Therapy, LLC, in the Greater Chicago area.
While social workers operate under different conditions, Nytko includes them when she talks about first responders because they often work in child welfare and with crisis hotlines to address people’s problems. She said the same goes for educators.
“Even though their work looks different than a police officer or a paramedic, firefighter and so forth, they are still really on the frontlines as well,” she said. “They’re in classrooms, especially post-COVID. They’re experiencing disinterest. They’re experiencing high parental engagement and high parental disengagement as well as a lot of community negativity. They have a hard job, too.”
Resources and organizations are available to help first responders and those close to them recognize and manage their emotional wellbeing and address their mental health care.
How to Support First Responders and Their Mental Health
The toll of a pandemic on top of other crisis situations can affect the mental health of first responders and health care workers especially, but the pressures of the job don’t go away when a pandemic subsides. First responders’ emotional wellbeing is critical for their communities as well as their circle of loved ones, friends and colleagues.
Physiological warning signs of stress should be monitored. The Substance Abuse and Mental Health Services Administration (SAMHSA) describes too much or too little sleep, loss of appetite or intrusive thoughts of self-harm as indicators of mental health problems.
Prevention can be important for workers on the front lines of crisis situations. Nytko highlighted practices to safeguard first responders:
Mental Health Action Plan for First Responders
Learn how to say no or not right now. Understand that it is OK to take time off.
Schedule regular daily activity.
Walking and other kinds of consistent physical activity provide a break from job stress.
Limit social media.
Negative coverage and discussions are not helpful to people prone to depression, anxiety or PTSD.
Be mindful about nutrition.
Drink water and be intentional about what you are putting in your body.
Do something you enjoy.
Give yourself something you look forward to outside of the regular work routine.
Spending time on activities or projects outside of work can reduce anxiety and stress. “What do you love doing?” Nytko said. “Don’t let that fall to the wayside.”
Coping Tips for First Responders Who Experience Trauma
Because first responders’ work can involve challenging emergencies such as domestic violence or natural disasters, they may witness trauma or experience secondary trauma from treating victims.
There is no single coping tactic that will work for everyone. While a professional counselor or therapist can help first responders in this area, Nytko shared techniques to use:
Trauma-Informed Coping Strategies for First Responders
Talk to someone.
Find that person you trust and tell them how you’re feeling. Even if they don’t have answers, their attention will be helpful.
Find a distraction.
Listen to music that relaxes you, work on crossword puzzles, paint a portrait or knit a scarf.
Start with short breathing exercises to prepare for a work shift and then end the day with the same to decompress.
Mindfulness helps to put some distance between work and everything else, Nytko said. “That clears away all the things that happened in the past and things they’re worried about in the future.”
How Employers Can Support First Responders
Employers can make a positive impact when they acknowledge that first responders work in situations where their health and emotions are put to the test.
Because tensions typically run high during emergencies, people can get distraught, angry or even combative as first responders arrive to address the situation. Police, firefighters or paramedics are dealing with others’ heightened emotions while doing their jobs responding to a train derailment, car accident, building fire or medical emergency at someone’s home.
“They’re dealing with very unhappy people,” Nytko said. “They’re dealing with social media and society where there’s still a lot of negative messaging that comes from being the first people to head off whatever is going on. They have thankless jobs.”
By prioritizing and normalizing mental health care, employers can let their first responders know that they understand the challenges of the job. “Create a culture and climate that supports mental health awareness, that empathizes and understands what it feels like to have post-traumatic stress,” Nytko said.
She provided specific considerations for employers:
How to Build a Work Culture That Supports Mental Health
Hold debriefing sessions after traumatic events.
This allows first responders to talk about what happened and share their experiences.
Start peer-to-peer support programs.
Train first responders to support co-workers during a mental health crisis and be available to assist them in getting professional help.
Have a flexible return-to-work policy.
When a first responder has taken time off for mental health treatment, be supportive of their needs as they transition back to the job.
Because people are different and may want to address their emotional wellbeing in different ways, employee surveys can be helpful in determining what types of support to offer. She suggested employers seek organizations or contractors that can do in-house training in the areas of compassion fatigue, secondary trauma, burnout prevention and PTSD. Like surveys, candid and open discussions can create a work environment that embraces mental health care, whereas avoiding the subject can make it taboo, Nytko said.
How Family and Friends Can Support First Responders’ Mental Health
Loved ones can help first responders deal with PTSD and look after their emotional wellbeing by being proactive.
They can initiate conversations about mental health to discourage stigma around the subject. “I really truly believe it comes from somebody bringing it up, because otherwise it becomes the elephant in the room where people just don’t talk about it and they just sort of pacify everybody,” Nytko said.
She suggested techniques to support first responders:
Reflect back what you observe.
If the first responder is acting erratically, not sleeping or not eating, gently bring this up. Similarly, if they are responding well to therapy, let them know that.
Listen to them.
Provide an opportunity for the first responder to talk about what happened at work and share their feelings. Even if you don’t have an answer to their problems, just listen.
If you are hearing your first responder describe traumatic events and aren’t trained to deal with that, you need to find what works for your own self-care to prevent vicarious trauma.
Assist in finding professional help.
Many programs, whether one-on-one counseling or group support, are available with information about compassion fatigue, secondary trauma and burnout prevention. Have information ready.
Many professional clinicians and groups are ready to support the mental health of first responders, Nytko said.
“I encourage organizations and leaders of organizations to be creative and look for resources. The internet is just a finger type away to find people that are willing to come out and do that.”
40 Resources to Help Support First Responders’ Mental Health and Emotional Wellbeing
From hotlines to peer support, here are some of the places where first responders and their families can get assistance. Use the links below to navigate to different sections of this article.
