Strategies for Public Safety Organizations

Public safety personnel face unique challenges in their line of duty as they respond to both built-in stressors and high-stress and traumatic calls, increasing the risk of mental health disorders.^1-3 Organizations are implementing individual- and organization-level strategies, including: 

• Reducing stigma by sharing resources and by offering time for open discussion of peers’ personal experiences 
• Utilizing screening and referral interventions and expanding confidential services for mental health
• Reducing barriers and promoting facilitators of mental health care for workers and learners
• Establishing positions for public safety personnel to promote worker and learner mental health
  
  

Evidence

Much of the evidence for mental health and stress/trauma supports comes from law enforcement literature. Stigma and negative organizational culture around mental health and trauma support can prevent workers from seeking help; however, interviews with staff suggest that organizations can work to change their culture and reduce stigma by helping workers realize they aren’t alone, creating buy-in to programs, identifying therapists with similar backgrounds to PSW, and being open to recommendations by staff.⁴

Evidence supports psychological treatment, such as cognitive behavioral therapy (CBT) and narrative exposure therapy, in treating PTSD and addressing other occupational stressors among public safety workers.^{5, 6} Screening and referral interventions among police were found to reduce symptoms of PTSD, barriers to care, and stigma among participants. Resilience training not only bolstered resiliency but also decreased symptoms related to depression, anxiety, and burnout among police officers.^7-9

‍Resources

A 1- hour webinar features Dr. Beth Murphy from Fire Engineering as she discusses behavioral health and fear of opening up about mental health among firefighters.

‍Firefighters helping firefighters shares videos of firefighters discussing their personal experiences and lists useful resources to help with the effects of stress/trauma.

‍Barriers and Facilitators to Seeking Mental Care Among First Responders, published in the Journal of the American Psychiatric Nurses Association, engages in many mental health support services and strategies. Jones et al. discuss mental health days, increasing access to coping strategies directly after traumatic events in addition to being continuously available.

‍Mental Health First Aid from National Council of Wellbeing provides public safety workers with mental health education resources for their peers and community members. 

The National Association of Emergency Medical Technicians provides a course for EMS personnel to become a Mental Health Resilience Officer for their agency.  

‍First Responder Center for Excellence (FRCE) provides resources for departments on creating and implementing behavioral health programs. These resources include a roadmap that allows departments to size and adjust the principals outlined to fit their own budget and needs. FRCE also includes a report on behavioral health screenings, giving insight on parameters, arising issues, and other helpful takeaways

‍Spotlights

‍Scott Geiselhart, retired assistant chief, joined Firefighters Success Podcast to share his story of recovery from PTSD, addiction, and attempted suicide.

‍Delaware’s Public Health Department created a toolkit for first responder organizations to support their workers with resources such as lists of clinicians, family support resources, documentary recommendations, and resiliency training courses.

‍References

1. Krakauer RL, Stelnicki AM, Carleton RN. Examining Mental Health Knowledge, Stigma, and Service Use Intentions Among Public Safety Personnel. Front Psychol. 2020;11:949. 
2. Carleton RN, Afifi TO, Taillieu T, et al. Exposures to potentially traumatic events among Public safety personnel in Canada. Canadian Journal of Behavioural. 2019;51(1):37-52. 
3. Carleton RN, Afifi TO, Turner S, et al. Mental Disorder Symptoms among Public Safety Personnel in Canada. The Canadian Journal of Psychiatry. 2018;63(1):54-64. 
4. Jones S, Agud K, McSweeney J. Barriers and Facilitators to Seeking Mental Health Care Among First Responders: “Removing the Darkness.” J Am Psychiatr Nurses Assoc. 2020;26(1):43-54.
5. Papazoglou K. Examining the Psychophysiological Efficacy of CBT Treatment for First Responders Diagnosed With PTSD: An Understudied Topic. SAGE Open. 2017;7(3):2158244017729407. 
6. Beahm JD, Landry CA, McCall HC, Carleton RN, Hadjistavropoulos HD. Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel: A Qualitative Analysis. Int J Environ Res Public Health. 2022;19(8):4744.
7. Chitra, T., Karunanidhi, S. The Impact of Resilience Training on Occupational Stress, Resilience, Job Satisfaction, and Psychological Well-being of Female Police Officers. J Police Crim Psych 36, 8–23 (2021). 
8. Christopher, M.S., Goerling, R.J., Rogers, B.S. et al. A Pilot Study Evaluating the Effectiveness of a Mindfulness-Based Intervention on Cortisol Awakening Response and Health Outcomes among Law Enforcement Officers. J Police Crim Psych. 2016;31, 15–28.
9. Kaplan JB, Bergman AL, Christopher M, Bowen S, Hunsinger M. Role of Resilience in Mindfulness Training for First Responders. Mindfulness (N Y). 2017;8(5):1373-1380.

