Superhero movies have dominated Hollywood for at least a decade. Ironically, this may be leading us to take real-life heroes for granted. First responders are the ones who run toward a crisis or disaster. They are emergency medical personnel, disaster response teams, firefighters, and more. They are the people you turn to in the worst moments of your life.
They put their bodies on the line every day. Yet, it’s more than that. First responders can face a massive emotional toll during a typical workday.
Sure, they chose their career. Yes, they are essential to every community. But we cannot underestimate the potentially traumatic conditions under which they operate. This helps to explain why depression, anxiety, and related concerns are not uncommon among these professionals.
By the Numbers
Roughly 20 percent of adults will develop a mental health condition like depression. This doesn’t include those with sub-clinical symptoms, aka folks who may not meet all the technical criteria or have the resources to be officially diagnosed, but live with depression or anxiety anyway.
For first responders, that number is 30 percent. Again, these numbers are based on reported symptoms, which many first responders will keep to themselves.
For all the danger in being a firefighter, they are at a greater risk of suicide than dying in the line of duty.
According to a 2018 SAMHSA article, reported rates of depression among various first responders including EMS professionals, emergency doctors, and disaster response teams ranged from 6.8% to over 21%.
The prevalence of reported and unreported mental health concerns among first responders makes more sense in context. The nature of this work consists of repeated exposure to experiences that activate the stress response, as well as erratic sleep schedules and competing priorities (especially for volunteer responders who may have a second job). These unpredictable schedules, coupled with internal cultural stigma and the pressure to “have it all together” compound the barriers to getting the support they may need.
On one hand, it makes sense that there would be a higher prevalence among these communities. On the other, it is one of the most insulated and stigmatized experiences. We can help turn this around by becoming aware of the signs, normalizing helping the helpers, and accommodating common barriers such as irregular schedules or lack of specialized training for therapists.
Signs of Depression in First Responders
We certainly expect first responders to be exhausted. And sure, they earn the right to get some rest. But severe fatigue can be a sign that depression is looming. Here are some other red flags to watch for:
Anger and irritability
Sleep disturbances
Losing interest in activities that once excited them
Loss of appetite
Frequent headaches
Talking about death, dying, and suicide
In addition, there’s a sign that is quite specific to first responders. Feeling guilty or hopeless may appear to be an occupational hazard. You witness plenty of nightmarish scenes. You can’t rescue everyone. Again, this may seem to come with the territory.
Read more: Survivor’s Guilt
However, there’s a difference between feeling bad and feeling depressed. A first responder struggling with depression may:
Question why they ever took the job
Blame themselves unnecessarily when a crisis scene ends badly
Lose sight of how important their work is
Struggle with existential questions in the face of ongoing suffering
This is not to say that any of the above automatically means depression is present. However, when you combine the above statistics with such individual behavior, there is cause for concern.
Supporting First Responders
Fight the Stigma
Here’s the thing. Therapy is bullshit, right? If you bring it up in most highly-stressful workplaces, that’s what you’ll hear.
Let’s bring things back to the superhero comparison. First responders may feel ashamed to admit they’re struggling. after all, they are literally the ones that others rely on. What does it mean if they need to rely on someone else?
Mental health care for first responders should be seen as a strength, a sign of reverence for the job, and just another skill to add to their repertoire.
The stigma is slowly being challenged. We need an environment where everyone—especially those who are at a higher risk—can feel safe and comfortable talking about depression, anxiety, post-traumatic stress, substance use, thoughts of suicide, and more.
Help Them Change On-Site Conditions
A big step toward ending the stigma is to normalize talk about mental health. Supervisors can lead by example. Over 70 percent of first responders stated that they’d be more comfortable talking about mental health if it was commonly discussed on-site—especially by higher-ups. Even more importantly, 80 percent said they speak up more often when a peer does, too.
Self-Care & Community Care
They spend all day caring for others who have been in life-threatening situations. It may feel self-indulgent to do self-care rituals when you get home. Conversely, it is non-negotiable. First responders—as much or more than anyone—need to create daily regimens that include restful sleep when possible, sustainable nutrition, exercise for fun and stress relief, supportive social and other relationships, and a consistent relaxation routine. Piece of cake, right?
Self-care makes you more resilient. Resilience is one of the most protective factors among first-responders who do not develop mental health concerns. Resilience is precisely what everyone needs to fend off depression.
What Mental Health providers can do For First Responders
It’s great to donate pro-bono or reduced rate sessions to those who support their communities in this way. In times of public crisis, many therapists come together to offer these services. However, as the trend fades, so do the offers. There are other, more consistent ways to tailor your services.
Some other options are to waive cancellation fees or offer more flexible scheduling. And it’s certainly important to continue to gain our own clinical training and experience for working with first responders. We need to be trauma-informed while also respecting and understanding the culture of their workplace, as well as the impact their work may have on their relationiships. It’s more than not flinching when you hear difficult stories. We also need to make sure we are not experiencing vicarious trauma if we serve a number of clients from these professions.
If you are a first responder seeking mental health support, please remember that private therapy is confidential, tailored to you, and can make you better at your job. Schedule a free consultation today.
Trauma-informed therapy for first responders in Long Beach and California
Prospect Therapy is a queer + trans affirming therapy practice based in Long Beach, CA, with a focus on mental health for first-generation, immigrant, and bicultural communities. We continue to provide online therapy for a variety of mental wellness and relationship concerns to clients throughout the state of California. Learn more about how we bring lived experience to our work with people of all ages in our communities by requesting a consultation below.