We Need to Talk About the Mental Health of First Responders

looking at emts through a car window

Maskot / Getty Images

Key Takeaways

  • First responders include emergency medical technicians (EMTs), paramedics, firefighters, and police officers.
  • To do their jobs, first responders face a great deal of stress, which can impact mental health.
  • There needs to be more understanding of how work-related stress affects the health of first responders.

On January 6, 2021, the US Capitol building was subjected to rioting, violence, and property destruction by extremists. Since then, 4 law enforcement officers who responded to the siege have died by suicide.

Despite the stress first responders face in their work, death by suicide is not considered "in the line of duty," which means that these officers will not be memorialized or entitled to federal survivor benefits for their families.

Given the mental health impacts of working as a first responder for the sake of the public, this outcome is problematic and warrants greater support for emergency medical technicians (EMTs), paramedics, firefighters, and police officers.

Working As a First Responder

Don Altemus, a 52-year old retiree since 2001, is now based in Coatesville, PA, but he lived in Philadelphia, PA when he worked as a first responder for 10 years, beginning as an EMT and retiring as a paramedic. He says, "I loved every aspect of the role but I wish my understanding of mental health and how to process trauma had been what it is now when I did this work."

Altemus explains that being a first responder is not a role that works for everyone. "Those who choose the field are passionate about the work they are doing and they are constantly exposed to trauma and stressors that people outside of the field barely understand," he says.

Despite his passion, Altemus acknowledges that working as a first responder had a large impact on his mental health. "During that phase of my life, I was not aware of the impact that trauma and vicarious trauma have on those who experience both day in and day out," he says.

Don Altemus, retired EMT

I loved every aspect of the role but I wish my understanding of mental health and how to process trauma had been what it is now when I did this work.

— Don Altemus, retired EMT

Altemus describes his main coping mechanism at that time as stuffing things down and pretending that they did not exist. "The result was that years and years of experiencing trauma both on the job and also in my personal life led to me developing PTSD," he says.

Due to mental health challenges, Altemus was unable to work for 6 years, which is why he wishes that people had an understanding of the things that first responders see and deal with at work. "First responders leave every call but some calls remain within the first responder forever," he says.

Altemus explains, "I wish people understood that there are things we wish we did not remember. One of the questions I hate that people ask all the time when they find out I am a retired first responder is "What's the worst thing you ever saw?" I refuse to answer that question."

Looking back, Altemus also wishes that people had an understanding of the appropriate uses of the 911 system and that they would give first responders working in the system some grace. "The 911 system is overburdened and having someone who needed a ride but not an ambulance scream at you when you explain the coverage adds to an already stressful job," he says. 

Altemus explains, "I wish the public was aware that the stigma of seeking mental health assistance is huge. First responders hesitate to ask for help because they don't want to be pulled from the positions they love and placed on desk duty. Seeking mental health assistance needs to become as commonplace as going to your primary doctor for the flu."

By addressing such stigma, Altemus highlights how normalizing accessing mental health assistance would lead to first responders being able to keep themselves mentally healthy. "In turn, that would lead to better patient care, less burnout, and less turnover in the field," he says.

Difficulty Seeking Help

Psychiatrist and regional medical director for Community Psychiatry + MindPath Care Centers, Leela R. Magavi, MD, says, "I evaluate many police officers, firefighters, paramedics and first responders who have endured symptoms of posttraumatic stress disorder for months to years but were too fearful to express their concerns."

Dr. Magavi explains, "During the pandemic, it has felt like each day I am provided with the empty cups of a traumatized nation, and I keep pouring relentlessly only to realize that the pain caused by months of loss persists. My hours are longer than they have ever been because my patients are suffering, and I am committed to doing whatever I can to help them."

Despite working with patients who often have disparate backgrounds and beliefs, Dr. Magavi notes that they tend to have significantly similar fears and insecurities. "First responders may avoid meeting with a psychiatrist or therapist due to fear of failure and being stigmatized," she says.

Leela R. Magavi, MD

I do whatever I can to raise awareness about burnout, so we can save first responders from the grasps of suicide.

— Leela R. Magavi, MD

Dr. Magavi highlights how some racial, sexual, and ethnic minorities have family members who perceive mental illness in a negative manner, as individuals relay that their upbringing or community deterred them. "I do whatever I can to raise awareness about burnout, so we can save first responders from the grasps of suicide," she says.

