It is true that compared to others, first responders meet the diagnosis for depression and PTSD or post-traumatic stress disorder at 5 times the rate of the civilian population (Ruderman Foundation, 2018). First responders are among the top 5 professions most at risk for suicide related to their careers according to the Centers for Disease Control and Prevention (2020). In a study published by the Firefighter Behavioral Health Alliance in 2018, it was found that death by suicide surpassed on-duty deaths in staggering rates beginning in 2014. First responders not only risk their physical well-being to ensure the safety of others, but they often bear invisible scars that may go undetected to the untrained eye.
From the perspective of the mental health provider, working with first responders is a worthy endeavor. At first glance, we would assume that this population requires special care to address the symptoms caused by on-the-job stressors. What we may not realize initially, is that like many others, first responders who seek help for mental health conditions are often struggling with a variety of symptoms and issues in different areas of their lives. Hypervigilance, a symptom of PTSD, can be useful on the job. At home, “being on” all the time can impact a person’s sleep, cause tension in their interactions with loved ones, and can feel overwhelming. For civilians, alcohol use may be a normal part of social. For first responders, alcohol is often a last resort to calm the nerves and get to sleep. Over time, these reactions to symptoms can seriously interfere with their ability to perform at work and at home.
The experience of trauma in the body, whether from exposure to critical incidents, or childhood trauma is cumulative. When at first the symptoms appear slowly and may go undetected, over time they can be debilitating. Early detection is paramount for first responders in order to quickly identify depression, PTSD, and substance use disorders before the consequences become severe. By the time a service member comes in contact with a mental health professional, it is often too late. Negative consequences at home and art work, may already be taking place. It is important that training and services are readily available to service members, city employees and family members to detect the signs of unresolved trauma. Pay attention to changes in sleep patterns or daily routines, excessive use of substances, lack of focus, or shifts in mood. If you have concerns about yourself, a coworker, or a loved one, contact your local peer support team, or Employee Assistance program directly. While you are preparing for an appointment with a mental health provider, try connecting with trusted companions, reengage in hobbies, or take some time away. A little distance between you and your stress will go a long way in preventing and resolving future problems.
Week 1: A first responder’s job inherently involves managing daily stressors. Whenever possible, keep a consistent daily routine. Get adequate sleep when home, make time for healthy meals, and connect with your peers after difficult calls. Focus on the areas of your life that you can control and the other parts that you can’t will feel a little easier to organize and address.
Week 2: Box breathing is a type of 4-part breathing that can teach your body to react to stress in a healthier way. If practiced frequently, it can even teach your body to naturally move through anxiety before it becomes panic. Exhale to the count of four, inhale at the same pace, hold for four, exhale again and restart the pattern. Imagine tracing an imaginary box as you breathe. Enjoy!
Week 3: Research shows that being hard on ourselves does not increase motivation. The brain (amygdala and hypothalamus) reacts to harsh criticism as an attack and will respond to negative self-talk as physical threat. When we shift into fight, flight, freeze, or collapse responses, we are actually less productive! If you want to make better use of your time, try practicing self-compassion instead of self-criticism. Treat yourself with kindness and humanity you will see your motivation increase!
Week 4: Be realistic when attempting to make a behavioral change. If you want to stop drinking caffeine, using nicotine, or engaging with toxic people, going “cold turkey” is usually a set up for failure! Relying on willpower alone is usually ineffective. Creating a plan that involves reducing the behavior in a comfortable way is step one. Once you see positive change, confidence will grow and you can reduce the behavior further. If you set the bar too high, the fall is hard to recover from.
Week 5: Although “inner-child healing” seems like a complicated mental health approach, it is actually quite simple in practice. It involves considering the needs of our younger self in our adult lives. For example, when you know you should have gone to bed an hour ago, remember, the child in you needs to rest. Feed your child self a healthy diet, but every once and while sneak in an ice cream cone. Buy the toy you always wanted but never had, you waited long enough! Connecting with our child self helps establish congruity, a skill important for success in trauma therapy. Who knew that acting like a kid could be so healing!
-Jamie Sousa, LMHC, NBCC, CTRS-BH, EMDR
(Jamie is mental health clinician who specializes in treating complex trauma. She has extensive experience working with veterans, active-duty military, and first responders. She is devoted to improving access to mental health services for these communities and volunteers her time with her county’s emergency services.)