When members of the public experience an emergency, they count on first responders — police, firefighters and EMS — to show up.
First responders pride themselves on being the ones who head toward those situations, from car wrecks to fires and violent crime. But, frequent exposure to the trauma surrounding incidents like fatality accidents, suicides and unattended deaths takes a toll on first responders, leading to significantly higher rates of mental illness and suicide.
According to a 2018 study by The Ruderman Family Foundation, Post-Traumatic Stress Disorder and depression rates among first responders are up to five times greater than the general population. That leads to significantly higher rates of suicide, to the extent that firefighters and police are far more likely to die by suicide than in the line of duty.
The Ruderman study found the number of law enforcement officers who died by suicide in 2017 was more than three times that of officers who were fatally shot in the line of duty.
Tasha Billingslea, community education manager at St. Mary’s Resilience Behavioral Health in Enid, Okla., said those higher rates of suicide often are preceded by higher-than-average rates of alcohol and substance abuse and divorce.
The cause of higher rates among first responders of PTSD, depression, substance abuse and suicide is no mystery, Billingslea said; they’re repeatedly exposed to trauma.
“They come across and see things the general public usually doesn’t have to,” Billingslea said. “Things you’d never want to see, they see on a regular basis.”
All those traumatic experiences build up, Billingslea said, leading to mental health issues like anxiety, loss of sleep, irritability and depression. She said most first responders recognize these warning signs, but are held back by an old fear.
“I think they know they need help,” Billingslea said, “but I think there is a fear they will be restricted from doing their job if they say they need treatment.”
Kathy Thomas has been watching that cultural aversion to mental health care develop since 1995, when she responded to the aftermath of the Murrah Federal Building bombing in Oklahoma City.
Thomas is the contract psychologist for the Oklahoma Highway Patrol and clinical director of Warrior’s Rest Foundation, which provides mental health and resiliency training to law enforcement agencies nationwide.
She’s built a career around a passion for helping first responders deal with the trauma they face — a passion she said started with the Oklahoma City Bombing.
“When the bombing happened, I didn’t even know a cop,” Thomas said. “I had never worked with first responders.”
After eight days of conducting death notifications and providing mental health support to recovery teams, she said she came away with a new, and more realistic, view of first responders.
“I had been guilty, like other people, of looking at first responders the way kids look at their parents,” Thomas said. “It is crazy thinking humans would not be impacted by having to do that kind of stuff. How crazy was it to expect people to pull babies out of a bombed building, and for them to not be impacted by it?”
She carried that new perspective, and her new-found passion for helping first responders, to the aftermath of the 9/11 terrorist attacks, four F5 tornado responses and 23 years of providing training and direct support to first responders.
Throughout those years of experience, Thomas said she’s seen a consistent need for first responders to have some source of joy and meaning outside their job, whether it’s a hobby, family or spiritual pursuit. That’s essential, she said, to counteract the darkness and death they encounter on the job.
“Everything they do is dealing with someone’s worst-case scenario,” Thomas said. “If they don’t have things in their lives that give them joy and meaning, then everything looks bad, and that’s when people become susceptible to things like divorce and suicide. The whole world is not bad, but when that’s all you deal with, it looks that way.”
And, she said, first responders need to feel empowered to and supported in seeking mental health help when it’s needed. But, that hasn’t always been the case.
“The culture among first responders, historically, has been very much about ‘It’s your job, suck it up and go on,'” Thomas said.
Fear of being pulled off the job, or being viewed negatively by peers, long kept first responders from seeking mental health care when it was needed, Thomas said.
“They felt like, if I acknowledge something bothers me, and yet this is my job, does that mean I can’t do my job,” Thomas said. “They wouldn’t say anything because they didn’t want to be judged. They judge themselves, and assume others would judge them.”
She said that stigma against seeking mental health care has improved in the last 10-15 years, “and it’s getting better all the time … but there’s still a lot of work to do there.”
“The younger, newer people coming into this profession get exposed to ‘It’s okay to take care of myself,'” Thomas said. “But you still have some of the more veteran responders who were enculturated with that idea of ‘Don’t talk about it, suck it up,’ and the younger responders are still carrying the weight of that.”
The lingering effects of that “suck it up” culture also mean many fire, police and EMS departments still lag behind on training — ahead of critical incidents — for how to identify mental health risks, deal with the effects of trauma and where to get help if it’s needed, Thomas said.