Talk and Text Hotlines
Copline: 24-hour hotline for law enforcement only answered by retired officers trained to be peer listeners and provide support for law enforcement officers and their families at 800-267-5463.
Crisis Text Line: 24/7 counseling support for first responders who are struggling with a mental health crisis and who text “BADGE” to 741741.
Frontline Helpline: staff of former first responders who offer support for first responders and their family members affected by their traumatic experiences at 866-676-7500.
National Suicide Prevention Lifeline: network of local crisis centers that provides emotional support to anyone in suicidal crisis or emotional distress 24/7 at 800-273-8255.
SAMHSA Disaster Distress Helpline: those experiencing emotional distress related to natural or human-caused disasters can call or text the 24/7, 365-day-a-year support line at 800-985-5990.
Calm: strategies, activities and other assistance with sleep, meditation and relaxation to improve emotional fitness.
Headspace: library and tools for better sleep, relaxing music, mindfulness exercises and other tension-releasing workouts.
Heroes Health Initiative: tool for healthcare workers and first responders to track their mental health and access helpful resources.
Mindshift CBT: science-based strategies to help you learn to relax and be mindful, develop more effective ways of thinking and manage anxiety.
PTSD Coach: tools for screening and tracking your symptoms, strategies for coping and direct links to support and help.
Addressing Suicide Among First Responders: How Colleagues, Friends, and Family Can Help, Counseling@Northwestern: suggestions for what to do about the serious mental health issues first responders can face.
America’s First Responders’ Struggle With PTSD and Depression, EMS1: list of PTSD symptoms and warning about asking questions that can be triggering.
EMS Resilience: Depression, PTSD and Suicide Prevention, EMS1: effects of the association between resilience and mental health.
Fire Departments Step Up Their Mental Health Game, American Psychological Association: initiatives that embrace peer support programs.
Putting First Responders’ Mental Health on the Front Lines, Counseling Today: understanding first responders’ unique counseling needs.
Trauma and First Responders: When the Helpers Need Help, Psychology Today: importance of addressing PTSD and the stigma of getting help.
First Responder Resilience: Caring for Public Servants, by Tania Glenn: guidance from a licensed clinician who helps first responders deal with burnout, PTSD and other mental health problems.
Treating PTSD in First Responders: A Guide for Serving Those Who Serve, by Richard A. Bryant: publication that examines PTSD in first responders and the complicating factors, which include organizational stressors.
Factsheets, Guides and Toolkits
Emergency Responders: Tips for Taking Care of Yourself, Centers for Disease Control and Prevention (CDC): strategies for coping before, during and after working during crisis situations.
First Responder Mental Health and Wellness, KaiserPermanente.org: advice for employers on how to address mental health and first responders.
First Responders: Behavioral Health Concerns, Emergency Response, and Trauma, SAMHSA (PDF, 269 KB): report on the behavioral health risks and intervention needs of police and firefighters.
First Responders Trauma and Suicide, Centre for Suicide Prevention: ways to recognize, prevent and address PTSD with a specific example of peer support in action.
Mental Health Fact Sheet – First Responders, Veterans Affairs (PDF, 1 MB): list of places that support first responders with meals, yoga therapy, comfort dogs and other needs.
Suicide Prevention for Healthcare Professionals, American Foundation for Suicide Prevention: hub for information on an online interactive screening program, including crisis help and support after a suicide loss.
Supporting Mental Health in First Responders: Recommended Practices, BCFirstRespondersMentalHealth (PDF, 202 KB): workplace campaigns and strategies for education, intervention and treatment to address mental health.
The Vicarious Trauma Toolkit, Office of Justice Programs, Department of Justice: Tools and resources for first responders, those in the fields of victim services and other allied professionals.
Organizations and Websites
911 Buddy Check Project: peer support and coaching services for police, firefighters, EMS and emergency dispatchers.
Behavioral Health – First Responder Center for Excellence: curated videos, articles and presentations to help improve the physical and psychological health of first responders.
The Code Green Campaign: organization that works to educate first responders on self care, peer care and advocate for systemic change in how mental health issues are addressed by their agencies.
COVID-19 – Frontline Workers, Mental Health America (MHA): online mental health screening and information on coping strategies to address stress and anxiety to prevent burnout.
Crisis Support Resources for Emergency Responders, Disaster Responder Assets Network (DRAN): one-stop shop listing organizations and crisis lines for first responders and health care workers.
Firefighter Behavioral Health Alliance: organization that offers behavioral health workshops to fire departments, EMS and dispatch organizations, focusing on behavioral health awareness with a strong emphasis on suicide prevention.
First Responder Support Network: collaboration of emergency service peers and family members, mental health clinicians, and chaplains who volunteer to offer intensive retreats and ongoing support.
Frontline Professionals, National Alliance on Mental Illness (NAMI): hub for information on professional support, peer support, techniques to build resilience and how to help family members.
Mental Health First Aid for Fire and EMS, National Council for Mental Wellbeing: program focuses on the unique experiences and needs of firefighters and EMS personnel.
Mental Health Resources, Infectious Diseases Society of America (IDSA): guidance to material on how to support the mental health of clinicians and other health care workers.
Project Healing Heroes: resiliency training and advice to help individuals and their families heal from the invisible wounds of trauma.
ResponderStrong: curated information on responder-informed crisis and clinical services, educational content and tools for responders, families, leaders and the clinicians who work with them.
Share the Load Program: effort to make available resources for first responders who need help managing and overcoming personal and work-related problems, including behavioral health issues.
Survive First: organization that helps first responders and their families navigate mental health challenges and reduce first responder suicide.
Last updated in January 2022