Rising to the Challenge: Mental Health Care for EMS First Responders

May 15-21 is National EMS Week. This annual celebration was first instituted in 1974 by President Gerald Ford to honor the hard work and sacrifice that paramedics, EMTs and the entire EMS workforce offer to communities all around the United States. This awareness week highlights the important contributions of EMS providers who safeguard the health, safety, and well-being of their communities, ensuring they are celebrated and recognized.

This year’s awareness week is organized around the theme, Rising to the Challenge, with activities administered by the National Association of Emergency Medical Technicians (NAEMT) and the American College of Emergency Physicians (ACEP). The theme reflects on the challenges that EMS workers face on the job, as well as the mental health issues that impact their life as a result of demanding work they do.

Serving Individuals in a Mental Health Crisis

EMS teams provide life-saving care under dangerous, high-pressure and exhausting conditions. There’s no space for their own feelings of anxiety, stress, or depression in these moments. Instead, they need to be focused solely on supporting the individual in crisis, and providing services to address a person’s mental and physical well-being.

One of the biggest challenges that EMS workers face is assisting members of their community who are in a mental health crisis. As of 2016, 10% of all 911 requests are mental-health related, yet only 7% of total US healthcare dollars are allocated to this area. Due to a shortage of mental health resources, EMS personnel are left to manage these cases with little to no training or expertise in the treatment of mental health care.

These situations prove to be challenging for a variety of reasons. First, many EMS workers do not have adequate training to address mental health concerns. Mental health first aid (MHFA) is still not considered core knowledge for first responders, and in many jurisdictions, is offered only as optional continuing education.

Another challenge that EMS workers face when dealing with an individual in a mental health crisis is communication and collaboration with other services. Unlike a car accident or a broken limb, diagnosing and treating a person living with a mental or behavioral health issue is not always a straightforward path. If the EMS team doesn’t have established relationships with local trauma intervention supports, it’s unlikely that the victim will get the help they need.

Mental Health Challenges Faced by First Responders

Due to the intense and stressful nature of their jobs, EMS workers are at an increased risk for developing mental health and substance use disorders. A study from the Journal of Emergency Medical Services found that first responders are 10% more likely than the general population to experience depression, anxiety, Acute Stress Disorder (ASD) and post-traumatic stress disorder (PTSD). In that same study, 69% of EMS workers say that they do not have enough time to recover from traumatic events, leading them to cope in unhealthy ways.

The second-hand trauma that EMS workers experience is just one of their occupational risk factors. Other relevant work-related risks include long and unpredictable hours and a lack of social support. In isolation, any one of these challenges would be harmful. However, when combined, they have contributed to the notable mental health challenges that affect this community. 

But this is just the tip of the iceberg. Here are some other mental health challenges EMS workers may face:

Compassion Fatigue: Compassion fatigue is a phenomenon that arises when an individual (often a first responder or another health professional) experiences a lower capacity for empathy. This is typically the result of stress, long hours, or a lack of resources. Eventually, compassion fatigue spills over into an individual’s personal life, contributing to mental health conditions like mood swings, anxiety, or depression.

Substance Use Disorders: To cope with the stress, second-hand trauma, and compassion fatigue brought on by their work, many EMS workers turn to substances like alcohol, cigarettes, and drugs to help them cope. One 2017 study found that female EMS workers were three times more likely to smoke or use alcohol and drugs than the general population.

Opioid Addiction: Opiate painkillers or prescription pain medications are common drugs that may be used among first responders. Some begin taking these substances to help return to work after injury, but narcotics can quickly become addictive, leading to potential medical and work-related challenges. Because EMS workers have increased access to opioids and other substances as part of their work-related responsibilities, it can also lead to misuse of substances. EMS workers may struggle to seek treatment for or even discuss their addiction with their peers for fear of losing their job, breaking a “code of silence”, or facing the perceived  “stigma” coworkers may have about their addiction.

Suicidal Ideation: As of 2021, EMS workers are more likely to die by suicide than in the line of duty, and they are 1.39 times more likely to commit suicide than the general population. Even given these high numbers, deaths of EMS workers by suicides are likely underreported, both because of the stigma of discussing traumatic events and a lack of research data in this area. 

Mental Health Care Support for EMS Workers and First Responders

To ensure their continued well-being at work and within their personal and family lives, we must encourage EMS workers to seek out both preventative care and treatment for their mental health conditions.

Since their job is so dependent on being able to support others, it can be challenging to ensure EMS workers get the same support when they need it most. Here are some tips that can help make it easier.  

  • Improve your knowledge of common mental health signs and symptoms. Being aware of the most common warning signs like excessive fear or sadness, mood swings, prolonged irritability or anger, and changes in sleeping or eating habits can help EMS workers recognize the signs of burnout and other mental health conditions in themselves and their peers.
  • Invest time in outside hobbies and interests. By ensuring the EMS workers have a full life outside of work, find distractions and positive interactions during periods of stress. Taking time for hobbies lets you connect with yourself, strengthen social connections, and build more pleasure into your daily life. Whether you play sports, pursue creative projects, cook, decorate, or read, these hobbies can help lower your cortisol levels, improve your mood and focus, and boost your overall well-being. If you don’t have any current hobbies, start by creating more space in your schedule, and try something new
  • Destigmatize mental health care. One of the reasons why so many EMS workers don’t ask for help is because of a long-standing ‘code of silence’ that stigmatizes speaking openly about these struggles. EMS workers can help break down these barriers by lending an empathetic ear to colleagues and being honest about their current and past challenges. Some peer support programs are available, but are still less common than they should be. 
  • Find support from a professional. If you or someone you love in the EMS field is struggling with stress, anxiety, depression, or another mental health challenge, seek help from a qualified mental health clinician immediately. Some great treatment options include various forms of therapy like cognitive behavioral therapy and interpersonal psychotherapy. If you want to stay in your  job, a behavioral health clinician can help develop a plan for self-care moving forward.

Free Resources

While getting help from a dedicated mental health clinician is a great way to help build positive coping strategies for the stress and strain that are pervasive to this profession, sometimes EMS workers need more immediate care. Here is a list of resources that can offer assistance in finding care fast through text, phone, or online chat.

Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself 

ACEP Wellness and Assistance Program: In partnership with Mines & Associates, ACEP members have exclusive access to three FREE counseling or wellness sessions. 

American Foundation for Suicide Prevention: Call: 800-273-8255 or text: TALK to 741741

National Alliance on Mental Illness Hotline: A free service that is available by phone (800-950-6264) , text, chat or email.

National Suicide Prevention Hotline: A free, 24-hour service that offers a confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. (800-273-8255) 

Safe Call NowA comprehensive, 24-hour crisis referral service staffed by first responders. This line is available to public safety employees, emergency services personnel, and their families. (206-459-3020)

As awareness around the importance of mental healthcare continues to grow, so does the demand for mental health services, which can quickly overwhelm behavioral health agencies. EHRs are key to generating efficiencies that free up administrative time so you can focus on supporting your clients. Our solution offers features designed to help keep your organization’s financial and clinical operations running smoothly, so you can focus on what you do best – taking care of others. To learn more about how NextStep Solutions is purpose-built to help behavioral health practices operate at their best, contact us today.

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