“Historically there wasn’t any kind of training on how to survive emotionally on the job,” Thomas said. “They get all kinds of training on how to survive physically, but they didn’t get any training on how to deal with death and all the things they have to see and deal with on a regular basis.”
The Ruderman study backed up that assertion about the lack of mental health training programs. According to their report, only 3-5 percent of the 18,000 law enforcement agencies in the U.S. have suicide prevention training programs.
Lack of mental health training and a culture that still stigmatizes mental health care are compounded by first responders often finding themselves isolated and unable to talk about their experiences — on or off the job.
Thomas said first responders often refrain from talking about traumatic experiences with family and friends, because they don’t want loved ones to see them differently or have to face what they’ve seen.
“They think they’re protecting them,” Thomas said. “They think ‘I don’t want them to have to carry around what I’m carrying around.'”
Thomas said first responders “don’t have to fill in the gory details,” but need to find someone to share experiences with, to give their brains a chance to process what they’ve seen and done.
“The more we can talk about an experience, the more our brain can process it,” Thomas said. She said responders have to be able to unpack their experiences, to family, friends, a chaplain, minister or pastor or a mental health professional.
Thomas said first responders, their peers and families should be aware of warning signs of mental illness and risk for suicide, which can include self-imposed isolation from friends and family, being more irritable, not doing things they used to enjoy, increase in alcohol use or substance abuse, loss of sleep and change in behavior patterns.
And, the need to watch for those risk factors doesn’t end when a first responder leaves the job. Thomas said the transition time to life after the job often is one of the highest risk periods for depression and suicide.
“A lot of times what we see is they’ll go through their entire career, and everything will appear OK,” Thomas said. “But, what happens is, when they hit retirement … all that stuff that’s been building up in their career comes back and hits them in the face, and they don’t know how to deal with it. They think, ‘I’ve never told anybody I had a problem with this, so how can I tell someone now?'”
Ideally, Thomas said she’d like to see first responder agencies implement mental health out-processing for responders leaving the job or retiring, so they can “empty their bucket before they move on to the next chapter in their life.”
Whether a first responder is just starting their career or transitioning to retirement, Thomas wants responders and their loved ones to have the same realization she did after the Oklahoma City bombing: first responders are human, and suffer normal human responses to trauma.
“You’re human — you were human before you became a cop, a firefighter or a paramedic, and as a human one of the reasons you got into this profession is because you wanted to help people,” Thomas said. “That compassion and that caring is what also makes us vulnerable to be impacted by things. But, it’s okay to be impacted. It’s okay to be human, and we can deal with that. It’s when we try to put that shield up and not allow ourselves to be human that we run into problems.”
Chaplains: The first responders to first responder mental health
When first responders need to work through the effects of trauma they’ve experienced on the job, their first help often comes from one of their own — a fellow first responder who also serves as a chaplain.
Butch Phillips, a chaplain with Garfield County Sheriff’s Office, learned firsthand the need for department chaplains who understand first responders.
Phillips started out as a reserve deputy in 1987, and said his path to the chaplaincy started when he responded with two other deputies to the aftermath of Hurricane Katrina, in New Orleans in 2005.
“I personally struggled with what I saw there,” Phillips said. “I knew I needed some support, but the chaplains there … they just stood there with their Bible under their arm, waving at us as we went out and as we came in.”
He knew then chaplains needed to be closer to the rank and file responders. His path also was directed by a tragedy a year earlier, when a close friend and fellow reserve deputy died by suicide.
“Up to that moment, I was arm-wrestling with God,” Phillips said. “I knew I was being called to ministry, I just didn’t know what that meant.”
Driven by the experiences from Katrina and the loss of his friend, Phillips enrolled in a licensed minister training program through the Christian Church (Disciples of Christ).
Since then, he has devoted himself to providing spiritual, emotional and psychological support to both victims and first responders affected by violence, death and other trauma.
Enid Police Department Patrolman Aaron Barber, who served six years as Fraternal Order of Police Chaplain for EPD until July, 2018, said that kind of support from someone in uniform is crucial to first responders’ well-being.
Frequent exposure to traumatic incidents wears down first responders, Barber said, resulting in post-traumatic stress disorder (PTSD). Barber said PTSD is a threat to first responders that wasn’t widely recognized until recent years.
