As we contemplated writing about the job-related behavioral health needs of first responders, we were reminded of the post 9/11 poster showing two swaggering 6-year-old boys wearing blankets as capes with the tagline “Even Superheroes Need Help Sometime.” This poster was part of an advertising campaign developed by the NYC Department of Health and Mental Hygiene in collaboration with the Mental Health Association to de-stigmatize seeking help after 9/11, particularly as it related to behavioral health needs.
This message is especially relevant for our first responders including emergency medical technicians, firefighters and police officers who are the first people to arrive at the scene of an accident, disaster, or other crisis/emergency. First responders may also include military personnel (including the National Guard) depending on the nature or location of the emergency, and can also include trained volunteers. Response may come in second or third waves of assistance as well, ranging from HAZMAT teams to K-9 units, Citizen Emergency Response Teams (CERTs) to Medical Reserve Corps volunteers. Response actions can include attempts to stabilize an otherwise ‘out of control’ situation, first aid, rescue, evacuation, etc. The men and women who are among the ranks of first responders are our present superheroes. First responders save countless lives and work to prevent emergencies from escalating as well as mitigate the effects of disasters that have occurred, all while putting their own lives at risk in service to their communities.
Because the work of first responders puts them at particular risk for emotional distress, trauma, burnout, fatigue and other behavioral health concerns it is important to have behavioral health resources available at the ready for first responders and to make them available, where, how, and when then want them.
Exposure to unusual events/circumstances: Even after extensive training, new first responders may encounter unexpected circumstances on the job, or simply realize that experiencing something directly for the first time is different than simulated exercises. Seasoned first responders with years of experience may still be called to respond to situations new to them, including acts of terrorism, incidents of mass violence, industrial accidents, etc. No matter the degree of training and preparation, sometimes first responders’ minds and bodies can still be overwhelmed during rescue and recovery work which can lead to distress or even trauma.
Longer than average shifts or deployments: Even on a ‘regular’ day, responders often work long shifts and sometimes for days at a time. But during disaster responses, shifts can go even longer – and without breaks or relief. Responders can also be deployed out-of-state (whether assigned or from volunteering), taking them away from coworkers, family and other familiar surroundings.
For additional distress risk factors, visit the Centers for Disease Control and Prevention’s Disaster Mental Health for Responders: Key Principles, Issues and Questions at www.emergency.cdc.gov/mentalhealth/responders.asp.
Recognizing the Signs of Disaster Related Distress
Signs that a first responder may be experiencing distress will vary person-to-person, but in general can include any one or more of the following:
- Isolation, withdrawal from family, friends or coworkers
- Difficulty concentrating or performing regular routines; faltering performance at work
- “Hyper-vigilance” at work or home- Increased levels in energy, feeling like one has to keep constantly busy, may volunteer for more work/shifts
- Irritability, mood swings; lashing out at family, friends or coworkers
- “Compassion fatigue” – Doubting the purpose of work, feeling less sensitive to victims’ needs, etc.
- Relying on tobacco, drugs (incl. prescription and over the counter medications), or alcohol as a means to cope with stress
- Other symptoms that may indicate depression, substance abuse or suicidal or homicidal thoughts/behaviors
For more information on warning signs for depression, visit the National Institute of Mental Health Signs & Symptoms of Depression at www.nimh.nih.gov/health/topics/depression/index.shtml.
Tips for Coping with Stress
Like the warning signs of distress, tips for coping for first responders also don’t come in a ‘one size fits all’ package, so it’s important to think about what the unique strengths or personality traits of a person experiencing distress may be and go from there.
Some common ways for first responders to cope include:
- Reaching out to trusted individuals for support, companionship
- Contacting an Employee Assistance Program (EAP) for coping resources and referrals (this can be done confidentially and anonymously)
- Making sure staff/volunteers take scheduled breaks during responses and are provided relief with food, rest, etc.
