The Psychological Toll of the Job
It may seem obvious that being a first responder carries significant psychological risk. Of course, by the very nature of the job, first responders and public safety personnel (for ease we use the term first responder) are exposed to multiple traumatic incidents that the rest of the population will likely never encounter. Repeated trauma exposure over years is a predictable part of the work and can lead to significant mental health problems.
Yet, many first responders are surprised when they start to experience mental health symptoms related to their job. In this article, we will explore why first responders are at risk beyond the obvious trauma exposure, help first responders and their loved ones identify early warning signs, and touch on preventative care.
What Makes First Responder Work Psychologically Demanding?
Unique occupational exposures
Being a first responder involves repeated exposure to:
- Trauma, violence, death, and human suffering
- High-adrenaline, life-or-death decisions
- Public scrutiny over decisions/actions
For most of us, our instinct is to run away when faced with horror; first responders not only have to approach traumatic experiences, they also have to take responsibility for managing the situation to keep the public safe. First responders also make decisions in dangerous and emotionally charged circumstances. Colleagues, supervisors, oversight bodies, and the public may later scrutinize these decisions. Although first responders often have a high desire for control, and are often extremely responsible and conscientious, the situations they enter often have a high degree of uncertainty and an inherent lack of control. These conditions often lead to distress – not only from what first responders witness, but from how they, or others, judge their own actions.
It’s also important to note that for some people, there is a specific call that may lead to PTSD or other conditions; whereas for others, their suffering may stem more from the repeated cumulative stress associated with the job. For many first responders, it is not one traumatic call, but the accumulation of stress over time that erodes mental health.
Operational stressors
Trauma exposure alone does not explain mental health difficulties in first responders. It’s not just the exposure to trauma that puts first responders at risk. There are other elements at play that can impact mental health including:
- Shift work and sleep disruption
- Hypervigilance on and off duty
- Exposure to public scrutiny and criticism
- Moral and ethical dilemmas
- A culture of stoicism and high responsibility
- Stigma
This matters because research demonstrates that it’s not an “individual weakness” that leads to mental health problems in first responders. First responders start their careers as some of the most mentally healthy individuals in society. It’s often these other factors that interact with the trauma exposure to cause problems.
For example, a police officer may use lethal force and then be investigated for his use of force right after the incident. They must process having taken a life while investigators, supervisors, and the public scrutinize their actions, which can lead to significant anxiety, self-blame, rumination, and self-doubt.
A firefighter who witnesses an awful fire may have to run immediately to another call and doesn’t have time to process his feelings about what happened. He shoves his emotions down repeatedly until it becomes too much. He also doesn’t feel safe sharing his feelings with his crew because he worries they will think he’s too emotional for the job and not trust him. Instead, he starts drinking at night to help him fall asleep.
A correctional officer who is assaulted by an inmate might feel that she needs to brush it off because of sexism in the workplace. She doesn’t want to be seen as being weak or needing special protection; she’s worked hard to be taken seriously by her male peers. She becomes extremely jumpy, even when at home, and finds it difficult to be touched by her husband and kids.
These are examples of how first responder mental health is affected not only by trauma exposure, but also by institutional policy, norms, and culture.
Mental Health Risks Associated With First Responder Work
Common symptoms and concerns include:
- Chronic stress and burnout
- Anxiety and persistent hypervigilance
- Depression and emotional exhaustion
- Post-traumatic stress symptoms
- Moral injury and loss of meaning
- Sleep disturbance
- Increased substance use as a coping tool
Early Warning Signs: When Stress May Be Becoming a Problem
Our first responder patients are often great at pushing away their emotions and avoiding unwanted and intrusive memories- until they aren’t. I like to describe it as trying to hold a beach ball under water- you can only hold it underwater for so long before it pops up and hits you in the face. Recognizing signs before you get smacked in the face by a serious mental health condition can help you prevent and avoid more serious issues. Below are some early warning signs that you might need professional first responder mental health support:
Emotional warning signs
- Irritability, anger, or emotional numbing
- Feeling detached from others
- Loss of interest in previously meaningful activities
Cognitive warning signs
- Intrusive memories or images
- Increasingly negative beliefs about safety, trust, or the world
- Difficulty concentrating or making decisions
Physical warning signs
- Persistent fatigue
- Sleep problems
- Headaches or unexplained physical symptoms
- Persistent hypervigilance or startle response beyond what is typical.
Behavioural warning signs
- Withdrawal from family or colleagues
- Increased use of alcohol or substances
- Avoidance of reminders or situations
- Overworking or inability to disengage from work
Everyone has these symptoms sometimes- but when they become a pattern and persist or interfere with daily life, it’s time to seek professional support.
Why First Responders Often Miss or Minimize Warning Signs
Why is it that first responders often avoid seeking help? By the time first responders come to see us, they have often been suffering for quite some time in silence. Reasons for this can include:
- Cultural expectations of toughness and self-reliance
- “Others have it worse” thinking, trauma comparison (e.g., my call wasn’t “that bad”)
- Fear of stigma or career consequences (fear of losing respect, rank, ability to carry a firearm)
- Normalization of distress within the profession
- “Good enough” coping strategies
Many first responders don’t realize how much they’re carrying until symptoms begin affecting sleep, relationships, or quality of life. Often their partners and family will start to notice signs before they do. Early awareness and support play a critical role in protecting first responder mental health and long-term functioning.
The Importance of Early Awareness
The good news is that early identification of these symptoms means you have a better chance of feeling better sooner. Early recognition allows for better outcomes and less disruption to work and relationships. Mental health awareness is part of operational readiness and longevity. Stress responses are understandable given the nature of this work. Noticing changes early is a strength.
We work with first responders at all points of the continuum. From new recruits who want to set up a therapeutic relationship early to ensure they have someone there if they need, to people who are starting to notice some effects of the job, to people who meet full threshold for a mental health condition and are off work. We will meet you wherever you are on the continuum. To learn more about our services for first responders, click here.
Dr. Katie Stewart, C. Psych