First responders' resilience masks a mounting mental health toll

First responders' resilience masks a mounting mental health toll
© Associated Press/John Minchillo

The ongoing COVID-19 pandemic has left first responders strained and exhausted as they struggle to keep up service to their communities in a time of constant stress, prompting calls for urgent support and efforts to break down the stigma around mental health.

While the past 18 months have taken a heavy toll on health care workers, the trauma of working on the front lines of the pandemic also extends to police, firefighters and emergency medical service workers, who are wrestling with depression, anxiety, post-traumatic stress disorder and addiction. 

Amid longer hours and fears about bringing the virus home, these first responders have been in a heightened state of “hypervigilance” for 19 months and counting without an end in sight.  

“I don't think we're going to know the true extent of what this has done to us for a long time to come,” said Frank Leto, former deputy director of the New York City Fire Department’s counseling service unit. 

Leto predicts the impact will “be felt for generations” as first responders have been responding to the pandemic for months without a chance to process what they've been through.

“You can’t relax because … it isn’t over,” he said.

“Once you're off the front pages, that's when it starts to have the emotional impact on you,” he added.

Bruce Evans, president of the National Association of Emergency Medical Technicians, said the current state of mental health among first responders is “at a level of extreme fatigue” with a shortage of workers leading to longer hours.

“Families are suffering catastrophic losses … and EMS is on the front line to kind of absorb the emotional impact of all this,” he said.

Little research has been conducted on the mental impact the COVID-19 pandemic has had on first responders. In one national survey of 189 first responders exposed to the virus, COVID-19-related worry was associated with anxiety, depression, severe alcohol use and PTSD symptoms, study author Anka Vujanovic said. 

Vujanovic, who directs the Trauma and Stress Studies Center at the University of Houston, said there’s “disproportionately less” research published on first responder mental health. She said policymakers, researchers and clinicians need to work with departments to lessen the stigma associated with mental health treatment, which “poses a significant barrier.”

“I think the emphasis has been on their strength for decades,” she said. “And I think we also need to understand their vulnerabilities to improve resilience where we need and bolster resilience where it's already there. And these conversations are all part of the change.”

“If we think of this as an almost two-year-long … crisis that they are responding to, then we really need to be following them into the future prospectively to see when the crisis is over,” she said.

In the meantime, Jeff Dill, the behavioral health administrator for Las Vegas Fire and Rescue, said emergency departments should prioritize creating complete behavioral health programs to address the growing mental health needs amid the pandemic.

“They're always on edge and staying on top of their game,” he said. “And when someone's hypervigilant that's exhausting, that takes a lot of stress and anxiety. And so you add that with the sleep deprivation and the extra work hours, it becomes a real problem for my brothers and sisters.”

The Firefighter Behavioral Health Alliance, an organization founded by Dill that tracks firefighter and EMS worker suicides, developed a 12-point course to implement such programs within departments. It involves education and training for officers and their families, as well as bolstering counselor resources and community relationships.

Advocates, including Dill, noted the progress first responder departments have made in the last decade, working with counselors trained on their unique experiences, along with peer support teams and more discussions about mental health. 

Experts said these conversations can help combat the continuing stigma against seeking mental health treatment. 

The first responder population is widely recognized as “resilient” working in a high-risk, stressful environment and responding regardless of how traumatic the emergency might be. 

However, President of the National Fraternal Order of Police Patrick Yoes said it’s important to remember responders are still human.

“Somehow we think that because they're law enforcement officers, that this doesn't affect them, and that's simply not the case,” he said.

Departments need preventative and “long range holistic approaches on how we're going to protect officers from the day that they apply for the job rather than trying to fix things that are broken,” he said.

“When we ask people to put their lives out there and put themselves in these positions and do this job … then we also need to recognize that the problems that come along with them doing this job, we all have a responsibility to help manage,” Yoes said.