- Practicing and engaging in spiritual/religious rituals and activities
- Following health and fitness routines, even during breaks in shifts or during deployments; modifying routines for time and location as needed, but always working to get in time for health, fitness and relaxation when possible
- Engaging in healthy coping year-round, to increase one’s resilience and ability to bounce back after particularly stressful or strenuous responses/deployments
For additional tips for Coping with Stress, visit Mental Health America’s Stress: Coping with Everyday Problems at www.mentalhealthamerica.net/conditions/stress-coping-everyday-problems.
Sometimes, even when first responders try to practice healthy coping, or if for any reason a responder feels that she/he is at risk for depression or other mental health concerns that go beyond coping, it’s important for them to talk to their supervisor/commanding officer if they feel comfortable doing so; a trusted healthcare provider; or reach out to a confidential 24/7 crisis/emotional service (see below).
How MHA-NYC Helps First Responders
MHA-NYC has a long history responding to natural and human-caused disasters. For over a decade, the organization and its programs and crisis hotline services have been at the center of the mental health response to many of this country’s greatest tragedies, including providing services for first responders.
iHelp: Sandy Stress Relief
Sandy iHelp is a 24/7 online cognitive behavioral therapy (CBT) program that provides easy access to help for New York State residents who are suffering emotional distress as a result of Superstorm Sandy: All that is needed is access to the internet. Sandy iHelp CBT is evidence-based and effectively addresses the most common emotional difficulties that surface after a disaster including insomnia, depression, anxiety and substance misuse. Call 1 (866) 793-2765 or visit iHELPCBT.COM online to learn more and enroll.
iHelp: Sandy Stress Relief is particularly well suited to the needs of first responders who may be reluctant to seek help in traditional office based settings . It is confidential, secure and is available 24/7, anywhere the first responder has access to the internet.
Disaster Distress Helpline: The Disaster Distress Helpline is the nation’s only crisis hotline dedicated to providing 24/7 counseling and emotional support. Calls (1-800-985-5990) and texts (text “TalkWithUs” to 66746; Spanish-speakers can text “Hablanos” to 66746) are confidential and answered by trained, caring counselors from a network of crisis centers across the country.
World Trade Center Health Program: The World Trade Center Health Program is a free health/mental health program that screens for access to benefits for responders, workers, and volunteers who helped with rescue, recovery, and cleanup at the World Trade Center and related sites in New York City on/after the 9/11 terrorist attacks, as well as for survivors who were working or residing in the disaster area. Call 1-203-594-9787 to learn more and to request an application.
Visit http://www.mhaofnyc.org to learn more about these and other programs.
Additional Mental Health Resources for First Responders
Friends of Firefighters (New York City): Friends of Firefighters, is dedicated to addressing the physical, mental health, and wellness needs of New York City’s firefighters and their families with long-term support and services through confidential counseling, wellness services, and other assistance required by firefighters and their families (www.friendsoffirefighters.org).
SAMHSA Disaster Technical Assistance Center (DTAC): SAMHSA’s DTAC Disaster Responder information series offers resources on self-care and stress management, a listing of organizations working with disaster responders, links to webinar and podcast trainings, and a summary of available disaster behavioral health interventions (www.archive.samhsa.gov/dtac/dbhis/dbhis_responders_intro.asp).
National Center for Posttraumatic Stress Disorder (PTSD): The National Center for PTSD (a program of the U.S. Department of Veterans Affairs) works to advance the clinical care and social welfare of America’s Veterans and others who have experienced trauma, or who suffer from PTSD, through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders (www.ptsd.va.gov/index.asp).
Recovery and Resilience
Just as first responders can experience distress, trauma and other mental health concerns, so too can they recover and even strengthen their emotional resilience over time with support from loved ones and coworkers, by practicing healthy coping and through accessing effective interventions. There is strength and courage in being the first on-scene and saving lives, and there is strength and courage in recognizing when you need help and then taking steps towards healing. After a disaster, emergency or other traumatic event, no one is ever alone- including responders.
Kathryn M. Salisbury, PhD, is Executive Vice President of Strategy and Business Development, Mental Health Association of New York City and Christian Burgess, LMSW, is the Director of the Disaster Distress Helpline at Mental Health Association of New York City/ Link2Health Solutions, Inc.