Public safety work is inherently stressful with high exposure to trauma. Organizations can address workers’ stress/trauma through the following: 

• Establishing programs for workers to communicate about and receive support around occupational distress and trauma in the workplace
• Cataloging existing mental health and stress/trauma resources to identify gaps between resources and public safety personnel needs

‍Evidence

Current public safety workers’ mental health and well-being programs focus primarily on education-based training for workers and learners to help them navigate traumatic/stressful events and their resulting effects. Resilience training, building coping skills, and increasing knowledge about stress and trauma have been shown to have a positive impact on workers.^{1, 2, 3} While not specifically studied in public safety workers, peer support has been effective at increasing the use of mental health services in similar populations, such as police and military.^{4, 5} Many of these techniques result in increased resilience, perception of social support, and mindfulness.^{4, 5}

Resources

First Responder’s Trauma Intervention Resource Toolkit is a report containing interventions and strategies along with anecdotal excerpts. 

‍How to Build Mental Health Resilience by EMS1 is an informational post structured around responding to questions about the importance of EMS resilience, risk factors for reducing resilience, and programs or interventions to implement. 

The Share the Load Support Program gives Fire, EMS, and their families access to information and tools to help with the mental health concerns that come from the high stress/trauma job description.  

The National Alliance on Mental Illness provides many resources for public safety professionals to build resilience, increase wellbeing, feel supported by their peers and employers, and improve their relationships.

The National Association of Emergency Medical Technicians lists multiple hotlines for mental health support, along with two American College of Emergency Physicians resources on wellness: a guide and program materials.

‍Responder Rel8 is an app for first responders that creates an online environment to communicate and share personal experiences.

‍Spotlights

‍The city of Irving, Texas implemented a Public Safety Wellness Unit for first responders. 

The fire chief of Goodyear, Arizona is working with city council members to ensure the physical and mental health of the city’s firefighters. Funding has enabled the city to build new, state-of-the-art fire stations that enable firefighters to decontaminate after a fire, thus reducing their risk of carcinogen exposure. Additionally, the city provides a free employee assistance program and an on-site psychologist at each station once a quarter. The psychologist provides services and has established a peer support team to address challenges when she is away. 

The National Volunteer Fire Council received the 2023 Power of Associations Gold Award for its Psychologically Healthy Fire Departments (PHFD) Initiative which includes a compiled list of behavioral health providers, an implementation toolkit for department leaders, and training courses to empower and educate leadership to promote health and well-being.

Psychologists and researchers at Nova Southeastern University collaborated with the Broward County, FL Sheriff’s Office to create a peer support program called Peers as Law Enforcement Support (PALS) for first responders in the county. The program uses peer facilitators to deliver specific content (e.g., stress, substance use, suicide) to peer support teams. In teams, members role-play scenarios to learn how to help each other during distressing and difficult situations. The developers of PALS provide considerations for confidentiality, refresher training, and evaluation of the program.

‍References

1. Corthésy-Blondin L, Genest C, Dargis L, Bardon C, Mishara BL. Reducing the impacts of exposure to potentially traumatic events on the mental health of public safety personnel: A rapid systematic scoping review. Psychol Serv. 2021;10.1037/ser0000572.
2. Díaz-Tamayo AM, Escobar-Morantes JR, García-Perdomo HA. Coping Strategies for Exposure to Trauma Situations in First Responders: A Systematic Review. Prehospital and Disaster Medicine. 2022;37(6):810-818. 
3. Carleton RN, Afifi TO, Turner S, et al. Mental health training, attitudes toward support and screening positive for mental disorders. Cogn Behav Ther. 2020;49(1):55-73.
4. Weir B, Cunningham M, Abraham L, Allanson-Oddy C. Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker. Journal of Mental Health. 2019;28:647-653.
5. Milliard B. Utilization and Impact of Peer-Support Programs on Police Officers’ Mental Health. Frontiers in psychology. 2020;11:1686-1686.