First responder mental healthcare: Evidence-based prevention, postvention, and treatment.

Abstract

Recent national tragedies of hurricanes, mass shootings, gun violence in schools, wild fires, and mudslides have drawn our attention to the trauma of affected individuals and schoolchildren, but less to the stressors of first responders. While commonly regaled as "heroes," responders face a scarcity of systemic and tailored mental health support. First responders are susceptible to witnessing a wide array of traumatic events, often in their own communities, that contribute to their stress (Benedek, Fullerton, & Ursano, 2007;Castellano & Plionis, 2006;Kleim & Westphal, 2011). This article critiques systemic resources for first responders' mental healthcare; addresses their personal-social characteristics as well as workplace cultural stigma about help-seeking attitudes; and includes a needs assessment of first responders' resilience that was conducted by one of the authors (Roysircar, 2008a). Using this evidencebased practice knowledge about first responders, the authors present three hypothetical vignettes that highlight the different challenges that commonly effect first responders and recommend interventions. The authors advocate for access to specialized resources that enhance first responders' preparedness for a potentially traumatic event (i.e., prevention education); increase their coping skills and social connections after an event (i.e., postvention service); and provide ongoing mental healthcare (i.e., treatment) that is culturally tailored to first responders' unique needs arising from their work context and identity. Public Significance StatementThe information included may be beneficial to mental health providers who are considering acting as first responders, treating first responders, and/or engaging in healthcare access and reform.

The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research

“…However, they are arguably 'the forgotten profession' within the healthcare system. Their contribution to the health and wellbeing of the community and to healthcare is overshadowed by more dominant dialogues and debates about community services, acute care and hospital emergency department tensions and resource demands [1][2][3][4].…”

“…In Australia, the nature of ambulance work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury [3][4][5]. In addition to the nature of the work, organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself [3,5,6].…”

Adapting meaning-centered psychotherapy for World Trade Center responders

“…Such factors common to responder populations include the emphasis on honor, steadiness, emotional suppression, and solidarity with colleagues, often at the expense of social and family relationships (e.g., Woody, 2005). Knowledge of these unique cultural components may be critical for understanding how WTC responders experience and make sense of themselves and the world (Lanza et al, 2018). Furthermore, the therapist should listen for experiences of illness and loss in the past, specifically the way in which emotions related to illness and loss were expressed in the responder's family of origin and in the workplace.…”

Occupational Stress and Anger: Mediating Effects of Resiliency in First Responders

“…There is, however, limited research on resiliency in first responders (Lanza et al 2018 ), especially in terms of whether it functions as a mechanism by which OS does or does not result in negative mental health consequences. Protective factors that counteract the development of adverse mental health consequences include a greater sense of self-worth, adaptive social functioning across occupational, social leisure activities, and familial domains (i.e., better social adjustment) during police academy training (Yuan et al 2011 ) and social support, with the latter being the most robust predictor for PTSD after traumatic events (Brewin et al 2000 ; Ozer et al 2003 ).…”