“Before PTSD really became accepted as an issue for law enforcement, it was believed if you reached out you were weak,” Barber said. “In reality, PTSD affects people more than anything else on this job.”
A 2018 study by the National Alliance on Mental Illness (NAMI) supports that assertion, finding as many as 19 percent of police officers experience PTSD symptoms, compared to 3.5 percent of the general population.
Barber said chaplains provide first-line spiritual help, and serve as facilitators to guide first responders to other resources, including licensed mental health care providers, if needed.
But, getting first responders, especially law enforcement officers, to accept that help can be hard, Phillips said, in part because of the personalities that make for good responders in the first place.
“They’re hired for their strength, but unfortunately that can lead to them seeing spirituality or the need for help as weakness,” Phillips said. “They don’t want to be perceived as being weak.”
That stigma remains one of the biggest hurdles chaplains face in getting responders to seek and accept help. Overcoming that hurdle should be seen, and trained, as a survival skill, Phillips said.
“We need them to understand it’s a sign of wisdom and strength to use all their resources,” he said. “If they’re in a street fight, they’re going to use every resource they have to survive, and this is no different. But, unfortunately, a lot of people still see it differently.”
Jim Gorton, chaplain with Woodward County Sheriff’s Office, said cultural barriers to seeking mental health care are improving, but are still an issue.
“It’s not as much a problem as it was a decade ago,” Gorton said. “A decade ago, if a law enforcement officer went outside the ranks, you were pretty much shunned, and very few people would even talk to you or work with you anymore.”
Gorton served 10 years with Woodward County Sheriff’s Office, until his retirement last October, and before the sheriff’s office he served 15 years as an emergency medical technician. He’s now in seminary for ordination in the Episcopal Church, and has served as a sheriff’s chaplain for more than five years — a position he still fills in his retirement.
The first and greatest task in getting responders to seek out mental health care, Gorton said, is getting them to trust mental health care providers.
When Gorton first started counseling other deputies, he said he quickly discovered confidentiality was of prime importance.
“If you don’t keep in confidence what’s brought to you in confidence, you have absolutely no credibility,” Gorton said. “That word will get around real quick, and pretty soon you won’t have anyone talking to you.”
One of the crucial skills of a chaplain is also knowing when to refer a responder for more formal mental health care, Gorton said. He has a hard and fast line for when to make that referral: “When I reach the end of my training.”
“I will talk with someone until I feel uneasy, and that’s when I know I’ve reached the limit of my ability to safely counsel someone, and then we start talking about them seeing a counselor or psychologist,” Gorton said. “It’s a dangerous step to go beyond that.”
Tim Dorsch, lead chaplain at Garfield County Sheriff’s Office since 2004, said discerning needs and helping responders find a place they feel comfortable to talk about trauma is crucial.
Dorsch retired from full-time Lutheran ministry in June, 2017 and still serves as a vacancy pastor at Redeemer Lutheran Church, while also serving as a chaplain to the sheriff’s office and area fire departments.
“Officers, firefighters and EMTs see things people really shouldn’t have to see,” Dorsch said, “and it can be really troubling, and if we’re not able to talk about that and process that it can cause problems.
“When we talk to others it helps our brains process those emotions, and what we’ve seen and smelled and done, and it makes it easier for our brain to process that and file it away,” Dorsch said. “If we try to handle it ourself, our brain isn’t able to do that, and we end up having nightmares and intrusive thoughts … if it’s not processed, it can damage our ability to do our job, to relate to others and it can become something that’s dangerous.”
Dorsch said he’s seen great strides over the years in first responder agencies implementing top-down policies to support front-line responders seeking mental health care.
One of those areas he’d like to see continue to expand is a process known as Critical Incident Stress Management, which provides debriefings and trained peer support to help responders process trauma before it leads to PTSD, depression or suicidal thoughts.
Barber, with EPD, is researching implementation of peer support counseling at his department. He said it’s an idea younger officers are ready for, and the older officers are coming around.
“With the younger guys it’s pretty well embraced, but with the older guys there’s still the stigma that if you say you need help it means you’re weak,” Barber said. “But, the older guys are seeing there’s more of a focus on it, and are becoming more willing to open up.”
For more information on suicide prevention for first responders visit the Suicide Prevention Resource Center. Anyone needing crisis support for risk of suicide can contact the National Suicide Prevention Lifeline at 1-800-273-TALK.