First Responder Mental Health and Suicide: An Evidence-Based approach

Researchers, federal partners look for ways to improve data collection and research related to first responder mental health and suicide

Working in EMS can be as rewarding as it is challenging, but little research has examined exactly how hard the job can be. More specifically, few studies have looked at exactly how big a problem mental health issues and suicide are among first responders, what makes professionals vulnerable, or how best to address these issues.

Answering those questions is why the National Highway Traffic Safety Administration (NHTSA) Office of EMS (OEMS) has partnered with the Centers for Disease Control and Prevention (CDC) and its National Institute for Occupational Safety & Health (NIOSH) to better understand first responder mental health and suicide.

“At OEMS it’s our job that when we recognize a gap or need for EMS or 911 professionals, we convene the right people and develop the right resources to fill that gap or need,” explains Kate Elkins, MPH, an EMS specialist with the NHTSA Office of EMS and a longtime paramedic. “As a profession, we are overrepresented for suicide and other mental health conditions. The reality is that we can do better to protect our people from adverse effects of the career. It is possible to thrive not just survive in EMS.”

Sizing Up the Problem

To that end, Elkins and her colleagues at NHTSA, CDC and NIOSH are taking a public health approach to the issues, which means first defining and understanding mental health issues faced by first responders related to the particular demands of their jobs. OEMS, CDC and NIOSH are collaborating now to gather data and build on what’s known so far.

For example, research shows individuals in certain occupations, including first responders, appear to be at increased risk for suicide. Firefighters and law enforcement officers are more likely to die by suicide than in the line of duty; and EMS clinicians are more likely to take their life than members of the general public. Public safety telecommunicators are at risk as well; studies have found that nearly one-quarter experience depression and as many as 24% have symptoms of post-traumatic stress disorder (PTSD).

As high as these numbers are, they are likely underreported. The OEMS, CDC and NIOSH collaboration led to the publication in April 2021 of “Suicides Among First Responders: A Call to Action.” Co-authors Hope M. Tiesman, PhD; Kate Elkins, MPH; Melissa Brown, DrPH; Suzanne Marsh, MPA; and Leslie M. Carson, MPH, MSW, examined three years of data from the National Violent Death Reporting System to begin an effort to paint a more complete picture of suicide among firefighters, law enforcement officers, EMS clinicians and 911 telecommunicators. The article examines what’s being done to prevent suicides, the challenges to reducing these numbers, and evidence-based interventions agencies can put in place.

The authors continue to work together to further study mental health issues and suicide among first responders and develop resources to help address the problem. Other collaborators include the National Institutes of Health, Department of Veterans Affairs, and the Substance Abuse and Mental Health Services Administration (SAMHSA), and other federal agencies.

The Search for Interventions That Work

There’s no shortage of those who desperately want to do better in supporting their first responders, Elkins says. Agencies want personnel to find ways to weather the stresses of the job so they can live healthier lives and enjoy their jobs more--and also stick with the profession and reduce turnover.

If you decide to take action to create more emotional and psychological support for your employees, Elkins advises proceeding carefully and with intention. “Do your research and ask others for advice and help,” she says. “Throwing money at any intervention isn’t necessarily the best solution for your department. Just like any health, wellness or education program it is best to do your research, invest wisely and evaluate any program.”

Start by identifying what’s most appropriate as well as what resources your department has. Some agencies have implemented an employee assistance program, only to find that staff don’t want to use it. “Often, first responders are sent to general mental health practitioners who may not understand the unique demands they face or the cultures in which they operate,” notes Tiesman, a research epidemiologist in the NIOSH Division of Safety Research.

Elkins often sees neighboring departments or jurisdictions that come together to collaborate on solutions they couldn’t build on their own.

Some interventions with successful outcomes include post-event decompression sessions, peer-to-peer support, mindfulness practice and resilience training. “Make sure there’s non-punitive access to resources; that’s incredibly important,” Elkins adds. “Part of the stigma that keeps people from seeking internal help is the fear of being deemed ‘unfit to work.’ Identify champions willing to discuss the fact that they’ve sought help and benefited from treatment, maintenance and prevention.”

Agencies can also turn to their state EMS offices for resources, as well as local, state and national EMS organizations. You can get involved in research—or conduct research yourself, if you have the resources to do so.

“Talk about mental health and suicide among first responders and overcome the stigma in talking about it,” says Elkins, who lost her best friend—who served as a firefighter, EMT and emergency telecommunicator–to suicide. To date, nine of her peers in EMS have taken their lives. “I’m tired of losing good people, dear friends and great providers. This is a club no one wants to belong to.”

She perseveres because she knows the EMS industry can and will do better in supporting its members. “We’re gathering better data so we can address what’s actually happening,” says Elkins. “Just like we don’t want you to have a career-ending back injury, we don’t want you to have a mental health injury either. We want you to retire healthy and whole.

“You can grow from stress,” she adds. “You don’t have to simply survive a career in EMS – you can thrive.”

If you or anyone you know needs help or is considering suicide, call the National Suicide Prevention Lifeline, 1-800-273-TALK (8255) at any time. The call is free and confidential, and you will be connected to a counselor in your area. For more information, visit the National Suicide Prevention Lifeline website.