Many first responders have told Dr. Magavi that they experience nightmares and flashbacks, which affect their ability to appreciate their time with loved ones or partake in hobbies they once enjoyed. "Secondhand grief may affect first responders who routinely care for individuals who are actively suffering and tackling emotional and physical pain," she says.

The Impact of Secondary Trauma

Dian Grier, LCSW, says, "As a therapist, I once worked as a first responder with many tragic events. My job was to be on the scene with dead bodies in the room, or at the scene of an accident to work with witnesses and family."

Grier describes working 12-hour shifts, as her team went from one tragedy to another, including fires, child deaths, car accidents, etc. "I can say that after four years of that work, I suffered from being close to and in the middle of the worst days of people's lives, I was severely affected," she says.

Since she never knew what she would face, Grier recognizes that her job included anxiety and hyperawareness, as she felt as if she had to be ready for anything. "After years of this job, I noticed an increase in medical issues, hyperarousal, anxiety, and depression," she says.

As an example, Grier shares, "I remember a horrible incident in which a good mother was in hysterics because she turned her back for a few minutes and her baby crawled through the dog door and drowned in a pool. How does the mother make sense of this, and how does a first responder process this? It is too much for a person to deal with on their own."

Grier describes how secondary trauma can occur in therapy when the people listening or seeing other people’s trauma also experience it, and are impacted secondarily. "Looking back at that time, I feel as if we were in the midst of a war, watching trauma daily," she says.

Dian Grier, LCSW

Looking back at that time, I feel as if we were in the midst of a war, watching trauma daily.

— Dian Grier, LCSW

A 2019 study in the European Journal of Psychotraumatology found low levels of secondary trauma among first responders, but researchers noted this may be under-reported due to social desirability and job-loss fears.

In this way, Grier explains how people often underestimate the toll this work takes. "Research says that the more events a person is exposed to, the more they believe it will happen to them or their family," she says.

Grier highlights how first responders may begin to believe that the odds of bad events happening are much higher to them and their loved ones because they witness it daily. "This brings a higher sense of stress to first responders, even in their personal lives," she says.

When she started to have symptoms of secondary trauma, Grier notes there were no options at work to process her feelings. "Many people in these jobs begin to experience symptoms similar to Post Traumatic Stress Disorder, including intrusive thoughts, avoidance, and hyperarousal," she says.

Grier explains, "The first responders may feel a sense of helplessness, confusion, and isolation. The culture of first responders is to laugh it off and gain a strange sense of humor. We didn’t talk about the difficulty of what we just saw, but made jokes about the event or said nothing."

What This Means For You

As detailed, first responders deserve more support given the mental health risks their work includes. In fact, Grier says, "The stigma of mental health within these professions must be dealt with. It must start with changing the culture. They need to understand just how much the job is affecting them and their higher risk for suicide."

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Schweitzer Dixon S. Law enforcement suicide: The depth of the problem and best practices for suicide prevention strategies. Aggression and Violent Behavior. 2021;61. doi:10.1016/j.avb.2021.101649

  2. Smith E, Dean G, Holmes L. Supporting the mental health and well-being of first responders from career to retirement: A scoping review. Prehospital and Disaster Medicine. Published online April 30, 2021. doi:10.1017/s1049023x21000431

  3. Misra S, Jackson VW, Chong J, et al. Systematic review of cultural aspects of stigma and mental illness among racial and ethnic minority groups in the United States: Implications for interventions. American Journal of Community Psychology. Published online April 3, 2021. doi:10.1002/ajcp.12516

  4. Ludick M, Figley CR. Toward a mechanism for secondary trauma induction and reduction: Reimagining a theory of secondary traumatic stress. Traumatology. 2017;23(1). doi:10.1037/trm0000096

  5. Greinacher A, Derezza-Greeven C, Herzog W, Nikendei C. Secondary traumatization in first responders: a systematic review. European Journal of Psychotraumatology. 2019;10(1). doi:10.1080/20008198.2018.1562840

By Krystal Jagoo
 Krystal Kavita Jagoo is a social worker, committed to anti-oppressive practice.